Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
Int J Med Inform. 2019 Sep;129:253-259. doi: 10.1016/j.ijmedinf.2019.06.011. Epub 2019 Jun 18.
Qualitative studies have provided important insights into how hospital pharmacists' work changes when electronic medication management (EMM) systems are introduced. Quantitative studies of work practice change are rare. Despite the use of EMM systems internationally, there are no cross-country comparative studies of their impact on health professionals' work. We aimed to quantify and compare the type and magnitude of changes in hospital pharmacists' work pre- and post-EMM implementation in two countries.
Parallel, direct observational, time and motion studies of pharmacists in Australia and England pre- and post-EMM implementation. 20 pharmacists were observed: 9 in an Australian 440-bed hospital (155 h); and 11 pharmacists in a 500-bed English hospital (258 h). The Work Observation Method By Activity Timing (WOMBAT) software was used to collect observational data. Proportions of observed time in 11 tasks by study period (pre- versus post-EMM) and site, time spent with others or alone, and using different tools (e.g computers, paper) were calculated. Magnitude of changes between pre- and post-EMM by task and country were determined using z-tests for proportions adjusting for multiple testing.
At baseline, Australian and English pharmacists spent the greatest proportion of time in medication review. Post-EMM, time in medication review (Australia 21.6%-27.5%; England 27.1%-33.8%) and history-taking (Australia 7.6%-13.3%; England 19.5%-28.9%) significantly increased. Despite country differences in these tasks at baseline, the magnitude of changes did not significantly differ. English pharmacists increased time engaged in medication discussions with patients post-EMM (from 5.9% to 10.8%; p = 0.01). The Australian rate did not change (18.0%-27.2%; p = 0.09), but was higher at baseline. Post-EMM, Australian pharmacists spent 63.4% of time working alone, compared to 92.0% for English pharmacists.
EMM systems impacted the same core areas of work and had a similar magnitude of effect on pharmacists' work in both countries. Anticipated reductions in medication review and history taking were not observed.
定性研究为了解电子医嘱管理（EMM）系统引入后医院药师工作的变化提供了重要见解。关于工作实践变化的定量研究很少。尽管国际上使用了 EMM 系统，但尚未对其对卫生专业人员工作的影响进行跨国比较研究。我们旨在量化和比较两个国家 EMM 实施前后医院药师工作的类型和变化程度。
在 EMM 实施前后，对澳大利亚和英国的药剂师进行平行、直接观察、时间和运动研究。观察了 20 名药剂师：澳大利亚 440 张床位的医院 9 名（155 小时）；英国 500 张床位的医院 11 名药剂师（258 小时）。使用活动时间观察法（WOMBAT）软件收集观察数据。根据研究期间（EMM 前后）和地点计算 11 项任务中观察时间的比例、与他人或独自度过的时间以及使用不同工具（例如计算机、纸张）的比例。使用调整后的 z 检验，根据任务和国家确定 EMM 前后的变化幅度。
基线时，澳大利亚和英国的药剂师在药物审查上花费的时间最多。EMM 后，药物审查（澳大利亚 21.6%-27.5%；英格兰 27.1%-33.8%）和病史采集（澳大利亚 7.6%-13.3%；英格兰 19.5%-28.9%）的时间显著增加。尽管基线时这些任务在两国之间存在差异，但变化幅度并无显著差异。EMM 后，英国药剂师与患者进行药物讨论的时间增加（从 5.9%增加到 10.8%；p=0.01）。澳大利亚的比例没有变化（18.0%-27.2%；p=0.09），但基线较高。EMM 后，澳大利亚药剂师有 63.4%的时间独自工作，而英国药剂师为 92.0%。
EMM 系统对两国药师的核心工作领域产生了相同的影响，对药师工作的影响程度也相似。预计药物审查和病史采集的减少并未出现。
