Without increasing the risk of bleeding, a CDS system requiring clinicians to document VTE risk assessment in the EMR promoted improved rates of pharmacologic prophylaxis at any time during an admission and a decreased risk of VTE in general medical patients but not all adult patients.

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SummaryBackground: Requiring indications for inpatient medication orders may improve the quality of prescribing and allow for easier placement of diagnoses on the problem list. Indications for inpatient medication orders are also required by some regulators. Objective: This study assessed a clinical decision support (CDS) system designed to obtain indications and document problems during inpatient computerized physician order entry (CPOE) of medications frequently used off-label. Methods: A convenience sample of three medications frequently used off-label were selected: the PPI lansoprazole; intravenous immune globulin, and recombinant Factor VIIa. Alerts triggered when a medication was ordered without an FDA approved indication in the problem list. The alerts prompted clinicians to enter either a labeled or off-label indication for the order. Chart review was used as the gold standard to assess the accuracy of clinician entered information. Results: The PPI intervention generated 873 alerts during 60 days of operation; IVIG 55 alerts during alerts during 93 days; Factor VIIa 25 alerts during 175 days. Agreement between indications entered and chart review was 63% for PPI, 49% for IVIG, and 29% for Factor VIIa. The alerts for PPI, IVIG and Factor VIIa alerts produced accurate diagnoses for the problem list 9%, 16% and 24% respectively. Rates of off-label use measured by chart review were 87% for PPI, and 100% for IVIG and factor VIIa, which were higher than if measured using the ordering clinicians' indications. Conclusion: This trial of indication-based prescribing using CDS and CPOE produced less than optimal accuracy of the indication data as well as a low yield of accurate problems placed on the problem list. These results demonstrate the challenge inherent in obtaining accurate indication information during prescribing and should raise concerns over potential mandates for indication based prescribing and motivate further study of appropriate mechanisms to obtain indications during CPOE.

OBJECTIVES: Cardiovascular diseases are the major health problem and adequate therapy, which includes usage of beta blockers (ATC, C07) and diuretics (ATC, C03), leads to reduction of cardiovascular morbidity and mortality. The aim of our study was to identify and analyze changes in the usage of these drugs in Croatia and Slovenia from 2000-2008 and to identify the rate of the generic drugs usage as well as the average price for 1 DDD. METHODS: The data concerning consumption have been obtained from the International Medical Statistics database for Croatia and they are presented in defined daily doses per 1000 inhabitants per day (DDD/1000). Financial expenditure data are presented in Euros and the average cost per DDD was calculated for each drug group. RESULTS: The total usage of diuretics is on average 19% higher in Croatia and continually increasing in both countries. Consumption rate of furosemid among diuretics is lower in Slovenia (43.96% in 2008), while in Croatia 67.28% (2008). The generic drugs usage is higher in Croatia during the whole investigated period, e.g. in 2008, 87.4 % of all prescribed diuretics were generics in Croatia, and in Slovenia 59.4%. The average price per 1 DDD was more than twice lower in Croatia (0.08 EUR/DDD vs. 0.17 EUR/DDD in Slovenia). The beta blockers drugs usage is 13% higher in Slovenia, but generic drugs usage is higher in Croatia. CONCLUSIONS: Increased diuretics and beta blockers drug usage is comparable to worldwide trends, but drug prescribing patterns are different when comparing both countries. Although the generic drugs usage is relatively high in Croatia, it should be further supported and promoted. According to our investigation there is a possibility for further price reduction of diuretics and beta blockers in Slovenia. This is important as a tool to decrease costs of healthcare systems.