The Utility of Adding Retrospective Medication Profiling to Computerized Provider Order Entry in an Ambulatory Care Population
- Peter A Glassman,
- Pamela Belperio,
- Andrew Lanto,
- Barbara Simon,
- Robert Valuck,
- Jeffrey Sayers,
- Martin Lee
- Affiliations of the authors: VA Greater Los Angeles Healthcare System, Los Angeles, California; VA HSR and D Center of Excellence for the Study of Healthcare Provider Behavior, Sepulveda, California; David Geffen School of Medicine at UCLA, Los Angeles, California; VA Center for Medication Safety, Hines, Illinois; VA Public Health Strategic Healthcare Group Center for Quality Management, Palo Alto, California; Department of Clinical Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, Colorado
- Correspondence and reprints: Peter A. Glassman, MBBS, MSc., Division of General Internal Medicine (111G), VA Greater Los Angeles Healthcare System, West Los Angeles Campus, 11301 Wilshire Blvd, Los Angeles, CA 90073; e-mail: <Peter.Glassman{at}va.gov>
- Received 25 October 2006
- Accepted 2 April 2007
Abstract
Background We assessed whether medication safety improved when a medication profiling program was added to a computerized provider order entry system.
Design Between June 2001 and January 2002 we profiled outpatients with potential prescribing errors using computerized retrospective drug utilization software. We focused primarily on drug interactions. Patients were randomly assigned either to Provider Feedback or to Usual Care. Subsequent adverse drug event (ADE) incidence and other outcomes, including ADE preventability and severity, occurring up to 1 year following the last profiling date were evaluated retrospectively by a pharmacist blinded to patient assignment.
Measurements Data were abstracted using a study-designed instrument. An ADE was defined by an Adverse Drug Reaction Probability scale score of 1 or more. Statistical analyses included negative binomial regression for comparing ADE incidence.
Results Of 913 patients in the analytic sample, 371 patients (41%) had one or more ADEs. Incidence, by individual, was not significantly different between Usual Care and Provider Feedback groups (37% vs. 45%; p = 0.06; Coefficient, 0.19; 95% CI: −0.008, 0.390). ADE severity was also similar. For example, 51% of ADEs in the Usual Care and 58% in the Provider Feedback groups involved symptoms that were not serious (95% CI for the difference, −15%, 2%). Finally, ADE preventability did not differ. For example, 16% in the Usual Care group and 17% in the Provider Feedback group had an associated warning (95% CI for the difference, −7 to 5%; p = 0.79).
Conclusion Medications safety did not improve with the addition of a medication profiling program to an electronic prescribing system.
Footnotes
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The authors gratefully acknowledge funding support for this study from VA Health Services Research and Development, SAF-98-144-1 (“Patient Profiling and Provider Feedback to Reduce Adverse Drug Events”).
We thank Mrs. Patricia Preyer for clerical support and Ms. Alissa Simon for work on abstraction forms. We are grateful to Jonathan Nebeker, MD and Steven Asch, MD for their thoughtful comments on the manuscript. We also thank Jocelyn Hayes-Hunter, PharmD for her efforts on the grant proposal and for comments on the manuscript. Finally, we appreciate the help of our anonymous reviewers.
Substantive data contained in this manuscript has not been presented or published previously. Some preliminary data (primarily economic) was presented at the VA HSR and D national meeting in 2004.
Other than providing technical support and services and a discounted licensing fee for the computerized retrospective drug utilization review program (RationalMed™), the licensor and/or its oversight company(ies) were not engaged in the study itself or in the writing or approval of the manuscript.
