Electronic medical records and quality of prescriptions in general practice

Abstract

Quality of care for elderly patients has become an increasingly important area of research especially due to rapid increase in the number and share of this population. Unfortunately, there is a persistent gap in quality of care received by elderly persons as compared to recommendations of clinical guidelines. In this thesis, we sought to understand the quality of prescribing and applicability of clinical rules for evaluation of quality of care among the elderly in general practice using existing electronic medical record (EMR) systems in the Netherlands. We conducted a systematic review and found that one in five prescriptions to elderly persons in primary care is inappropriate. In another study, we established that approximately half of the elderly patients who received prescriptions of NSAIDs in general practice in the Netherlands do not get concomitant prescription of gastroprotective medication as recommended by guidelines. We also found that the brand of EMR is associated with differences in the rate of prescription of gastroprotective medications. Furthermore, we developed Logical Elements Rule Method (LERM) to assess the amenability of clinical rules for use in automatic evaluation of quality of care. Using the LERM, we investigated the applicability of computerized assessment of quality care based on a set of clinical rules recommended for use in Dutch general practice. We found that clear definition of clinical rules; optimal design of databases and electronic linkage between primary and secondary healthcare facilities can improve automatic evaluation of quality of care and implementation of clinical decision support