TY - JOUR AU - Sattar, Anum AU - Rehman, Hina AU - Naveed, Safila AU - Khadim, Sumaira AU - Khan, Nargis AU - Kazi, Furqan Ahmad AU - Syed, Wajid AU - Al-Rawi, A. Mahmood Basil AU - Jamshed, Shazia PY - 2025/4/17 TI - Trustworthiness of Web-Based Pharmacy Apps in Pakistan Based on the Mobile App Rating Scale: Content Analysis and Quality Evaluation JO - JMIR Mhealth Uhealth SP - e59884 VL - 13 KW - online pharmacy KW - online pharmacy apps KW - apps KW - mobile app KW - smartphone app KW - trustworthiness KW - pharmacy KW - digital platforms KW - questionnaire KW - engagement KW - functionality KW - Mobile App Rating Scale KW - MARS KW - user KW - efficacy KW - Pakistan N2 - Background: Web-based pharmacy apps facilitate the electronic exchange of health-related supplies. They are digital platforms that run on websites and smartphones. Pakistan is experiencing significant progress in smartphone integration and digital services, leading to the expansion of the online pharmacy business. However, concerns remain over the legitimacy and precision of these apps. Objective: The aim of this study was to undertake a thorough assessment of digital pharmacy apps accessible in Pakistan. Specifically, our focus was on apps accessible via the Google Play Store and the iOS App Store. To fulfill this objective, an evaluation of these apps was performed using the Mobile App Rating Scale (MARS). Methods: A research investigation was conducted to analyze the online pharmacy apps in Pakistan. Initially, 50 apps were identified, but 10 were excluded for not meeting pre-established criteria, 10 were excluded for being in languages other than English, and 7 could not be downloaded. All paid and non-English apps were also excluded. A total of 23 apps were selected for the study, acquired via the Google Play Store and iOS App Store. The evaluation was conducted by 2 researchers who maintained independence from one another by using the MARS. Results: Initially, 50 apps were identified, of which 27 were excluded for not meeting the predetermined criteria. A total of 23 apps were selected for the study, acquired via the Google Play Store and iOS App Store. Strong positive correlations between higher user engagement and better app functionality and information quality were observed. The average rating of the 23 apps ranged between 2.64 and 4.00 on a scale up to 5. The aesthetics dimension had the highest mean score of 3.6, while the information dimension had the lowest mean score of 3.2. For credibility and reliability, different tests (intraclass correlation, Cohen ?, Krippendorff ?, and Cronbach ?) on each dimension of the MARS were performed by using SPSS Statistics 27. The intraclass correlation of all MARS dimensions ranged from 0.702?0.913 (95% CI 0.521?0.943), the Cohen ? of all MARS dimensions ranged from 0.388?0.907 (95% CI 0.151?0.994), the Krippendorff ? of all MARS dimensions ranged from 0.705?0.979 (95% CI 0.657?0.923), and Cronbach ? had a lower score of 0.821 in the information dimension and a higher score of .911 in the subjective quality dimension of the MARS. Conclusion: This study evaluated online pharmacy apps in Pakistan by using the MARS. It is the first study on online pharmacy apps in Pakistan. The findings of the evaluation have provided insights into the reliability and efficacy of these apps. UR - https://mhealth.jmir.org/2025/1/e59884 UR - http://dx.doi.org/10.2196/59884 ID - info:doi/10.2196/59884 ER - TY - JOUR AU - Lambert, Aurélien AU - Hombourger, Benoit AU - Salleron, Julia AU - Chergui, Fadila AU - Vallance, Catherine AU - Nicolas, Nadège AU - Moussouni, Marie AU - Cherif, Lounisse AU - Chenot, Emile AU - Gavoille, Céline AU - Massard, Vincent PY - 2025/4/9 TI - Impact of Electronic Transition and Prefilled Templates on Drug Prescription Compliance: Retrospective Study JO - J Med Internet Res SP - e57782 VL - 27 KW - drug prescription KW - electronic prescription KW - handwriting KW - medical oncology KW - ambulatory care N2 - Background: The transition from traditional handwritten prescriptions to electronic prescribing systems represents a significant advancement, with the potential to enhance treatment efficacy, patient safety, and professional communication. Objective: This study aimed to examine the impact of this transition within a medical oncology service, assessing the compliance of electronic prescriptions with established good practice standards and exploring the associated risks. Methods: In this retrospective analysis, we compared handwritten prescriptions from the pre-electronic era (January to May 2018) with electronic prescriptions (January to May 2021) following the implementation of the electronic prescribing system PandaLab Pro (PandaLab SAS). The inclusion criteria focused on outpatient oncology treatments, with a clear set of exclusion parameters to ensure a focused study scope. We defined good compliance as the written mention of the evaluated terms. The compliance rates were then compared using a chi-square test. Results: Our findings, based on a sample size of 260 prescriptions (randomized among 30,526 archived prescriptions), indicate a substantial improvement in electronic prescriptions? compliance with prescribers and patient details, treatment accuracy, and overall adherence to regulatory standards. Notably, electronic formats achieved a remarkable 80.8% accuracy rate in compliance with safety criteria compared with 8.5% for handwritten prescriptions (P<.001). The use of prefilled prescriptions significantly increased compliance from a safety perspective (56% vs 96.2%; P<.001) compared with electronic prescriptions from scratch. Conclusions: The analysis further underscores the advantages of prefilled electronic prescription templates, which significantly improved compliance rates compared with manually filled electronic and handwritten prescriptions. Furthermore, the study revealed a marked shift in prescribing behaviors, with electronic prescriptions tending to be more concise yet more numerous, suggesting an impact on medication management and patient adherence, which warrants further investigation. The study supports the transition to electronic prescribing systems in oncology, highlighting enhanced traceability, compliance