Incorporating Indications into Medication Ordering — Time to Enter the Age of Reason

Schiff, Gordon D.; Seoane‐Vazquez, Enrique; Wright, Adam

doi:10.1056/nejmp1603964

Cited by 65 publications

(60 citation statements)

References 3 publications

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“…31 Patients who have optimal knowledge about their medications demonstrate better adherence and fewer errors. 32 To enhance knowledge, the US Food and Drug Administration’s efforts are focused on ways in which regulatory strategies, labeling, and patient information can interdigitate with healthcare delivery to improve medication adherence.…”

Section: | Practical Approaches To Address Medication Adherence Witmentioning

confidence: 99%

Disparities in hypertension and cardiovascular disease in blacks: The critical role of medication adherence

Ferdinand

Yadav

Nasser

et al. 2017

J of Clinical Hypertension

146

100

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Blacks are two to three times as likely as whites to die of preventable heart disease and stroke. Declines in mortality from heart disease have not eliminated racial disparities. Control and effective treatment of hypertension, a leading cause of cardiovascular disease, among blacks is less than in whites and remains a challenge. One of the driving forces behind this racial/ethnic disparity is medication nonadherence whose cause is embedded in social determinants. Eight practical approaches to addressing medication adherence with the potential to attenuate disparities were identified and include: (1) patient engagement strategies, (2) consumer-directed health care, (3) patient portals, (4) smart apps and text messages, (5) digital pillboxes, (6) pharmacist-led engagement, (7) cardiac rehabilitation, and (8) cognitive-based behavior. However, while data suggest that these strategies may improve medication adherence, the effect on ameliorating racial/ethnic disparities is not certain. This review describes the relationship between disparities and medication adherence, which likely plays a role in persistent disparities in cardiovascular morbidity and mortality.

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Section: | Practical Approaches To Address Medication Adherence Witmentioning

confidence: 99%

Disparities in hypertension and cardiovascular disease in blacks: The critical role of medication adherence

Ferdinand

Yadav

Nasser

et al. 2017

J of Clinical Hypertension

146

100

View full text Add to dashboard Cite

show abstract

“…Patient understanding of indications for medication therapy has been identified as poor, with approximately 13% of patients not understanding the indication for at least one of their medications . Incorporation of medication indications into the prescribing process may help to improve medication safety by identifying medications ordered for the wrong patient; wrong medications ordered for an indication and a patient's comorbidities; or even the wrong dosage for an indication . A study evaluating the EHR used the MedLEE NLP system to extract and encode medications from an outpatient population to indications derived from a medication information source .…”

Section: Examples Of Nlp By Data Sourcementioning

confidence: 99%

“…52 Incorporation of medication indications into the prescribing process may help to improve medication safety by identifying medications ordered for the wrong patient; wrong medications ordered for an indication and a patient's comorbidities; or even the wrong dosage for an indication. 53 A study evaluating the EHR used the MedLEE NLP system to extract and encode medications from an outpatient population to indications derived from a medication information source. 37 The authors identified improvements that could be made to increase the removal of comorbidities that were chronic from their system (due to temporality) and typographical errors in the patient record that were not accounted for.…”

Section: Electronic Health Recordsmentioning

confidence: 99%

Natural Language Processing and Its Implications for the Future of Medication Safety: A Narrative Review of Recent Advances and Challenges

Wong

Plasek

Montecalvo³

et al. 2018

Pharmacotherapy

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The safety of medication use has been a priority in the United States since the late 1930s. Recently, it has gained prominence due to the increasing amount of data suggesting that a large amount of patient harm is preventable and can be mitigated with effective risk strategies that have not been sufficiently adopted. Adverse events from medications are part of clinical practice, but the ability to identify a patient's risk and to minimize that risk must be a priority. The ability to identify adverse events has been a challenge due to limitations of available data sources, which are often free text. The use of natural language processing (NLP) may help to address these limitations. NLP is the artificial intelligence domain of computer science that uses computers to manipulate unstructured data (i.e., narrative text or speech data) in the context of a specific task. In this narrative review, we illustrate the fundamentals of NLP and discuss NLP's application to medication safety in four data sources: electronic health records, Internet-based data, published literature, and reporting systems. Given the magnitude of available data from these sources, a growing area is the use of computer algorithms to help automatically detect associations between medications and adverse effects. The main benefit of NLP is in the time savings associated with automation of various medication safety tasks such as the medication reconciliation process facilitated by computers, as well as the potential for near-real-time identification of adverse events for postmarketing surveillance such as those posted on social media that would otherwise go unanalyzed. NLP is limited by a lack of data sharing between health care organizations due to insufficient interoperability capabilities, inhibiting large-scale adverse event monitoring across populations. We anticipate that future work in this area will focus on the integration of data sources from different domains to improve the ability to identify potential adverse events more quickly and to improve clinical decision support with regard to a patient's estimated risk for specific adverse events at the time of medication prescription or review.

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“…Access to this information and the ability to quickly and efficiently communicate information back to prescribers would greatly impact the community pharmacist's ability to effectively address patient issues, such as the inability of a patient to afford a medication and subsequent need for a less expensive medication, educating a patient about the intended and appropriate use of a medication, educating the patient about the intended goals and duration of therapy, and developing a plan to address an important adverse event that would otherwise affect adherence. Demonstration projects and forums have already begun to evaluate issues around defining and improving access to necessary information, but much more work is required before these changes become widely adopted …”

Section: The Pharmacist As An Integral Part Of a Patient‐centered Sysmentioning

confidence: 99%

“…Demonstration projects and forums have already begun to evaluate issues around defining and improving access to necessary information, but much more work is required before these changes become widely adopted. 29,[36][37][38] 6 | CONCLUSION Medication adherence is a complex problem. Unfortunately, the large body of research focusing on adherence has done little more than provide some insight into barriers and predictors of adherence.…”

Section: Development Of Collaborativementioning

confidence: 99%

Medication adherence: Scope of the problem, ways to measure, ways to improve, and the role of the pharmacist

Touchette

Sharp

2019

J Am Coll Clin Pharm

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Background Medications are the cornerstone for the management of chronic conditions; however, approximately half of Americans do not take their prescribed medications as intended. Such behavior results in suboptimal clinical outcomes and financial strains on the health care system. Aims This manuscript outlines challenges with addressing medication adherence and proposes an integrated conceptual model with opportunities for pharmacists to intervene. Discussion and conclusion Pharmacists have many opportunities to support patients in adhering to their medications by addressing contextual issues.

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Incorporating Indications into Medication Ordering — Time to Enter the Age of Reason

Cited by 65 publications

References 3 publications

Disparities in hypertension and cardiovascular disease in blacks: The critical role of medication adherence

Disparities in hypertension and cardiovascular disease in blacks: The critical role of medication adherence

Natural Language Processing and Its Implications for the Future of Medication Safety: A Narrative Review of Recent Advances and Challenges

Medication adherence: Scope of the problem, ways to measure, ways to improve, and the role of the pharmacist

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