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Computerized medication alert systems may need to be more specific for home health care patients
Medicare requires that home health agencies (HHAs) conduct a complete medication assessment for every patient at the start of care. In recent years, many HHAs have invested in point-of-care computers that allow nurses to enter a patient's clinical and medication information and run an electronic drug utilization review (DUR) program. However, the DUR program generated a high number of potentially trivial or inappropriate drug alerts when it was used for patients with diabetes and/or hypertension, who were taking an average of seven medications each.
According to a study supported by the Agency for Healthcare Research and Quality (HS11523), the DUR program triggered severe, moderate, or duplicate drug alerts for more than two-thirds (68 percent) of patients with diabetes and half of patients with hypertension. Among patients with diabetes, 74 percent of duplicate alerts were trivial or inappropriate compared with 4 percent among patients with hypertension.
The researchers conclude that more specific alert systems should be developed and tested to focus clinicians' attention on clinically important alerts and enhance the usefulness of computerized DUR for reducing medication problems. Their findings were based on analysis of the drug alerts of 150 patients with diabetes and 150 patients with hypertension discharged from a large urban HHA in 2002. The HHA had been using a computerized DUR system for several years to identify all potential drug-drug interactions and duplicate medications. It also had an alert system that flagged three levels of interaction severity, as well as instances of duplicate therapy.
More details are in "Exploring the utility of automated drug alerts in home healthcare," by Penny Hollander Feldman, Ph.D., Margaret McDonald, M.S.W., C.S.W., Robert J. Rosati, Ph.D., and others, in the January 2006 Journal for Healthcare Quality 28(1), pp. 29-40.
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