with health authority standards, and patient safety. The implementation of prefilled templates supported by pharmacists has emerged as a pivotal factor in this improved process. While acknowledging certain limitations, such as the nonquantitative assessment of time savings and acceptability, this research advocates for the widespread adoption of electronic prescriptions and serves as a benchmark for future e-prescription initiatives in France. UR - https://www.jmir.org/2025/1/e57782 UR - http://dx.doi.org/10.2196/57782 UR - http://www.ncbi.nlm.nih.gov/pubmed/40202779 ID - info:doi/10.2196/57782 ER - TY - JOUR AU - Flo, L. Gayle AU - Alzate Aguirre, Mateo AU - Gochanour, R. Benjamin AU - Hynes, J. Kristin AU - Scott, G. Christopher AU - Fink, L. Angela AU - M Arruda-Olson, Adelaide PY - 2025/3/28 TI - Pharmacist-Initiated Team-Based Intervention for Optimizing Guideline-Directed Lipid Therapy of Hospitalized Patients With Acute Coronary Syndrome: Pilot Study Using a Stepped-Wedge Cluster Design JO - JMIR Cardio SP - e58837 VL - 9 KW - coronary disease KW - follow-up studies KW - lipids KW - myocardial infarction KW - statins N2 - Background: Clinical guidelines recommend high-intensity statin therapy for patients with acute coronary syndrome (ACS). However, high-intensity statins have been underused in this population. Objective: The objective of this study was to evaluate the feasibility of a pharmacist-initiated, team-based intervention for the delivery of individualized, guideline-directed, lipid-lowering therapy for patients with ACS. Methods: Patients admitted with ACS to cardiology hospital services at Mayo Clinic from August 1, 2021, to June 19, 2022, were assigned to a pharmacist-initiated, team-based intervention group or control group using a stepped wedge cluster study design. For the intervention group, pharmacists reviewed electronic health records and provided recommendations for lipid lowering therapy in hospital and at follow-up. In the control group, patients received usual care. Neither care team, nor study team were blinded to study assignments. The primary outcome was the proportion of patients with ACS discharged on high-intensity statins in the intervention group compared to controls. Secondary outcomes were (1) proportion of patients in the intervention group with a specific templated pharmacist intervention note in their electronic health records, (2) frequency of low-density lipoprotein (LDL) measurements in hospital, (3) proportion of patients with information related to lipid follow-up in their discharge summary, and (4) proportion of patients that received LDL monitoring at the outpatient follow-up 4 to 12 weeks post discharge. Results: There were 410 patients included in this study (median age 68, IQR 60-78 years) of whom 285 (69.5%) were male. Of the 402 patients alive at discharge, 355 (88.3%) were discharged taking a high-intensity statin, with no significant difference (P=.89) observed between groups. Lipid levels were measured in the hospital for 176/210 (83.8%) patients in the intervention group and 155/200 (77.5%) patients in the control group (P=.14). Fifty-four of 205 (26.3%) intervention patients alive at discharge had lipid-related recommendations in their discharge summary compared to 27/197 (13.7%) controls (P=.002). Forty-seven of 81 (58%) patients with lipid management recommendations provided in the discharge summary had LDL measured in the follow-up period compared with only 119/321 (37.1%) patients without these recommendations (P=.001). Of the 402 patients who survived to discharge, 166 (41.3%) had LDL measured at follow-up; the median LDL level was 63.5 (IQR 49-79) mg/dL, and distributions were similar by group (P=.95). Only 101/166 (60.8%) patients had follow-up LDL values below the target of 70 mg/dL. Conclusions: During hospitalization, there was no group difference in the primary outcome of high-intensity statin therapy. Feasibility of an effective pharmacist-initiated intervention for improvement of lipid management was demonstrated by entry of recommendations in the discharge summary and related adjustment in outpatient statin therapy. The main opportunity for future improvement in lipid management of patients with ACS is in longitudinal patient follow-up. UR - https://cardio.jmir.org/2025/1/e58837 UR - http://dx.doi.org/10.2196/58837 ID - info:doi/10.2196/58837 ER - TY - JOUR AU - Yu, Wei-Ning AU - Cheng, Yih-Dih AU - Hou, Yu-Chi AU - Hsieh, Yow-Wen PY - 2025/3/27 TI - Implementation of Medication-Related Technology and Its Impact on Pharmacy Workflow: Real-World Evidence Usability Study JO - J Med Internet Res SP - e59220 VL - 27 KW - medication error KW - dispensing error KW - medication-related technology KW - pharmacy KW - smart dispensing counter N2 - Background: Medication errors constitute a major contributor to patient harm, driving up health care costs and representing a preventable cause of medical incidents. Over the past decade, many hospitals have integrated various medication-related technologies into their pharmacy operations. However, real-world evidence of the impact of these advanced systems on clinical prescription dispensing error rates remains limited. Objective: This study aims to prospectively detect and record the categories and rates of dispensing errors to illustrate how medication-related technologies, such as automated dispensing cabinet (ADC), barcode medication administration (BCMA), and smart dispensing counter (SDC), can be used to minimize dispensing errors. Methods: This study used a before-and-after design at a 2202-bed academic medical center in Taiwan to assess the impact of implementing medication-related technologies (ADC, BCMA, and SDC) on patient medication safety. Dispensing error rates were analyzed from January 1, 2017, to December 31, 2023, using data from the China Medical University Hospital Patient Safety Database. The study periods were defined as stage 0 (preintervention, January to November 2017), stage 1 (post-ADC intervention, December 2017 to June 2018), stage 2 (post-BCMA intervention, July 2018 to October 2020), and stage 3 (post-SDC intervention, November 2020 to December 2023). Medication errors were defined