Assessment of a computerised decision support system for allergic rhino-conjunctivitis counselling in German pharmacy

Bertsche, Thilo; Nachbar, Markus; Fiederling, Jonas; Schmitt, Simon P. W.; Kaltschmidt, Jens; Seidling, Hanna M.; Haefeli, Walter E.

doi:10.1007/s11096-011-9584-0

Cited by 18 publications

(25 citation statements)

References 10 publications

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“…No studies investigated patient outcomes arising from the decision support intervention. Most studies produced a statistically significant positive effect of CDSS on pharmacist activity, exhibited as improved counselling, improved prescribing and better direct collaboration with prescribers or, indirectly, via patient education …”

Section: Resultsmentioning

confidence: 99%

“…Pharmacist counselling for assessment and treatment for allergic rhinitis was improved through the use of a Web‐based CDSS, with a median seven of nine mandatory guideline questions asked compared with two of nine ( P < 0·001) . Pharmacist–patient interventions were a reduction in chronic high‐dose proton‐pump inhibitors (PPIs) (1·67 active vs. 0·17 control interventions per 100 high‐dose PPI prescriptions) and introduction of an antiplatelet agent for prevention of stroke in diabetic patients (1·74 active vs. 0·91 control interventions per 100 patients, P < 0·001).…”

Section: Resultsmentioning

confidence: 99%

“…Very few CDSS studies have been undertaken in community pharmacy practice; however, the majority of these studies have shown positive results. Assisted patient questioning with minimal impact on counselling time may improve medication selection or the requirement for patient referral . Resistance to change was noted in several trials and is a known barrier to change in community pharmacy practice .…”

Section: Discussionmentioning

confidence: 99%

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Review of computerized clinical decision support in community pharmacy

Curtain

Peterson

2014

J Clin Pharm Ther

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Summary What is known and objective Clinical decision support software (CDSS) has been increasingly implemented to assist improved prescribing practice. Reviews and studies report generally positive results regarding prescribing changes and, to a lesser extent, patient outcomes. Little information is available, however, concerning the use of CDSS in community pharmacy practice. Given the apparent paucity of publications examining this topic, we conducted a review to determine whether CDSS in community pharmacy practice can improve medication use and patient outcomes. Methods A literature search of articles on CDSS relevant to community pharmacy and published between 1 January 2005 and 21 October 2013 was undertaken. Articles were included if the healthcare setting was community pharmacy and the article indicated that pharmacy use of CDSS was part of the study intervention. Results and discussion Eight studies were found which assessed counselling, selected drug interactions, inappropriate prescribing and under‐prescribing. One study was halted due to insufficient data collection. Six studies showed statistically significant improvements in the measured outcomes: increased patient counselling, 31% reduced frequency of drug–drug interactions (DDIs), reduced frequency of inappropriate medications in the elderly (2·2–1·8% patients) and in pregnant women (5·5–2·9% patients), and increased pharmacists' interventions for under‐prescribed low‐dose aspirin (1·74 vs. 0·91 per 100 patients with type 2 diabetes) and over‐prescribed high‐dose proton‐pump inhibitors (PPIs) (1·67 vs. 0·17 interventions per 100 high‐dose PPI prescriptions). What is new and conclusion Most studies showed improved prescribing practice, via direct communication between pharmacists and doctors or indirectly via patient education. Factors limiting the impact of improved prescribing included alert fatigue and clinical inertia. No study investigated patient outcomes and little investigation had been undertaken on how CDSS could be best implemented. Few studies have been undertaken in community pharmacy practice, and based on the positive findings reported, further research should be directed in this area, including investigation of patient outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Review of computerized clinical decision support in community pharmacy

Curtain

Peterson

2014

J Clin Pharm Ther

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“…After reading the abstracts, 336 articles were preselected for the evaluation of full text. At the end of the article selection process, 26 articles met the specific inclusion criteria. Figure illustrates the progressive selection of the studies used for this review.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty studies showed the effects of documentation in the working process of dispensing practice and, of these, 23 studies included statistical evidence (Table ). According to the methodological analysis of the studies, no article fully met the STROBE and CONSORT criteria.…”

