Wei Wenfei, Felippi Rafael, Abbasi Ghalib, Pinn Theresa, Rose Kelly St, Rana Isha
Department of Pharmacy, Houston Methodist, Houston, TX, USA.
Physicians' Alliance for Quality Department, Houston Methodist, Houston, TX, USA.
Hosp Pharm. 2023 Apr;58(2):212-218. doi: 10.1177/00185787221130689. Epub 2022 Oct 31.
Assess the impact of electronic health record interventions on patient access to post-hospital discharge prescriptions. Five interventions were implemented in the electronic health record to improve patient access to prescriptions after discharge from hospital: electronic prior authorization, alternative medication suggestions, order sets, mail order pharmacy alerts, and medication interchange instructions. This was a retrospective cohort study of patient responses from discharges during 6 months before the first intervention implementation and 6 months after the last intervention implementation documented in the electronic health record and a transition-in-care platform. Primary endpoint was the proportion of discharges with patient-reported issues that would have been prevented by the studied interventions out of number of discharges with at least one prescription, analyzed using Chi-squared test (level of significance .05). Discharges with patient-reported issues that would have been prevented by the studied interventions decreased from 1.68 to 1.07 out of 1000 discharges with prescriptions ( < .001). Interventions in the electronic health record reduced barriers faced by patients to picking up prescriptions post-discharge from hospital, potentially leading to improved patient satisfaction and improved health outcomes. Important factors to consider for electronic health record intervention implementation are workflow development and intrusiveness of clinical decision support. Multiple targeted electronic health record interventions can improve patients' access to prescriptions after discharge from hospital.
评估电子健康记录干预措施对患者获取出院后处方的影响。在电子健康记录中实施了五项干预措施,以改善患者出院后获取处方的情况:电子预先授权、替代药物建议、医嘱集、邮购药房提醒和药物互换说明。这是一项回顾性队列研究,研究对象为电子健康记录和护理转接平台中记录的首次干预措施实施前6个月及最后一项干预措施实施后6个月期间出院患者的反应。主要终点是在至少有一张处方的出院患者中,经研究的干预措施可预防的患者报告问题的出院比例,采用卡方检验进行分析(显著性水平为0.05)。在每1000例有处方的出院患者中,经研究的干预措施可预防的患者报告问题的出院例数从1.68降至1.07(P<0.001)。电子健康记录中的干预措施减少了患者出院后取药时面临的障碍,可能会提高患者满意度并改善健康结局。实施电子健康记录干预措施时需要考虑的重要因素包括工作流程开发和临床决策支持的侵入性。多项有针对性的电子健康记录干预措施可改善患者出院后获取处方的情况。