according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). Chi-square or Fisher exact tests were used to analyze differences between intervention periods, with Bonferroni correction for multiple comparisons. Statistical significance was set at P<.05. Results: Following the introduction of medication-related technologies, the average dispensing error incidence rate significantly decreased by 39.68%, 44.44%, and 77.78%, from 0.0063% in stage 0 to 0.0038%, 0.0035%, and 0.0014% in stages 1, 2, and 3, respectively (P<.001). The frequency of ?wrong drug? errors, the most common error type in stage 0, significantly decreased by 51.15%, 56.85%, and 81.26% in stages 1, 2, and 3, respectively. All error types, except for ?wrong dosage form,? ?wrong strength,? ?wrong time,? and ?others,? demonstrated statistically significant differences (P<.001). The majority of harm severities were categorized as ?A? (no error; 97%-98.8%) and ?B-D? (error, no harm; 1.2%-3%) according to the NCC MERP classification. The severity of ?no error? (category A) significantly decreased at each stage (P<.001). Statistically significant differences in dispensing error rates were observed between all stages (P<.001), except between stages 2 and 1 (P>.99). Conclusions: This study provides significant evidence that the implementation of medication-related technologies, including ADC, BCMA, and SDC, effectively reduces dispensing errors in a hospital pharmacy setting. Specifically, we observed a substantial decrease in the average dispensing error rate across 3 stages of technology implementation. Importantly, this study appears to be the first to investigate the combined impact of these 3 specific technologies on dispensing error rates within a hospital pharmacy. UR - https://www.jmir.org/2025/1/e59220 UR - http://dx.doi.org/10.2196/59220 UR - http://www.ncbi.nlm.nih.gov/pubmed/40019479 ID - info:doi/10.2196/59220 ER - TY - JOUR AU - Ivanova, Julia AU - Cummins, R. Mollie AU - Soni, Hiral AU - Ong, Triton AU - Bunnell, E. Brian AU - López, Esteban AU - Welch, M. Brandon PY - 2025/3/20 TI - Mental Health Providers? Challenges and Solutions in Prescribing Over Telemedicine: Content Analysis of Semistructured Interviews JO - JMIR Hum Factors SP - e65419 VL - 12 KW - telemedicine KW - telehealth KW - prescribe KW - prescription KW - drug KW - pharmacology KW - pharmacotherapy KW - pharmaceutical KW - medication KW - barrier KW - buprenorphine KW - mental health KW - digital health KW - informatics KW - qualitative analysis KW - content analysis KW - provider perspective KW - provider KW - experience KW - attitude KW - opinion KW - perception KW - perspective N2 - Background: In response to the COVID-19 pandemic, the United States extended regulatory flexibilities to make telemedicine more accessible to providers and patients. Some of these flexibilities allowed providers to intake patients over telemedicine and prescribe certain scheduled medications without an in-person visit. Objective: We aim to understand providers? parameters for their comfort in prescribing over telemedicine and report on solutions providers have adopted in response to potential barriers and challenges in prescribing via telemedicine. Methods: As part of a larger mixed methods study between February and April 2024, we conducted 16 semistructured interviews with mental health providers who prescribe via telemedicine within the United States. We used the results of a web-based, cross-sectional survey to develop a codebook and support recruitment. We analyzed a subsection of the 16 interviews using content analysis to capture comfort, barriers, and workarounds in telemedicine prescribing. We reported codes by frequency and by provider. Results: Participants were typically male (11/16, 69%), provided care mostly or completely over telemedicine (11/16, 69%), and were psychiatrists (8/16, 50%) or other physician (3/16, 19%). Providers? primary states (10/16, 62%) of practice included Oregon, Texas, New York, and California. The content analysis yielded a total of 234 codes, with three main codes?comfort (98/234, 41.9%), barriers or challenges (85/234, 36.3%), and workarounds or solutions (27/234, 11.5%)?and two subcodes?uncomfortable prescribing (30/98, 31%) and comfortable prescribing (68/98, 69%) over telemedicine. Participants reported being comfortable prescribing over telemedicine as long as they could meet their main parameters of working within their expertise, having access to needed patient health information, and being compliant with rules and regulations. Participants reported frustrations with e-prescription workflows and miscommunications with pharmacies. Solutions to ease frustrations and alleviate discomforts in prescribing over telemedicine included developing workflows to help patients complete laboratory tests and physical examinations and directly communicating with pharmacies. Conclusions: By applying content analysis to the semistructured provider interviews, we found that physicians are comfortable prescribing via telemedicine when they feel they are practicing within their personal parameters for safety. While many providers experience frustrations such as miscommunication with pharmacies, these barriers appear to not prevent them from telemedicine prescribing. With expected changes in 2024 and 2025 to the US laws and regulations for telemedicine prescribing, we may see changes in provider comfort in prescribing. UR - https://humanfactors.jmir.org/2025/1/e65419 UR - http://dx.doi.org/10.2196/65419 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65419 ER - TY - JOUR AU - Alturkistani, Abrar AU - Beaney, Thomas AU - Greenfield, Geva AU - Costelloe, E. Ceire PY - 2025/3/11 TI - Prescription Refill Adherence Before and After Patient Portal Registration in Among General Practice Patients in England Using the Clinical Practice Research Datalink: Longitudinal Observational Study JO - JMIR Med Inform SP - e50294 VL - 13 KW - patient portals KW - personal health records KW - general practice KW - delivery of health care KW - medication ordering KW - health care KW - medication adherence KW - clinical practice research KW - patient portal KW - England KW - longitudinal analysis KW - patient health KW - medication KW - cardiovascular disease KW - diabetes KW - chronic kidney disease N2 - Background: Patient portal use has been associated with improved patient health and improved adherence to medications, including statins. However, there is limited research on the association between patient portal registration and outcomes such as statin prescription refill adherence in the context of the National Health Service of England, where patient portals have been widely available since 2015. Objective: We aimed to explore statin prescription refill adherence among general practice patients in England. Methods: This study was approved by the Clinical Practice Research Datalink Independent Scientific Advisory Committee (ID: 21_000411). We used patient-level general practice data from the Clinical Practice Research Datalink in England. The data included patients with cardiovascular disease, diabetes, and chronic kidney disease, who were registered on the patient portal. The primary aim was to investigate whether statin prescription refill adherence, defined as ?80% adherence based on the medication possession ratio, improved after patient portal registration. We used a multilevel logistic regression model to compare aggregate adherence 12 months before and 12 months after patient portal registration. Results: We included 44,141 patients in the study. The analysis revealed a 16% reduction in the odds of prescription refill adherence 12 months after patient portal registration (odds ratio [OR]: 0.84, 95% CI 0.81-0.86) compared to 12 months before registration in the fully adjusted model for patient- and practice-level variables. Conclusions: This study evaluated prescription refill adherence after patient portal registration. Registering to the portal does not fully explain the mechanisms underlying the relationship between patient portal use and health-related outcomes such as medication adherence. Although a small reduction in prescription refill adherence was observed, this reduction disappeared when the follow up time was reduced to 6 months. Given the limitations of the study, reduction in prescription refill adherence cannot be entirely attributable to patient portal registration. However, there may be potential confounding factors influencing this association which should be explored through future research. UR - https://medinform.jmir.org/2025/1/e50294 UR - http://dx.doi.org/10.2196/50294 ID - info:doi/10.2196/50294 ER - TY - JOUR AU - Yanagisawa, Yuki AU - Watabe, Satoshi AU - Yokoyama, Sakura AU - Sayama, Kyoko AU - Kizaki, Hayato AU - Tsuchiya, Masami AU - Imai, Shungo AU - Someya, Mitsuhiro AU - Taniguchi, Ryoo AU - Yada, Shuntaro AU - Aramaki, Eiji AU - Hori, Satoko PY - 2025/3/11 TI - Identifying Adverse Events in Outpatients With Prostate Cancer Using Pharmaceutical Care Records in Community Pharmacies: Application of Named Entity Recognition JO - JMIR Cancer SP - e69663 VL - 11 KW - natural language processing KW - pharmaceutical care records KW - androgen receptor axis-targeting agents KW - adverse events KW - outpatient care N2 - Background: Androgen receptor axis-targeting reagents (ARATs) have become key drugs for patients with castration-resistant prostate cancer (CRPC). ARATs are taken long term in outpatient settings, and effective adverse event (AE) monitoring can help prolong treatment duration for patients with CRPC. Despite the importance of monitoring, few studies have identified which AEs can be captured and assessed in community pharmacies, where pharmacists in Japan dispense medications, provide counseling, and monitor potential AEs for outpatients prescribed ARATs. Therefore, we anticipated that a named entity recognition (NER) system might be used to extract AEs recorded in pharmaceutical care records generated by community pharmacists. Objective: This study aimed to evaluate whether an NER system can effectively and systematically identify AEs in outpatients undergoing ARAT therapy by reviewing pharmaceutical care records generated by community pharmacists, focusing on assessment notes, which often contain detailed records of AEs. Additionally, the study sought to determine whether outpatient pharmacotherapy monitoring can be enhanced by using NER to systematically collect AEs from pharmaceutical care records. Methods: We used an NER system based on the widely used Japanese medical term extraction system MedNER-CR-JA, which uses Bidirectional Encoder Representations from Transformers (BERT). To evaluate its performance for pharmaceutical care records by community pharmacists, the NER system was first applied to 1008 assessment notes in records related to anticancer drug prescriptions. Three pharmaceutically proficient researchers compared the results with the annotated notes assigned symptom tags according to annotation guidelines and evaluated the performance of the NER system on the assessment notes in the pharmaceutical care records. The system was then applied to 2193 assessment notes for patients prescribed ARATs. Results: The F1-score for exact matches of all symptom tags between the NER system and annotators was 0.72, confirming the NER system has sufficient performance for application to pharmaceutical care records. The NER system automatically assigned 1900 symptom tags for the 2193 assessment notes from patients prescribed ARATs; 623 tags (32.8%) were positive symptom tags (symptoms present), while 1067 tags (56.2%) were negative symptom tags (symptoms absent). Positive symptom tags included ARAT-related AEs such as ?pain,? ?skin disorders,? ?fatigue,? and ?gastrointestinal symptoms.? Many other symptoms were classified as serious AEs. Furthermore, differences in symptom tag profiles reflecting pharmacists? AE monitoring were observed between androgen synthesis inhibition and androgen receptor signaling inhibition. Conclusions: The NER system successfully extracted AEs from pharmaceutical care records of patients prescribed ARATs, demonstrating its potential to systematically track the presence and absence of AEs in outpatients. Based on the analysis of a large volume of pharmaceutical medical records using the NER system, community pharmacists not only detect potential AEs but also actively monitor the absence of severe AEs, offering valuable insights for the continuous