University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, 2511 Rennebohm Hall, Madison, WI, 53704, USA.
University of Wisconsin-Madison School of Nursing, Madison, WI, USA.
BMC Med Inform Decis Mak. 2022 Feb 25;22(1):50. doi: 10.1186/s12911-022-01779-9.
Prescription opioid misuse is a serious national crisis; in 2018 the top drugs involved in prescription overdose deaths included pain medications (opioids), benzodiazepines, and stimulants. Health information technology (health IT) provides a means to address this crisis through technologies that streamline the prescribing and discontinuation process. CancelRx is a health IT function that communicates when medications, such as controlled substances, are discontinued at the clinic and therefore should not be filled at the pharmacy. Prior to CancelRx, the communication of discontinued medications was a manual process, requiring the patient or a clinic staff member to personally contact the pharmacy to inform them of the change. The objective of this study was to assess how controlled substance medication discontinuations were communicated over time, before and after the implementation of CancelRx.
Secondary data from a midwestern academic health system electronic health record and pharmacy platform were collected 12-months prior to CancelRx implementation and for 12-months post implementation. The study utilized an interrupted time series analysis (ITSA) to capture the percentage of controlled substance medications that were discontinued in the clinic's electronic health record and discontinued in the pharmacy's dispensing software. The ITSA plotted the percentage of successful discontinuation messages over time, particularly after the health system's implementation of CancelRx, a novel technology.
After CancelRx implementation there was an immediate (change = 77.7 percentage point) and significant (p < 0.001) increase in the number of controlled substance medications that were successfully discontinued at the pharmacy after being discontinued in the clinic. This change was sustained in the year following CancelRx (slope = 0.03 pp, 95% CI - 0.050 to 0.110) and did not revert to pre-CancelRx levels. The health IT functionality was able to effectively complete discontinuation tasks and potentially reduce workload for clinic staff.
Overall, this study demonstrates the role that technology can play in promoting communication between clinics and pharmacies, especially when medications such as controlled substances are discontinued.
处方类阿片类药物滥用是一个严重的全国性危机；2018 年涉及处方过量死亡的主要药物包括止痛药（阿片类药物）、苯二氮䓬类药物和兴奋剂。健康信息技术（health IT）提供了一种通过简化处方和停药流程的技术来应对这一危机的方法。CancelRx 是一种健康信息技术功能，可在药物（如受控物质）在诊所停药时进行通信，因此不应在药房配药。在 CancelRx 之前，停用药物的通信是一个手动过程，需要患者或诊所工作人员亲自联系药房告知他们药物变化情况。本研究的目的是评估在实施 CancelRx 前后，随着时间的推移，受控物质药物停药情况的沟通方式。
从中西部学术医疗系统的电子健康记录和药房平台收集了实施 CancelRx 前 12 个月和实施后 12 个月的二级数据。该研究利用中断时间序列分析（ITSA）来捕获诊所电子健康记录中停用和药房配药软件中停用的受控物质药物的百分比。ITSA 随着时间的推移绘制了成功停药消息的百分比，特别是在医疗系统实施新型技术 CancelRx 之后。
在实施 CancelRx 后，在诊所停药后，药房成功停药的受控物质药物数量立即（变化=77.7 个百分点）且显著（p<0.001）增加。在实施 CancelRx 后的一年中，这种变化持续存在（斜率=0.03pp，95%CI-0.050 至 0.110），且并未恢复到实施 CancelRx 前的水平。健康信息技术功能能够有效地完成停药任务，并可能减轻诊所工作人员的工作量。
总体而言，本研究表明技术在促进诊所和药房之间的沟通方面可以发挥作用，尤其是在停用受控物质等药物时。
