Impact of Electronic Health Record Interface Design on Unsafe Prescribing of Ciclosporin, Tacrolimus, and Diltiazem: Cohort Study in English National Health Service Primary Care
Autor: | Richard Croker, Seb Bacon, Brian MacKenna, Ben Goldacre, Helen J Curtis, Alex J Walker |
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Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
Male
020205 medical informatics Health Informatics Inappropriate Prescribing 02 engineering and technology Primary care lcsh:Computer applications to medicine. Medical informatics Tacrolimus ciclosporin Cohort Studies primary care clinical software Electronic health record health services administration 0202 electrical engineering electronic engineering information engineering Medicine Humans Medical prescription health care economics and organizations Retrospective Studies Original Paper branded prescribing Primary Health Care business.industry lcsh:Public aspects of medicine diltiazem prescribing Retrospective cohort study lcsh:RA1-1270 National health service medicine.disease Ciclosporin electronic health records England Cyclosporine lcsh:R858-859.7 Female Medical emergency business Cohort study medicine.drug |
Zdroj: | Journal of Medical Internet Research Journal of Medical Internet Research, Vol 22, Iss 10, p e17003 (2020) |
ISSN: | 1438-8871 1439-4456 |
Popis: | Background In England, national safety guidance recommends that ciclosporin, tacrolimus, and diltiazem are prescribed by brand name due to their narrow therapeutic windows and, in the case of tacrolimus, to reduce the chance of organ transplantation rejection. Various small studies have shown that changes to electronic health record (EHR) system interfaces can affect prescribing choices. Objective Our objectives were to assess variation by EHR systems in breach of safety guidance around prescribing of ciclosporin, tacrolimus, and diltiazem, and to conduct user-interface research into the causes of such breaches. Methods We carried out a retrospective cohort study using prescribing data in English primary care. Participants were English general practices and their respective EHR systems. The main outcome measures were (1) the variation in ratio of safety breaches to adherent prescribing in all practices and (2) the description of observations of EHR system usage. Results A total of 2,575,411 prescriptions were issued in 2018 for ciclosporin, tacrolimus, and diltiazem (over 60 mg); of these, 316,119 prescriptions breached NHS guidance (12.27%). Breaches were most common among users of the EMIS EHR system (breaches in 18.81% of ciclosporin and tacrolimus prescriptions and in 17.99% of diltiazem prescriptions), but breaches were observed in all EHR systems. Conclusions Design choices in EHR systems strongly influence safe prescribing of ciclosporin, tacrolimus, and diltiazem, and breaches are prevalent in general practices in England. We recommend that all EHR vendors review their systems to increase safe prescribing of these medicines in line with national guidance. Almost all clinical practice is now mediated through an EHR system; further quantitative research into the effect of EHR system design on clinical practice is long overdue. |
Databáze: | OpenAIRE |
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