Development and pilot testing of PHARAO-a decision support system for pharmacological risk assessment in the elderly

Autor: Marine L. Andersson, Tero Shemeikka, Maria Edlert, Janne Lähdesmäki, Margaretha Julander, Tuomas Korhonen, Ylva Böttiger, Kari Laine
Rok vydání: 2017
Předmět:
Risk
medicine.medical_specialty
Decision support system
Drug-Related Side Effects and Adverse Reactions
Attitude of Health Personnel
Pharmacoepidemiology and Prescription
Pharmacology toxicology
Social and Clinical Pharmacy
Adverse drug reaction
Clinical decision support system
Drug interactions
Polypharmacy
Elderly
Pilot Projects
Comorbidity
030226 pharmacology & pharmacy
Risk profile
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Drug Utilization Review
Medicine
Humans
Pharmacology (medical)
030212 general & internal medicine
Intensive care medicine
Adverse effect
Geriatric Assessment
Finland
Aged
Pharmacology
Aged
80 and over

Sweden
Internet
Primary Health Care
business.industry
Samhällsfarmaci och klinisk farmaci
General Medicine
medicine.disease
Decision Support Systems
Clinical

Geriatrics
Chronic Disease
Workforce
business
Risk assessment
Zdroj: European Journal of Clinical Pharmacology
ISSN: 1432-1041
Popis: Purpose The aims of this study are to describe the development of PHARAO (Pharmacological Risk Assessment Online), a decision support system providing a risk profile for adverse events, associated with combined effects of multiple medicines, and to present data from a pilot study, testing the use, functionality, and acceptance of the PHARAO system in a clinical setting. Methods About 1400 substances were scored in relation to their risk to cause any of nine common and/or serious adverse effects. Algorithms for each adverse effect score were developed to create individual risk profiles from the patient’s list of medication. The system was tested and integrated to the electronic medical record, during a 4-month period in two geriatric wards and three primary healthcare centers, and a questionnaire was answered by the users before and after the test period. Results A total of 732 substances were tagged with one or more of the nine risks, most commonly with the risk of sedation or seizures. During the pilot, the system was used 933 times in 871 patients. The most common signals generated by PHARAO in these patients were related to the risks of constipation, sedation, and bleeding. A majority of responders considered PHARAO easy to use and that it gives useful support in performing medication reviews. Conclusions The PHARAO decision support system, designed as a complement to a database on drug-drug interactions used nationally, worked as intended and was appreciated by the users during a 4-month test period. Integration aspects need to be improved to minimize unnecessary signaling.
Databáze: OpenAIRE