Division of Isotope Application, Institute of Nuclear Energy Research, Taiwan, ROC.
Int J Med Inform. 2012 Sep;81(9):605-11. doi: 10.1016/j.ijmedinf.2012.04.009. Epub 2012 Jun 15.
There is an evidence that pregnant women have been prescribed a significant number of improper medications that could lead to potential damage for a developing fetus due to discontinuity of care. The safety of pregnant women raises public concern and there is a need to identify ways to prevent potential adverse events to the pregnant woman. This study used a health smart card with a clinical reminder system to keep continuous records of general outpatient visits of pregnant women to protect them from potential adverse events caused by improper prescription.
The health smart card, issued to all 23 million citizens in Taiwan, was used to work with a Computerized Physician Order Entry (CPOE) implemented at a 700-bed teaching medical center in Taipei to provide the outpatient information of pregnant women. FDA pregnancy risk classification was used to categorize the risk of pregnant women. The log file, combined with the physicians' and patients' profiles, were statistically examined using the Mantel-Haenszel technique to evaluate the impact of system in changing physician's prescription behavior.
A total of 441 patients ranged in age from 15 to 50 years with 1114 prescriptions involved in FDA pregnancy risk classification C, D, and X during the study period. 144 reminders (13.1%) were accepted by physicians for further assessment and 100 (69.4%) of them were modified. Non-obstetric physicians in non-emergency setting were more intended to accept reminders (27.8%, 4.9 folds than obstetricians). Reminders triggered on patients in second trimester (15.5%) were accepted by all physicians more than third trimester (OR 1.52, p<0.05).
A health smart card armed with CPOE reminder system and well-defined criteria had the potential to decrease harmful medication prescribed to pregnant patients. The results show better conformance for non-obstetric physicians (26%) and when physicians accepted the alerts they are more likely to went back and review their orders (69%). In sum, reminder criteria of FDA pregnancy risk classification C for obstetricians and reminder based on different trimesters is suggested to be refined to improve system acceptability and to decrease improper prescription.
有证据表明，孕妇被开具了大量可能对胎儿造成潜在伤害的不当药物，这是由于医疗护理的连续性中断所致。孕妇的安全引起了公众的关注，有必要找到防止孕妇发生潜在不良事件的方法。本研究使用带临床提醒系统的健康智能卡，对孕妇的普通门诊就诊进行连续记录，以保护她们免受不当处方带来的潜在不良事件。
该健康智能卡已发放给台湾 2300 万公民，与台北一家 700 床位教学医疗中心实施的计算机化医嘱录入系统（CPOE）一起使用，以提供孕妇的门诊信息。使用 FDA 妊娠风险分类对孕妇的风险进行分类。使用 Mantel-Haenszel 技术对日志文件与医生和患者的档案进行统计分析，以评估系统改变医生处方行为的影响。
在研究期间，共有 441 名年龄在 15 至 50 岁之间的患者，涉及 1114 张 FDA 妊娠风险分类 C、D 和 X 的处方。医生接受了 144 次（13.1%）提醒，以进一步评估，其中 100 次（69.4%）进行了修改。非紧急情况下的非产科医生更倾向于接受提醒（27.8%，4.9 倍于产科医生）。接受提醒的患者中，有 15.5%处于孕中期，比接受提醒的孕晚期患者（OR 1.52，p<0.05）更多。
配备 CPOE 提醒系统和明确标准的健康智能卡有可能减少对孕妇开具的有害药物。结果表明，非产科医生的一致性更好（26%），当医生接受警报时，他们更有可能回去复查他们的医嘱（69%）。总之，建议细化妇产科医生的 FDA 妊娠风险分类 C 的提醒标准和基于不同孕期的提醒标准，以提高系统的可接受性，减少不当处方。
