Electronic Health Record–Nested Reminders for Serum Lithium Level Monitoring in Patients With Mood Disorder: Randomized Controlled Trial

Autor: Tomotsugu Seki, Morio Aki, Toshi A Furukawa, Hirotsugu Kawashima, Tomotaka Miki, Yujin Sawaki, Takaaki Ando, Kentaro Katsuragi, Takahiko Kawashima, Senkei Ueno, Takashi Miyagi, Shun'ichi Noma, Shiro Tanaka, Koji Kawakami
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Journal of Medical Internet Research, Vol 25, p e40595 (2023)
Druh dokumentu: article
ISSN: 1438-8871
DOI: 10.2196/40595
Popis: BackgroundClinical guidelines recommend regular serum lithium monitoring every 3 to 6 months. However, in the real world, only a minority of patients receive adequate monitoring. ObjectiveThis study aims to examine whether the use of the electronic health record (EHR)–nested reminder system for serum lithium monitoring can help achieve serum lithium concentrations within the therapeutic range for patients on lithium maintenance therapy. MethodsWe conducted an unblinded, single-center, EHR-nested, parallel-group, superiority randomized controlled trial comparing EHR-nested reminders with usual care in adult patients receiving lithium maintenance therapy for mood disorders. The primary outcome was the achievement of therapeutically appropriate serum lithium levels between 0.4 and 1.0 mEq/L at 18 months after enrollment. The key secondary outcomes are included as follows: the number of serum lithium level monitoring except for the first and final monitoring; exacerbation of the mood disorder during the study period, defined by hospitalization, increase in lithium dose, addition of antipsychotic drugs or mood stabilizers, or addition or increase of antidepressants; adherence defined by the proportion of days covered by lithium carbonate prescription during the study period. ResultsA total of 111 patients were enrolled in this study. A total of 56 patients were assigned to the reminder group, and 55 patients were assigned to the usual care group. At the follow-up, 38 (69.1%) patients in the reminder group and 33 (60.0%) patients in the usual care group achieved the primary outcome (odds ratio 2.14, 95% CI 0.82-5.58, P=.12). The median number of serum lithium monitoring was 2 in the reminder group and 0 in the usual care group (rate ratio 3.62; 95% CI 2.47-5.29, P
Databáze: Directory of Open Access Journals
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