Glassman Peter A, Belperio Pamela, Simon Barbara, Lanto Andrew, Lee Martin
VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.
Med Care. 2006 Mar;44(3):250-6. doi: 10.1097/01.mlr.0000199849.08389.91.
We tested whether interval exposure to an automated drug alert system that included approximately 2000 drug-drug interaction alerts increased recognition of selected interacting drug pairs. We also examined other perceptions about computerized order entry.
We administered cross-sectional surveys in 2000 and 2002 that included more than 260 eligible clinicians in each time period.
We studied clinicians practicing in ambulatory settings within a Southern California Veterans Affairs Healthcare System and who responded to both surveys (97 respondents).
We sought to measure (1) recognition of selected drug-drug and drug-condition interactions and (2) other benefits and barriers to using automated drug alerts.
Clinicians correctly categorized similar percentages of the 7 interacting drug-drug pairs at baseline and follow-up (53% vs. 54%, P = 0.51) but improved their overall recognition of the 3 contraindicated drug-drug pairs (51% vs. 60%, P = 0.01). No significant changes from baseline to follow-up were found for the 8 interacting drug-condition pairs (60% vs. 62%, P = 0.43) or the 4 contraindicated drug-condition pairs (52% vs. 56%, P = 0.24). More providers preferred using order entry at follow-up than baseline (63% vs. 45%, P < 0.001). Signal-to-noise ratio remained the biggest reported problem at follow-up and baseline (54 vs. 57%, P = 0.75). In 2002, clinicians reported seeing a median of 5 drug alerts per week (representing approximately 12.5% of prescriptions entered), with a median 5% reportedly leading to an action.
Interval exposure to automated drug alerts had little to no effect on recognition of selected drug-drug interactions. The primary perceived barrier to effective utilization of drug alerts remained the same over time.
我们测试了间歇性接触包含约2000条药物相互作用警报的自动化药物警报系统是否能提高对选定相互作用药物对的识别率。我们还研究了对计算机化医嘱录入的其他看法。
我们在2000年和2002年进行了横断面调查，每个时间段有超过260名符合条件的临床医生参与。
我们研究了在南加州退伍军人事务医疗系统的门诊环境中执业且对两项调查都做出回应的临床医生（97名受访者）。
我们试图测量（1）对选定的药物相互作用和药物与疾病相互作用的识别率，以及（2）使用自动化药物警报的其他益处和障碍。
临床医生在基线和随访时对7对相互作用的药物对进行正确分类的比例相似（53%对54%，P = 0.51），但对3对禁忌药物对的总体识别率有所提高（51%对60%，P = 0.01）。从基线到随访，8对药物与疾病相互作用对（60%对62%，P = 0.43）或4对禁忌药物与疾病相互作用对（52%对56%，P = 0.24）均未发现显著变化。与基线相比，更多的提供者在随访时更倾向于使用医嘱录入（63%对45%，P < 0.001）。随访和基线时，信噪比仍是报告的最大问题（54%对57%，P = 0.75）。2002年，临床医生报告每周看到的药物警报中位数为5条（约占录入处方的12.5%），据报道其中位数5%会导致采取行动。
间歇性接触自动化药物警报对选定药物相互作用的识别影响很小或没有影响。随着时间的推移，有效利用药物警报的主要感知障碍保持不变。