improvement of patient safety management. UR - https://cancer.jmir.org/2025/1/e69663 UR - http://dx.doi.org/10.2196/69663 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69663 ER - TY - JOUR AU - Cummins, R. Mollie AU - Ivanova, Julia AU - Soni, Hiral AU - Robbins, Zoe AU - Bunnell, E. Brian AU - López, Esteban AU - Welch, M. Brandon PY - 2025/3/11 TI - Telemedicine Prescribing by US Mental Health Care Providers: National Cross-Sectional Survey JO - JMIR Form Res SP - e63251 VL - 9 KW - telemedicine KW - telehealth KW - telemental KW - provider KW - professional KW - experience KW - attitude KW - opinion KW - perception KW - perspective KW - prescribing KW - prescription KW - drug KW - pharmacology KW - pharmacotherapy KW - pharmaceutic KW - pharmaceutical KW - medication KW - mental health KW - digital health KW - informatics KW - buprenorphine KW - ketamine KW - cross sectional KW - survey KW - questionnaire N2 - Background: In the postpandemic era, telemedicine continues to enable mental health care access for many people, especially persons living in areas with mental health care provider shortages. However, as lawmakers consider long-term telemedicine policy decisions, some question the safety and appropriateness of prescribing via telemedicine, and whether there should be requirements for in-person evaluation, especially for controlled substances. Objective: Our objective was to assess US telemental health care provider perceptions of comfort and perceived safety in prescribing medications, including controlled substances, via telemedicine. Methods: We conducted a web-based, cross-sectional survey of US telemental health care providers who prescribe via telemedicine, using nonprobability, availability sampling of a national telehealth research panel from February 13 to April 28, 2024. We used descriptive statistics, visualization, and thematic analysis to analyze results. We assessed differences in response distribution by health care provider licensure type (physician vs nonphysician) and specialty (psychiatry vs nonpsychiatry) using the Mann-Whitney U test. Results: A total of 115 screened and eligible panelists completed the survey. Overall, participants indicated high levels of comfort with prescribing via telemedicine, with 84% (102/115) of health care providers indicating they strongly agree with the statement indicating comfort in prescribing medications via telemedicine. However, participants indicated less comfort in prescribing if they have never seen a patient in person, or if the patient is located out-of-state. Most participants indicated they can safely prescribe controlled substances via telemedicine, without having previously provided care to a patient in person. However, 14.8% (17/115) to 19.1% (30/115) of health care providers (by schedule) felt that they could rarely or never safely prescribe controlled substances. There were some differences in perception of comfort and safety by licensure and specialty. Among controlled substance schedules, participants indicated the least perceived safety with schedule IV medications, and the most safety with schedule II and III medications. Conclusions: These health care providers were highly comfortable prescribing both scheduled and unscheduled medications via telemedicine. Comfort and perceived safety with telemedicine prescribing varied somewhat by licensure type (physician vs nonphysician) and specialty (psychiatry vs nonpsychiatry). Perceived safety varied moderately for scheduled medications (controlled substances), especially for schedule IV and V medications. Participants indicated use of adaptive strategies to prescribe safely depending upon the clinical context. In ongoing efforts, we are analyzing additional survey results and conducting qualitative research related to telemedicine prescribing. A strong understanding of prescriber perspectives and experience with telemedicine prescribing is needed to support excellent clinical practice and effective policy making in the United States. UR - https://formative.jmir.org/2025/1/e63251 UR - http://dx.doi.org/10.2196/63251 ID - info:doi/10.2196/63251 ER - TY - JOUR AU - Watanabe, Seiya AU - Kizaki, Hayato AU - Hori, Satoko PY - 2025/3/6 TI - Development of a Patient-Centered Symptom-Reporting Application in Pharmacy Settings Using a Hierarchical Patient-Friendly Symptom List: Developmental and Usability Study JO - JMIR Hum Factors SP - e71439 VL - 12 KW - patient symptom monitoring KW - hierarchical symptom list KW - community pharmacy KW - interview survey KW - mobile application N2 - Background: Effective symptom identification, a key responsibility for community pharmacists, requires patients to describe their symptoms accurately and comprehensively. However, current practices in pharmacies may be insufficient in capturing patient-reported symptoms comprehensively, potentially affecting the quality of pharmaceutical care and patient safety. Objective: This study aimed to construct a new, hierarchical symptom list derived from the Patient-Friendly Term List of the Medical Dictionary for Regulatory Activities (MedDRA) and to develop and evaluate a mobile app incorporating this list for facilitating symptom reporting by patients in pharmacy settings. The study also aimed to assess the usability and acceptance of this app among potential users. Methods: Subjective symptom-related terms were extracted from the Patient-Friendly Term List version 23.0 of the MedDRA. These terms were systematically consolidated and organized into a hierarchical, user-friendly symptom list. A mobile app incorporating this list was developed for pharmacy settings, featuring a symptom selection interface and a free-text input field for additional symptoms. The app included an instructional video explaining the importance of symptom reporting and guidance on navigation. Usability tests and semistructured interviews were conducted with participants aged >20 years. Interview transcripts were analyzed using the Unified Theory of Acceptance and Use of Technology (UTAUT) model to evaluate factors influencing the acceptance of technology. Results: From the initial 1440 terms in the Patient-Friendly Term List, 795 relevant terms were selected and organized into 40 