Safer prescription of drugs: impact of the PREFASEG system to aid clinical decision-making in primary care in Catalonia

Abstract

Background In 2008, the Institut Català de la Salut (ICS, Catalan Health Institute) implemented a prescription decision support system in its electronic clinical workstation (ECW), which automatically generates online alerts for general practitioners when a possible medication-related problem (MRP) is detected. This tool is known as PREFASEG, and at the time of beginning a new treatment, it automatically assesses the suitability of the treatment for the individual patient. This analysis is based on ongoing treatments, demographic characteristics, existing pathologies, and patient biochemical variables. As a result of the assessment, therapeutic recommendations are provided. The objective of this study is to present the PREFASEG tool, analyse the main alerts that it generates, and determine the degree of alert acceptance. Methods A cross-sectional descriptive study was carried out to analyse the generation of MRP-related alerts detected by PREFASEG during 2016, 2017, and 2018 in primary care (PC) in Catalonia. The number of MRP alerts generated, the drugs involved, and the acceptance/rejection of the alerts were analysed. An alert was considered "accepted" when the medication that generated the alert was not prescribed, thereby following the recommendation given by the tool. The MRP alerts studied were therapeutic duplications, safety alerts issued by the Spanish Medicines Agency, and drugs not recommended for use in geriatrics. The prescriptions issued by 6411 ICS PC physicians who use the ECW and provide their services to 5.8 million Catalans through 288 PC teams were analysed. Results During the 3 years examined, 67.2 million new prescriptions were analysed, for which PREFASEG generated 4,379,866 alerts (1 for every 15 new treatments). A total of 1,222,159 alerts (28%) were accepted. Pharmacological interactions and therapeutic duplications were the most detected alerts, representing 40 and 30% of the total alerts, respectively. The main pharmacological groups involved in the safety alerts were nonsteroidal anti-inflammatory drugs and renin-angiotensin system inhibitors. Conclusions During the period analysed, 28% of the prescriptions wherein a toxicity-related PREFASEG alert was generated led to treatment modification, thereby helping to prevent the generation of potential safety MRPs. However, the tool should be further improved to increase alert acceptance and thereby improve patient safety.

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

“…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.…”

“…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 ). The computerized medical history notifies the professionals when a patient is visited by another professional and explains the medication changes made.…”

Epidemiological and clinical characteristics of SARS-CoV-2 reinfections in a Spanish region

“…Data were taken from two different information systems. On the one hand, patients registered with the public system who consulted their general practitioner or an emergency service by means of the Electronic clinical workstation (SAP® and Electronic-Centre d’Atenció Primaria (ECAP) for its acronym in Spain 15 ) programmes. On the other hand, all cases of SARS-CoV-2 notified to our region’s public health authorities.…”

Do clinical decision support systems for prescribing improve patient safety? a systematic literature review

“…The discussion on electronic prescription alerts is only mapped to two impacts, namely reducing prescribing errors and improving compliance with protocols. [6], [7], [18], [24], [26], [29], [30], [35], [39], [43]- [46], [48], [49], [55] [31], [42] [2], [40], [41], [53] [5], [8], [19] CDSS and EHR (or other system) integration [34], [50], [52] [17], [47], [51] [33] [25] Electronic prescription alert [6], [11], [14], [18], [28], [32], [35], [36], [37], [38], [43], [46], [48], [49] [27], [54] --DDI [11], [14], [36], [37] ---…”

“…Various diseases, including hypertension, cardiovascular disease, gastrointestinal and respiratory tract diseases, diabetes, acquired immunodeficiency syndrome (AIDS), appendicitis, malaria, high blood potassium, kidney disease, and mental illness, have been prescribed using the CDSS [16]. Several prescribing-related CDSS have been developed, such as: i) MedSafety scan [15], which is a hospital-based CDSS to identify patients at risk, and help reduce the risk of harm caused by drugs; ii) PEDeDose [17], supports healthcare professionals caring for pediatric and neonatal patients, enabling them to make informed, evidence-based decisions; iii) PREFASEG [18], automatically generates online alerts for general practitioners when a possible medication-related problems (MRP) is detected; iv) computerized antibiotic stewardship study (COMPASS), a CDSS that has been integrated into an in-house computerized physician order entry system, has been developed to assist physicians in making antimicrobial prescribing decisions [19], [20].…”