Lapane Kate L, Waring Molly E, Schneider Karen L, Dubé Catherine, Quilliam Brian J
Department of Community Health, Brown Medical School, Providence, RI 02903, USA.
J Gen Intern Med. 2008 Apr;23(4):442-6. doi: 10.1007/s11606-008-0505-4.
The objective of this paper was to describe primary care prescribers' perspectives on electronic prescribing drug alerts at the point of prescribing.
We used a mixed-method study which included clinician surveys (web-based and paper) and focus groups with prescribers and staff.
Prescribers (n = 157) working in one of 64 practices using 1 of 6 e-prescribing technologies in 6 US states completed the quantitative survey and 276 prescribers and staff participated in focus groups.
The study measures self-reported frequency of overriding of drug alerts; open-ended responses to: "What do you think of the drug alerts your software generates for you?"
More than 40% of prescribers indicated they override drug-drug interactions most of the time or always (range by e-prescribing system, 25% to 50%). Participants indicated that the software and the interaction alerts were beneficial to patient safety and valued seeing drug-drug interactions for medications prescribed by others. However, they noted that alerts are too sensitive and often unnecessary. Participant suggestions included: (1) run drug alerts on an active medication list and (2) allow prescribers to set the threshold for severity of alerts.
Primary care prescribers recognize the patient safety value of drug prescribing alerts embedded within electronic prescribing software. Improvements to increase specificity and reduce alert overload are needed.
本文的目的是描述基层医疗开方者在开方时对电子开方药物警示的看法。
我们采用了混合方法研究，包括临床医生调查（基于网络和纸质）以及与开方者和工作人员的焦点小组访谈。
在美国6个州使用6种电子开方技术之一的64家医疗机构中工作的157名开方者完成了定量调查，276名开方者和工作人员参与了焦点小组访谈。
该研究测量了自我报告的忽略药物警示的频率；对“你如何看待你的软件为你生成的药物警示？”这一问题的开放式回答。
超过40%的开方者表示他们大多数时候或总是忽略药物相互作用警示（按电子开方系统范围，为25%至50%）。参与者表示软件和相互作用警示对患者安全有益，并且重视查看他人所开药物的药物相互作用。然而，他们指出警示过于敏感且往往不必要。参与者的建议包括：（1）对当前用药清单运行药物警示，以及（2）允许开方者设定警示严重程度的阈值。
基层医疗开方者认识到电子开方软件中嵌入的药物开方警示对患者安全的价值。需要进行改进以提高特异性并减少警示过载。