site-specific subcategories, which were then grouped into broader site categories (mental, head, trunk, upper limb, lower limb, physical condition, and others). These terms were further consolidated into 211 patient-friendly symptom terms, forming a hierarchical symptom list. The app?s interface design limited options to 10 items per screen to assist with decision-making. A total of 5 adults participated in the usability test. Participants found the interface intuitive and easy to use, requiring minimal effort, and provided positive feedback regarding the potential utility of the app in pharmacy settings. The UTAUT analysis identified several facilitating factors, including ease of use and the potential for enhanced pharmacist-patient communication. However, concerns were raised about usability for older adults and the need for simplified technical terminology. Conclusions: The user-friendly app with a hierarchically structured symptom list and complementary free-text entry has potential benefits for improving the accuracy and efficiency of symptom reporting in pharmacy settings. The positive user acceptance and identified areas for improvement provide a foundation for further development and implementation of this technology to enhance communication between patients and pharmacists. Future improvements should focus on addressing usability for older adults and simplifying technical terminology. UR - https://humanfactors.jmir.org/2025/1/e71439 UR - http://dx.doi.org/10.2196/71439 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053749 ID - info:doi/10.2196/71439 ER - TY - JOUR AU - Naughton, D. Bernard PY - 2025/2/21 TI - Planned Behavior in the United Kingdom and Ireland Online Medicine Purchasing Context: Mixed Methods Survey Study JO - JMIR Form Res SP - e55391 VL - 9 KW - planned behavior KW - consumer behavior KW - perceived behavioral control KW - attitudes KW - online purchasing KW - medicine N2 - Background: Online medicine purchasing is a growing health care opportunity. However, there is a scarcity of available evidence through a behavioral lens, which addresses why consumers buy medicines online. Governments try to influence online medicine purchasing behavior using health campaigns. However, there are little data regarding specific online medicine purchasing behaviors to support these campaigns. Objective: The theory of planned behavior explains that perceived behavioral control (PBC), attitudes, and norms contribute to intentions, leading to behaviors. This study challenges these assumptions, by testing them in an online medicine purchasing context. We asked: What is the role of attitudes, norms, and PBC in an online medicine purchasing context. Methods: An anonymous online snowball convenience sample survey, including open and closed questions concerning online medicine purchasing, was implemented. The data were thematically analyzed until data saturation. The emerging themes were applied to each individual response, as part of a case-by-case narrative analysis. Results: Of the 190 consumers from the United Kingdom and Ireland who consented to participate in the study, 46 participants had purchased medicines online, 9 of which were illegal sales. Of the 113 participants who demonstrated an intention to purchase, 42 (37.2%) completed a purchase. There were many cases in which participants demonstrated an intention to buy medicines online, but this intention did not translate to a purchasing behavior (71/190, 37.4%). Reasons for consumers progressing from intention to behavior are suggested to be impacted by PBC and attitudes. Qualitative data identified access to medicine as a factor encouraging online medicine purchasing behaviors and a facilitator of behavior transition. Despite understanding the importance of why some medicines required a prescription, which is described as an example of legal and health norms, and despite suspicion and concern categorized as negative attitudes in this paper, some participants were still buying products illegally online. Risk reduction strategies were performed by 17 participants (17/190, 9%). These strategies facilitated a transition from intention to behavior. Conclusions: The study results indicate that a consumer?s intention to buy does not automatically translate to a purchasing behavior online; instead, a transition phase exists. Second, consumers followed different pathways to purchase and used risk reduction practices while transitioning from an intention to a behavior. Finally, owing to the covert nature of online medicine purchasing, norms do not appear to be as influential as PBC and attitudes in an online medicine purchasing setting. Understanding how a consumer transitions from an intention to a behavior could be useful for researchers, health care professionals, and policymakers involved in public health campaigns. We encourage future research to focus on different consumer behavior pathways or ideal types, rather than taking a blanket approach to public health campaigns. UR - https://formative.jmir.org/2025/1/e55391 UR - http://dx.doi.org/10.2196/55391 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55391 ER - TY - JOUR AU - Knowles, Kayla AU - Lee, Susan AU - Yapalater, Sophia AU - Taylor, Maria AU - Akers, Y. Aletha AU - Wood, Sarah AU - Dowshen, Nadia PY - 2025/2/19 TI - Simulation of Contraceptive Access for Adolescents and Young Adults Using a Pharmacist-Staffed e-Platform: Development, Usability, and Pilot Testing Study JO - JMIR Pediatr Parent SP - e60315 VL - 8 KW - adolescent KW - contraception KW - telemedicine KW - user-centered design KW - young adult KW - reproductive KW - design KW - usability KW - experience KW - mHealth KW - mobile health KW - app KW - youth KW - teenager KW - drug KW - pharmacology KW - pharmacotherapy KW - pharmaceutics KW - medication KW - pharmacy KW - digital health KW - platform KW - access N2 - Background: Offering contraceptive methods at pharmacies without a prescription is an innovative solution to reduce the incidence of unintended pregnancies among adolescents and young adults (AYA). Pharmacy-prescribed contraception may increase the convenience, simplicity, and affordability of contraceptives. Objective: The aim of this study was to develop, pilot