Supporting clinical rules engine in the adjustment of medication (SCREAM): protocol of a multicentre, prospective, randomised study

Gonzalvo, Carlota Mestres; Wit, Hugo A. J. M. de; Oijen, Brigit P. C. van; Hurkens, Kim P. G. M.; Janknegt, R.; Schols, Jos M. G. A.; Mulder, Wubbo J.; Verhey, Frans R.J.; Winkens, Björn; Kuy, Paul-Hugo M. van der

doi:10.1186/s12877-017-0426-3

Cited by 14 publications

(9 citation statements)

References 27 publications

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“…However, this type of technological support did not extend to supporting clinical decision-making. There was little data on the effect of CDSS in NHs, but there is ongoing research on this topic ( 83 ). Its impact in the long-term environment remains to be seen as recent trials on CDSS to optimize prescribing in primary and acute care have shown negative results on clinical outcomes [ 84 , 85 ].…”

Section: Discussionmentioning

confidence: 99%

Interventions to optimize medication use in nursing homes: a narrative review

2021

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Purpose Polypharmacy, medication errors and adverse drug events are frequent among nursing home residents. Errors can occur at any step of the medication use process. We aimed to review interventions aiming at optimization of any step of medication use in nursing homes. Methods We narratively reviewed quantitative as well as qualitative studies, observational and experimental studies that described interventions, their effects as well as barriers and enablers to implementation. We prioritized recent studies with relevant findings for the European setting. Results Many interventions led to improvements in medication use. However, because of outcome heterogeneity, comparison between interventions was difficult. Prescribing was the most studied aspect of medication use. At the micro-level, medication review, multidisciplinary work, and more recently, patient-centered care components dominated. At the macro-level, guidelines and legislation, mainly for specific medication classes (e.g., antipsychotics) were employed. Utilization of technology also helped improve medication administration. Several barriers and enablers were reported, at individual, organizational, and system levels. Conclusion Overall, existing interventions are effective in optimizing medication use. However there is a need for further European well-designed and large-scale evaluations of under-researched intervention components (e.g., health information technology, patient-centered approaches), specific medication classes (e.g., antithrombotic agents), and interventions targeting medication use aspects other than prescribing (e.g., monitoring). Further development and uptake of core outcome sets is required. Finally, qualitative studies on barriers and enablers for intervention implementation would enable theory-driven intervention design.

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Section: Discussionmentioning

confidence: 99%

Interventions to optimize medication use in nursing homes: a narrative review

2021

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“…The COME-ON cRCT is a complex, multifaceted intervention, including interdisciplinary case conferences, on the appropriateness of prescribing of medicines in Belgian nursing homes [34]. The SCREAM study aims to use a computerised clinical support system that analyses the NHR’ medications in terms of interactions, dose appropriateness and other clinical data to reduce the time resources for medication reviews by pharmacists and nursing home physicians [35]. Our study’s emphasis is on the combination of a standardised pharmacist-led medication review and changing interprofessional cooperation.…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary intervention to improve medication safety in nursing home residents: protocol of a cluster randomised controlled trial (HIOPP-3-iTBX study)

et al. 2019

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BackgroundMedication safety is an important health issue for nursing home residents (NHR). They usually experience polypharmacy and often take potentially inappropriate medications (PIM) and antipsychotics. This, coupled with a frail health state, makes NHR particularly vulnerable to adverse drug events (ADE). The value of systematic medication reviews and interprofessional co-operation for improving medication quality in NHR has been recognized. Yet the evidence of a positive effect on NHR’ health and wellbeing is inconclusive at this stage. This study investigates the effects of pharmacists’ medication reviews linked with measures to strengthen interprofessional co-operation on NHR’ medication quality, health status and health care use.MethodsPragmatic cluster randomised controlled trial in nursing homes in four regions of Germany. A total of 760 NHR will be recruited. Inclusion: NHR aged 65 years and over with an estimated life expectancy of at least six months. Intervention with four elements: i) introduction of a pharmacist’s medication review combined with a communication pathway to the prescribing general practitioners (GPs) and nursing home staff, ii) facilitation of change in the interprofessional cooperation, iii) educational training and iv) a “toolbox” to facilitate implementation in daily practice. Analysis: primary outcome - proportion of residents receiving PIM and ≥ 2 antipsychotics at six months follow-up. Secondary outcomes - cognitive function, falls, quality of life, medical emergency contacts, hospital admissions, and health care costs.DiscussionThe trial assesses the effects of a structured interprofessional medication management for NHR in Germany. It follows the participatory action research approach and closely involves the three professional groups (nursing staff, GPs, pharmacists) engaged in the medication management. A handbook based on the experiences of the trial in nursing homes will be produced for a rollout into routine practice in Germany.Trial registrationRegistered in the German register of clinical studies (DRKS, study ID DRKS00013588, primary register) and in the WHO International Clinical Trials Registry Platform (secondary register), both on 25th January 2018.

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“…Similarly, Yang et al (2018) proposed reminder systems, based on patients' allergy background, to prevent hypersensitivity reactions to radiocontrast media, according to the Korean health policy. Gonzalvo et al (2017) proposed a DDSS based on the CONSORT guidelines, providing treatment recommendations for poly-medicated patients. Another well-known example is DxPlain (Barnett et al, 1987;Hoffer et al, 2005), an early DDSS dedicated to providing recommendations for primary care, which is still available 5 .…”

Section: A Loss Of Confidence In Physicians' Diagnostic Skills and Knmentioning

confidence: 99%

What does it mean to provide decision support to a responsible and competent expert?

Richard

Mayag

Talbot

et al. 2020

EURO Journal on Decision Processes

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Decision support consists in helping a decision-maker to improve his/her decisions. However, clients requesting decision support are often themselves experts and are often taken by third parties and/or the general public to be responsible for the decisions they make. This predicament raises complex challenges for decision analysts, who have to avoid infringing upon the expertise and responsibility of the decision-maker. The case of diagnosis decision support in healthcare contexts is particularly illustrative. To support clinicians in their work and minimize the risk of medical error, various decision support systems have been developed, as part of information systems that are now ubiquitous in healthcare contexts. To develop, in collaboration with the hospitals of Lyon, a diagnostic decision support system for day-today customary consultations, we propose in this paper a critical analysis of current approaches to diagnostic decision support, which mainly consist in providing them with guidelines or even full-fledged diagnosis recommendations. We highlight that the use of such decision support systems by physicians raises responsibility issues, but also that it is at odds with the needs and constraints of customary consultations. We argue that the historical choice to favor guidelines or recommendations to physicians implies a very specific vision of what it means to support physicians, and we argue that the flaws of this vision partially ex-A.

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Supporting clinical rules engine in the adjustment of medication (SCREAM): protocol of a multicentre, prospective, randomised study

Cited by 14 publications

References 27 publications

Interventions to optimize medication use in nursing homes: a narrative review

Interventions to optimize medication use in nursing homes: a narrative review

Multidisciplinary intervention to improve medication safety in nursing home residents: protocol of a cluster randomised controlled trial (HIOPP-3-iTBX study)

What does it mean to provide decision support to a responsible and competent expert?

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