Effectiveness of Clinical Decision Support Based Intervention in the Improvement of Care for Adult Sickle Cell Disease Patients in Primary Care

Abstract

Introduction: Although most patients with rare diseases like sickle cell disease (SCD) are treated in the primary care setting, primary care physicians may find it challenging to keep abreast of medication improvements and complications associated with treatment for rare and complex diseases. The purpose of this study was to evaluate the effectiveness of a clinical decision support (CDS)-based intervention system for transfusional iron overload in adults with SCD to improve management in primary care. Methods: An electronic medical record based clinical decision support system for potential transfusional iron overload in SCD patients in primary care was evaluated. The intervention was implemented in 3 family medicine clinics with a control group of 3 general internal medicine clinics. Data were collected in the 6 months before the intervention and 6 months after the intervention. There were 47 patients in the family medicine group and 24 in the general internal medicine group. Results: There was no management change in the control group while the intervention group improved primary care management from 0% to 44% (P < .001). Conclusion: A CDS tool can improve management of SCD patients in primary care. (J Am Board Fam Med 2018;31:812–816.)

Optimizing Hospital Electronic Prescribing Systems: A Systematic Scoping Review

“… 79 Again, in some cases, the educational component was focused on effecting organizational change, whereas, in one example, it was provided by the ePrescribing system vendor to enable clinical users of the system to manage changes to the CDS. 57 …”

“…Most studies (n = 50) reported on interventions that used more than 1 approach to optimize ePrescribing systems (Table 3). 4,41–94 Table 3 summarizes the various combinations of optimization strategies and intervention components that were used in the included studies and the overall reported effectiveness of the intervention on the primary outcome.…”

“…One study, for example, used a strategy of training clinical staff, while at the same time supporting cultural change to empower pharmacists to enforce restrictions within the prescribing process 79 . Again, in some cases, the educational component was focused on effecting organizational change, whereas, in one example, it was provided by the ePrescribing system vendor to enable clinical users of the system to manage changes to the CDS 57 …”

“…79 Again, in some cases, the educational component was focused on effecting organizational change, whereas, in one example, it was provided by the ePrescribing system vendor to enable clinical users of the system to manage changes to the CDS. 57 Eighteen studies used some form of organizational/process redesign. As with interventions involving education or stakeholder engagement, organizational/process redesign interventions typically accompanied some form of technological intervention.…”

Novelle QLL 2020 – welche Auswirkungen haben die neu empfohlenen Hämoglobin-Transfusionstrigger auf die klinische Versorgung?

“…B. ein Hb-Dialogfenster vor Anforderung 40 . Mittlerweile gibt es einige Vorschläge, die Anämiediagnostik und -therapie per CDSS zu unterstützen 41 , 42 , 43 , 44 , 45 , 46 . Eine CDSS-Umsetzung aus der Labormedizin heraus hat im deutschsprachigen Raum das AMPEL-System (Analyse- und Meldesystem zur Verbesserung der Patientensicherheit durch Echtzeitintegration von Laborbefunden) der Universitätsmedizin Leipzig erreicht ( ), mithilfe dessen wir für Applikationen in der Laboratoriumsmedizin bereits erste Effekte und Potenziale für die Verbesserung der Patientensicherheit zeigen können 47 , 48 , 49 .…”