Pons-Mesquida M Àngels, Oms-Arias Míriam, Figueras Albert, Diogène-Fadini Eduard
Unitat de Coordinació i Estratègia del Medicament (UCEM), Institut Català de la Salut, Barcelona, Spain.
Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Barcelona, Spain.
BMC Med Inform Decis Mak. 2022 Mar 19;22(1):70. doi: 10.1186/s12911-022-01809-6.
In 2008, in the context of a complete computerisation of medical records, the Institut Català de la Salut (ICS, Catalan Health Institute) implemented a system in its electronic clinical workstation (ECW) to assist decision-making at the prescription level. This system is known as Self Audit, and it supports physicians in reviewing the medication of their patients. Self Audit provides lists of patients presenting medication-related problems (MRPs) that have potential for improvement, and provides therapeutic recommendations that are easy to apply from the system itself. The aim of this study was to analyse the main results derived from the use of Self Audit in primary care (PC) in Catalonia, and the effect of an incentive-based safety indicator on the results obtained.
A descriptive cross-sectional study was carried out to analyse variations in the MRPs detected by Self Audit during 2016, 2017, and 2018 in PC in Catalonia. The effect of a safety indicator on the results obtained was also studied. This safety indicator includes the most clinically relevant MRPs (i.e., therapeutic duplications, safety alerts from the Spanish Medicines Agency, and incidences of polymedication in patients over 65 years of age). Variation in the MRPs was measured using the differences between two evaluation points (initial and final). An MRP was considered resolved if the recommendation specified in the alert was followed. The prescriptions of 6411 PC doctors of the ICS who use the ECW and provide their services to 5.8 million Catalans through 288 PC teams were analysed.
Analysis of the total safety-based MRPs detected by Self Audit gave overall resolutions from April to December of 9% (21,547) in 2016, 7% (15,924) in 2017, and 1% (2392) in 2018 out of the total number of MRPs recorded in April each year. Examination of the 3 types of MRPs with the highest clinical relevance that were linked to the safety indicator gave overall resolutions of 41% in 2016 (17,358), 20% in 2017 (7655), and 21% in 2018 (8135).
The ICS Self Audit tool assists in reducing the number of safety-based MRPs in a systematic manner, and yields superior results for the MRPs linked to a safety indicator included in the incentives of PC physicians.
2008年，在医疗记录全面计算机化的背景下，加泰罗尼亚卫生研究所（ICS）在其电子临床工作站（ECW）中实施了一个系统，以协助处方层面的决策。该系统名为“自我审核”，支持医生审查其患者的用药情况。“自我审核”提供了存在有待改进的用药相关问题（MRP）的患者名单，并提供了易于从系统本身应用的治疗建议。本研究的目的是分析在加泰罗尼亚基层医疗（PC）中使用“自我审核”得出的主要结果，以及基于激励的安全指标对所获结果的影响。
开展了一项描述性横断面研究，以分析2016年、2017年和2018年加泰罗尼亚基层医疗中“自我审核”检测到的MRP的变化情况。还研究了一个安全指标对所获结果的影响。该安全指标包括临床上最相关的MRP（即治疗重复、西班牙药品管理局的安全警报以及65岁以上患者的多重用药发生率）。使用两个评估点（初始和最终）之间的差异来衡量MRP的变化。如果遵循了警报中指定的建议，则认为MRP得到解决。分析了ICS的6411名使用ECW并通过288个基层医疗团队为580万加泰罗尼亚人提供服务的基层医疗医生的处方。
对“自我审核”检测到的基于安全的MRP总数进行分析，2016年4月至12月的总体解决率为9%（21,547例），2017年为7%（15,924例），2018年为1%（2392例），均相对于每年4月记录的MRP总数。对与安全指标相关的临床相关性最高的3种类型的MRP进行检查，2016年的总体解决率为41%（17,358例），2017年为20%（7655例），2018年为21%（8135例）。
ICS的“自我审核”工具有助于系统地减少基于安全的MRP数量，并且对于与基层医疗医生激励措施中包含的安全指标相关的MRP能产生更好的结果。
