Impact of a system to assist in clinical decision-making in primary healthcare in Catalonia: prescription Self Audit

Abstract

Background In 2008, in the context of a complete computerisation of medical records, the Institut Català de la Salut (ICS, Catalan Health Institute) implemented a system in its electronic clinical workstation (ECW) to assist decision-making at the prescription level. This system is known as Self Audit, and it supports physicians in reviewing the medication of their patients. Self Audit provides lists of patients presenting medication-related problems (MRPs) that have potential for improvement, and provides therapeutic recommendations that are easy to apply from the system itself. The aim of this study was to analyse the main results derived from the use of Self Audit in primary care (PC) in Catalonia, and the effect of an incentive-based safety indicator on the results obtained. Methods A descriptive cross-sectional study was carried out to analyse variations in the MRPs detected by Self Audit during 2016, 2017, and 2018 in PC in Catalonia. The effect of a safety indicator on the results obtained was also studied. This safety indicator includes the most clinically relevant MRPs (i.e., therapeutic duplications, safety alerts from the Spanish Medicines Agency, and incidences of polymedication in patients over 65 years of age). Variation in the MRPs was measured using the differences between two evaluation points (initial and final). An MRP was considered resolved if the recommendation specified in the alert was followed. The prescriptions of 6411 PC doctors of the ICS who use the ECW and provide their services to 5.8 million Catalans through 288 PC teams were analysed. Results Analysis of the total safety-based MRPs detected by Self Audit gave overall resolutions from April to December of 9% (21,547) in 2016, 7% (15,924) in 2017, and 1% (2392) in 2018 out of the total number of MRPs recorded in April each year. Examination of the 3 types of MRPs with the highest clinical relevance that were linked to the safety indicator gave overall resolutions of 41% in 2016 (17,358), 20% in 2017 (7655), and 21% in 2018 (8135). Conclusions The ICS Self Audit tool assists in reducing the number of safety-based MRPs in a systematic manner, and yields superior results for the MRPs linked to a safety indicator included in the incentives of PC physicians.

Evaluation of Triple Whammy Prescriptions After the Implementation of a Drug Safety Algorithm

“…In a scoping review, the clinical validation of several CDSSs for drug-related problems revealed a sensitivity of 28%–85% and a specificity of 42–75% [ 36 ], though these were not studies of CDSS for TW management. A general acceptance rate above 60% is suggested for action-oriented interventions [ 37 ]; our TW algorithm compliance rate was 77.7%, which compares favourably with this standard and with the acceptance rates reported for primary care TW CDSSs (30–82%) [ 26 , 28 , 29 ]. The acceptance rate differed between the alerts and was highest within patients with a kidney function below 30 ml/min/1.73m2.…”

Pharmacological treatments and medication-related problems in nursing homes in Catalonia: a multidisciplinary approach

“…Regarding the therapeutic duplications, excluding the prevalence of vitamin D or analogs associated with calcium, the rest was observed to be due to patients who are undergoing drug dose adjustments or changes. Both PREFASEG and Self-Audit detect therapeutic duplication, which helps explain the low percentage of duplications detected in this medication review ( Pons-Mesquida et al, 2021 ; 2022 ). In a recent study done in a pediatric health system, where they designed clinical decision support to reduce therapeutic duplication with acetaminophen and ibuprofen, they saw a therapeutic duplication reduction, but it was associated with high rates of user frustration and alert fatigue ( E Dawson et al, 2023 ).…”

“…Government of Catalonia, 2022 ). The main sources of information used by the clinical pharmacologist to conduct the review and give recommendations comprised the information contained in the technical data sheets, the support tools Self-Audit and PREFASEG (PREscripción FArmacéutica SEGura) ( Pons-Mesquida et al, 2021 ; 2022 ), and the list of potentially inappropriate drugs proposed by the Catalan Health Service ( Department of Health. Government of Catalonia, 2014 ; Catalan Health Service.…”

“…Self-Audit identifies and resolves safety MRPs systematically. It generates a list of patients with active MRPs to facilitate changes or suspensions of a treatment ( Pons-Mesquida et al, 2022 ). PREFASEG generates online notifications when starting a treatment to warn clinicians of potential problems related to drug use and prevent medication errors ( Pons-Mesquida et al, 2021 ).…”

¿Recomendar la frecuencia de administración de medicamentos en la prescripción electrónica mejora su adecuación? Estudio antes-después

“…En el ámbito de AP, la Estación Clínica de Atención Primaria (ECAP) es el programa de historia clínica electrónica (HCE) utilizado por los profesionales sanitarios del Institut Català de la Salut (ICS). Integrado en dicha HCE, a nivel de prescripción, encontramos dos sistemas de apoyo a la toma de decisiones clínicas, el PREFASEG 10 y el Self Audit 11 , cuyo objetivo es fomentar la seguridad clínica en el uso de medicamentos.…”