Section: Resultsmentioning

confidence: 99%

Can we document the practice of dispensing? A systematic review

et al. 2016

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SUMMARYWhat is known: Documentation is a process indicator utilized to evaluate quality clinical pharmacist services. In this framework, documentation of dispensing, besides supporting patient care, allows evaluation of the impact of counselling. Objective: To identify and assess studies of documentation by pharmacists in the dispensing process. Method: A systematic review was carried out according to the following steps: (i) identification of studies in the following databases: PubMed/Medline, Web of Science, Scopus and Lilacs, using the descriptors 'counselling', 'dispensing', 'community pharmacy services', 'pharmacies' and 'pharmacists' in different combinations; (ii) evaluation of studies, in which the title, abstract and full text of the studies, and the evaluation of the methodological quality of the selected studies were analysed. Results: In total, 26 articles met the specific criteria. Few studies addressed documentation as part of the dispensing working process (3), and 16 articles reported documentation using nonelectronic systems. The main variables documented were patient information, drug therapy problems and clinical interventions. Furthermore, 20 studies showed the effects of documentation in the dispensing process and 23 studies included statistical evidence. Eight articles met between 42% and 75% of the 28 items recommended by the STROBE initiative, and two articles met approximately 60% of the 36 items recommended by the CONSORT initiative.

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The status of the performance of medication reviews in German community pharmacies and assessment of the practical performance

et al. 2016

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Background Pharmacist-led medication reviews have shown to prevent drug-related problems (DRPs). So far, data is rare about the implementation in routine care, the conditions for intensifying this service and the practical skills of community pharmacists to perform medication reviews. Objective To assess the current status of medication review implementation in German community pharmacies and the performance of identifying DRPs in a ficticious patient example. Setting German community pharmacies. Method An online survey was conducted from July to September 2015 including questions about medication reviews currently performed in routine care of community pharmacies and hidden DRPs in a ficticious patient example. Pharmacists were invited via newsletters from three local chambers of pharmacists. Main outcome measure (i) Frequency, conditions for implementation, and criteria of medication reviews currently being performed in routine care, (ii) requested further information to perform medication reviews, and (iii) proportion of pharmacists who identify DRPs in the patient example. Results A total of 143 community pharmacists completed the questionnaire. (i) One hundred and twenty-seven respondents (89 %) reported reviewing the medication regularly in routine care, whereas 56 (39 %) stated that they performed medication reviews between one and five times monthly. For 124 pharmacists (87 %), remuneration would be a necessary condition for performing medication reviews more frequently. When reviewing the medication, 112 (78 %) of the pharmacists considered the criterion 'drug-drug interactions' and 107 (75 %) reviewed the criterion 'correct dosage'. One of the least reviewed criteria was 'effectiveness of medication' [22 (16 %)]. (ii) According to the participants, laboratory values should be available in the community pharmacy, since 87/143 (61 %) would appreciate the GFR and the HbA1c level. Twenty-two of 54 respondents (41 %) would appreciate further administration instructions and 5 of 54 (15 %) think they would benefit from information about the recommended duration of drug use. (iii) Depending on the category, 4 (3 %) to 49 (34 %) of all 143 pharmacists identified the hidden DRP in the patient example. Conclusion German community pharmacists reported reviewing the medication of their patients regularly; however, most of the respondents review the medication very rarely in routine care. Consequently, their practical performance needs to be improved.

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Assessment of a computerised decision support system for allergic rhino-conjunctivitis counselling in German pharmacy

Abstract: Pharmacists omitted many questions mandatory to assess whether self-medication is appropriate. Using the newly developed PDSS more than doubled the number of mandatory questions asked. The results suggest that the PDSS is ready for evaluation of its impact in real patients.

Cited by 18 publications

References 10 publications

Review of computerized clinical decision support in community pharmacy

Review of computerized clinical decision support in community pharmacy

Can we document the practice of dispensing? A systematic review

The status of the performance of medication reviews in German community pharmacies and assessment of the practical performance

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