test, and evaluate the acceptability and feasibility of a telemedicine electronic platform app simulating pharmacist prescribing of contraceptives to AYA as well as assess agreement between pharmacist-simulated contraceptive approvals and contraception as prescribed in routine clinic visits. Methods: This study was conducted in two phases: (1) development and usability testing of a prototype app to simulate pharmacists prescribing contraceptives to AYA and (2) pilot testing the app in a simulation for AYA requesting contraception from a pharmacist with pharmacist review and request approval or rejection. Eligibility criteria in both phases included the following: assigned female sex at birth, age 15-21 years, seeking contraceptive services at an academic adolescent medicine clinic, prior history of or intention to have penile-vaginal intercourse in the next 12 months, smartphone ownership, and English language proficiency. Phase 1 (usability) involved a video-recorded ?think aloud? interview to share feedback and technical issues while using the app prototype on a smartphone and the completion of sociodemographic, sexual history, and perception of the prototype surveys to further develop the app. Phase 2 (pilot) participants completed phase 1 surveys, tested the updated app in a simulation, and shared their experiences in an audio-recorded interview. Descriptive analyses were conducted for quantitative survey data, and thematic analyses were used for interview transcripts. Results: Of the 22 participants, 10 completed usability testing, with a mean age of 16.9 (SD 1.97) years, and 12 completed pilot testing, with a mean age of 18.25 (SD 1.48) years. Three issues with the prototype were identified during ?think aloud? interviews: challenges in comprehension of medical language, prototype glitches, and graphic design suggestions for engagement. Usability testing guided the frontend and backend creation of the platform. Overall, participants agreed or strongly agreed that using an app to receive contraceptives would make it easier for teens to access (n=19, 86%) and make contraceptive use less stigmatizing (n=19, 86%). In addition, participants agreed that receiving contraception prescriptions from a pharmacist without a clinic visit would be safe (n=18, 82%), convenient (n=19, 86%), acceptable (n=18, 82%), and easy (n=18, 82%). Pharmacists and medical providers had 100% agreement on the prescribed contraceptive method for pilot participants. Conclusions: AYA found contraceptive prescription by a pharmacist via an app to be highly acceptable and provided critical feedback to improve the design and delivery of the app. Additionally, pharmacist contraceptive approvals and contraception as prescribed in routine clinic visits were identical. UR - https://pediatrics.jmir.org/2025/1/e60315 UR - http://dx.doi.org/10.2196/60315 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60315 ER - TY - JOUR AU - Vordenberg, E. Sarah AU - Nichols, Julianna AU - Marshall, D. Vincent AU - Weir, Rebecca Kristie AU - Dorsch, P. Michael PY - 2025/2/18 TI - Authors? Reply: Enhancing the Clinical Relevance of Al Research for Medication Decision-Making JO - J Med Internet Res SP - e72007 VL - 27 KW - older adults KW - artificial intelligence KW - vignette KW - pharmacology KW - medication KW - decision-making KW - aging KW - attitude KW - perception KW - perspective KW - electronic heath record UR - https://www.jmir.org/2025/1/e72007 UR - http://dx.doi.org/10.2196/72007 UR - http://www.ncbi.nlm.nih.gov/pubmed/39964740 ID - info:doi/10.2196/72007 ER - TY - JOUR AU - Wang, Qi AU - Chen, Mingxian PY - 2025/2/18 TI - Enhancing the Clinical Relevance of Al Research for Medication Decision-Making JO - J Med Internet Res SP - e70657 VL - 27 KW - older adults KW - artificial intelligence KW - medication KW - decision-making KW - data security KW - patient trust UR - https://www.jmir.org/2025/1/e70657 UR - http://dx.doi.org/10.2196/70657 UR - http://www.ncbi.nlm.nih.gov/pubmed/39964744 ID - info:doi/10.2196/70657 ER - TY - JOUR AU - Kim, Yong Jin AU - Marshall, D. Vincent AU - Rowell, Brigid AU - Chen, Qiyuan AU - Zheng, Yifan AU - Lee, D. John AU - Kontar, Al Raed AU - Lester, Corey AU - Yang, Jessie Xi PY - 2025/2/11 TI - The Effects of Presenting AI Uncertainty Information on Pharmacists? Trust in Automated Pill Recognition Technology: Exploratory Mixed Subjects Study JO - JMIR Hum Factors SP - e60273 VL - 12 KW - artificial intelligence KW - human-computer interaction KW - uncertainty communication KW - visualization KW - medication errors KW - safety KW - artificial intelligence aid KW - pharmacists KW - pill verification KW - automation N2 - Background: Dispensing errors significantly contribute to adverse drug events, resulting in substantial health care costs and patient harm. Automated pill verification technologies have been developed to aid pharmacists with medication dispensing. However, pharmacists? trust in such automated technologies remains unexplored. Objective: This study aims to investigate pharmacists? trust in automated pill verification technology designed to support medication dispensing. Methods: Thirty licensed pharmacists in the United States performed a web-based simulated pill verification task to determine whether an image of a filled medication bottle matched a known reference image. Participants completed a block of 100 verification trials without any help, and another block of 100 trials with the help of an imperfect artificial intelligence (AI) aid recommending acceptance or rejection of a filled medication bottle. The experiment used a mixed subjects design. The between-subjects factor was the AI aid type, with or without an AI uncertainty plot. The within-subjects factor was the four potential verification outcomes: (1) the AI rejects the incorrect drug, (2) the AI rejects the correct drug, (3) the AI approves the incorrect drug, and (4) the AI approves the correct drug. Participants? trust in the AI system was measured. Mixed model (generalized linear models) tests were conducted with 2-tailed t tests to compare the means between the 2 AI aid types for each verification outcome. Results: Participants had an average trust propensity score of 72 (SD 18.08) out