Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
J Am Med Inform Assoc. 2012 Jan-Feb;19(1):22-30. doi: 10.1136/amiajnl-2011-000304. Epub 2011 Aug 18.
The US Agency for Healthcare Research and Quality funded an evidence report to address seven questions on multiple aspects of the effectiveness of medication management information technology (MMIT) and its components (prescribing, order communication, dispensing, administering, and monitoring).
Medline and 11 other databases without language or date limitations to mid-2010. Randomized controlled trials (RCTs) assessing integrated MMIT were selected by two independent reviewers. Reviewers assessed study quality and extracted data. Senior staff checked accuracy.
Most of the 87 RCTs focused on clinical decision support and computerized provider order entry systems, were performed in hospitals and clinics, included primarily physicians and sometimes nurses but not other health professionals, and studied process changes related to prescribing and monitoring medication. Processes of care improved for prescribing and monitoring mostly in hospital settings, but the few studies measuring clinical outcomes showed small or no improvements. Studies were performed most frequently in the USA (n=63), Europe (n=16), and Canada (n=6).
Many studies had limited description of systems, installations, institutions, and targets of the intervention. Problems with methods and analyses were also found. Few studies addressed order communication, dispensing, or administering, non-physician prescribers or pharmacists and their MMIT tools, or patients and caregivers. Other study methods are also needed to completely understand the effects of MMIT.
Almost half of MMIT interventions improved the process of care, but few studies measured clinical outcomes. This large body of literature, although instructive, is not uniformly distributed across settings, people, medication phases, or outcomes.
美国医疗保健研究与质量局资助了一项证据报告，以解决有关药物管理信息技术（MMIT）及其组成部分（处方、医嘱传达、配药、给药和监测）的多个方面的有效性的七个问题。
检索了 Medline 和其他 11 个数据库，未设置语言或日期限制，检索时间截至 2010 年中期。两名独立评审员选择了评估综合 MMIT 的随机对照试验（RCT）。评审员评估了研究质量并提取了数据。高级工作人员检查了准确性。
87 项 RCT 中的大多数主要集中在临床决策支持和计算机化医嘱输入系统上，在医院和诊所进行，主要涉及医生，有时涉及护士，但不涉及其他卫生专业人员，研究了与处方和监测药物相关的流程变化。护理流程在医院环境中主要在处方和监测方面得到了改善，但少数测量临床结果的研究显示出较小或没有改善。这些研究主要在美国（n=63）、欧洲（n=16）和加拿大（n=6）进行。
许多研究对系统、安装、机构和干预目标的描述有限。还发现了方法和分析方面的问题。很少有研究涉及医嘱传达、配药或给药、非医师处方者或药剂师及其 MMIT 工具，或患者和护理人员。还需要其他研究方法来全面了解 MMIT 的效果。
几乎一半的 MMIT 干预措施改善了护理过程，但很少有研究测量临床结果。尽管这大量文献具有启发性，但它在设置、人员、药物阶段或结果方面并没有均匀分布。
