Alerts for community pharmacist-provided medication therapy management: recommendations from a heuristic evaluation

Abstract

Background Medication therapy management (MTM) is a service, most commonly provided by pharmacists, intended to identify and resolve medication therapy problems (MTPs) to enhance patient care. MTM is typically documented by the community pharmacist in an MTM vendor’s web-based platform. These platforms often include integrated alerts to assist the pharmacist with assessing MTPs. In order to maximize the usability and usefulness of alerts to the end users (e.g., community pharmacists), MTM alert design should follow principles from human factors science. Therefore, the objectives of this study were to 1) evaluate the extent to which alerts for community pharmacist-delivered MTM align with established human factors principles, and 2) identify areas of opportunity and recommendations to improve MTM alert design. Methods Five categories of MTM alerts submitted by community pharmacists were evaluated: 1) indication, 2) effectiveness ; 3) safety ; 4) adherence ; and 5) cost-containment . This heuristic evaluation was guided by the Instrument for Evaluating Human-Factors Principles in Medication-Related Decision Support Alerts (I-MeDeSA) which we adapted and contained 32 heuristics. For each MTM alert, four analysts’ individual ratings were summed and a mean score on the modified I-MeDeSA computed. For each heuristic, we also computed the percent of analyst ratings indicating alignment with the heuristic. We did this for all alerts evaluated to produce an “overall” summary of analysts’ ratings for a given heuristic, and we also computed this separately for each alert category. Our results focus on heuristics where ≤50% of analysts’ ratings indicated the alerts aligned with the heuristic. Results I-MeDeSA scores across the five alert categories were similar. Heuristics pertaining to visibility and color were generally met. Opportunities for improvement across all MTM alert categories pertained to the principles of alert prioritization; text-based information; alarm philosophy; and corrective actions. Conclusions MTM alerts have several opportunities for improvement related to human factors principles, resulting in MTM alert design recommendations. Enhancements to MTM alert design may increase the effectiveness of MTM delivery by community pharmacists and result in improved patient outcomes. Electronic supplementary material The online version of this article (10.1186/s12911-019-0866-0) contains supplementary material, which is available to authorized users.

Experiences Applying Technology to Overcome Common Challenges in Pharmacy Practice-Based Research in the United States

“…Conversely, we have found that the REDCap and Qualtrics programs offer features like data validation, force-functions and data repositories that decrease the likelihood of such data-collection mistakes. Overall, we found that the use of e-form/survey programs facilitated PPBR in a wide variety of methods, subjects and settings and are particularly helpful to conduct surveys and collect data [15,16,23,27].…”

“…The authors used several electronic tools to develop and deploy novel electronic data collection forms (i.e., e-forms/surveys) [4,[16][17][18][19][20][21][22][23]. In our experiences, we found that these 'e-form/survey' programs required little-to-no informatics training and were often accessible via desktop computers, tablets and other mobile devices alike.…”

“…Today, we are beginning to use digital applications designed for desktops and mobile devices, like Dragon, Google Voice and InfraWare Dictation (InfraWare Inc.) to record video and audio data. Several of the authors have used HIPAA-compliant versions of these applications to record semi-structured interviews, focus-groups, contextual inquiries and investigator observations in past and current PPBR research projects [15,23,[28][29][30]. While Dragon and Google Voice use artificial intelligence to transcribe recordings, the InfraWare records dictation via smart-phone, computer, or tablet for the researcher to upload to the application's web-based platform for human transcription.…”

“…We found that desktop capture software proved useful in facilitating PPBR data collection and training research personnel [16,23]. Potentially available through researchers' organizations/universities, desktop capture software can be still (i.e., capture of a single screenshot image), or dynamic (i.e., recording screen movement over a period of time).…”

Decision-Centered Design of Patient Information Visualizations to Support Chronic Pain Care

“…The designer participated in the qualitative analysis of the clinician interviews and the design workshop, and therefore had a deep understanding of the decision requirements and information needs. In addition, the designer's knowledge of clinical workflow and EHR use was informed by previous research and design projects including studies evaluating clinical decision support for medication therapy management, 43 designing a prototype for consult management for the Veteran's Health Administration, 44 and evaluating a modular decision support application for colorectal cancer screening. 45 Exploratory concepts started as sketches with pencil and paper.…”