of 100, indicating a positive attitude toward trusting automated technologies. The introduction of an uncertainty plot to the AI aid significantly enhanced pharmacists? end trust (t28=?1.854; P=.04). Trust dynamics were influenced by AI aid type and verification outcome. Specifically, pharmacists using the AI aid with the uncertainty plot had a significantly larger trust increment when the AI approved the correct drug (t78.98=3.93; P<.001) and a significantly larger trust decrement when the AI approved the incorrect drug (t2939.72=?4.78; P<.001). Intriguingly, the absence of the uncertainty plot led to an increase in trust when the AI correctly rejected an incorrect drug, whereas the presence of the plot resulted in a decrease in trust under the same circumstances (t509.77=?3.96; P<.001). A pronounced ?negativity bias? was observed, where the degree of trust reduction when the AI made an error exceeded the trust gain when the AI made a correct decision (z=?11.30; P<.001). Conclusions: To the best of our knowledge, this study is the first attempt to examine pharmacists? trust in automated pill verification technology. Our findings reveal that pharmacists have a favorable disposition toward trusting automation. Moreover, providing uncertainty information about the AI?s recommendation significantly boosts pharmacists? trust in AI aid, highlighting the importance of developing transparent AI systems within health care. UR - https://humanfactors.jmir.org/2025/1/e60273 UR - http://dx.doi.org/10.2196/60273 UR - http://www.ncbi.nlm.nih.gov/pubmed/39932773 ID - info:doi/10.2196/60273 ER - TY - JOUR AU - Tsai, Chuan-Ching AU - Kim, Yong Jin AU - Chen, Qiyuan AU - Rowell, Brigid AU - Yang, Jessie X. AU - Kontar, Raed AU - Whitaker, Megan AU - Lester, Corey PY - 2025/1/31 TI - Effect of Artificial Intelligence Helpfulness and Uncertainty on Cognitive Interactions with Pharmacists: Randomized Controlled Trial JO - J Med Internet Res SP - e59946 VL - 27 KW - CDSS KW - eye-tracking KW - medication verification KW - uncertainty visualization KW - AI helpfulness and accuracy KW - artificial intelligence KW - cognitive interactions KW - clinical decision support system KW - cognition KW - pharmacists KW - medication KW - interaction KW - decision-making KW - cognitive processing N2 - Background: Clinical decision support systems leveraging artificial intelligence (AI) are increasingly integrated into health care practices, including pharmacy medication verification. Communicating uncertainty in an AI prediction is viewed as an important mechanism for boosting human collaboration and trust. Yet, little is known about the effects on human cognition as a result of interacting with such types of AI advice. Objective: This study aimed to evaluate the cognitive interaction patterns of pharmacists during medication product verification when using an AI prototype. Moreover, we examine the impact of AI?s assistance, both helpful and unhelpful, and the communication of uncertainty of AI-generated results on pharmacists? cognitive interaction with the prototype. Methods: In a randomized controlled trial, 30 pharmacists from professional networks each performed 200 medication verification tasks while their eye movements were recorded using an online eye tracker. Participants completed 100 verifications without AI assistance and 100 with AI assistance (either with black box help without uncertainty information or uncertainty-aware help, which displays AI uncertainty). Fixation patterns (first and last areas fixated, number of fixations, fixation duration, and dwell times) were analyzed in relation to AI help type and helpfulness. Results: Pharmacists shifted 19%-26% of their total fixations to AI-generated regions when these were available, suggesting the integration of AI advice in decision-making. AI assistance did not reduce the number of fixations on fill images, which remained the primary focus area. Unhelpful AI advice led to longer dwell times on reference and fill images, indicating increased cognitive processing. Displaying AI uncertainty led to longer cognitive processing times as measured by dwell times in original images. Conclusions: Unhelpful AI increases cognitive processing time in the original images. Transparency in AI is needed in ?black box? systems, but showing more information can add a cognitive burden. Therefore, the communication of uncertainty should be optimized and integrated into clinical workflows using user-centered design to avoid increasing cognitive load or impeding clinicians? original workflow. Trial Registration: ClinicalTrials.gov NCT06795477; https://clinicaltrials.gov/study/NCT06795477 UR - https://www.jmir.org/2025/1/e59946 UR - http://dx.doi.org/10.2196/59946 UR - http://www.ncbi.nlm.nih.gov/pubmed/39888668 ID - info:doi/10.2196/59946 ER - TY - JOUR AU - Vordenberg, E. Sarah AU - Nichols, Julianna AU - Marshall, D. Vincent AU - Weir, Rebecca Kristie AU - Dorsch, P. Michael PY - 2024/12/16 TI - Investigating Older Adults? Perceptions of AI Tools for Medication Decisions: Vignette-Based Experimental Survey JO - J Med Internet Res SP - e60794 VL - 26 KW - older adults KW - survey KW - decisions KW - artificial intelligence KW - vignette KW - drug KW - pharmacology KW - pharmaceutic KW - medication KW - decision-making KW - geriatric KW - aging KW - surveys KW - attitude KW - perception KW - perspective KW - recommendation KW - electronic heath record N2 - Background: Given the public release of large language models, research is needed to explore whether older adults would be receptive to personalized medication advice given by artificial intelligence (AI) tools. Objective: This study aims to identify predictors of the likelihood of older adults stopping a medication and the influence of the source of the information. Methods: We conducted a web-based experimental survey in which US participants aged ?65 years were asked to report their likelihood of stopping a medication based on the source of information using a 6-point Likert scale (scale anchors: 1=not at all likely; 6=extremely likely). In total, 3 medications were presented in a randomized order: aspirin (risk of bleeding), ranitidine (cancer-causing chemical), or simvastatin (lack of benefit with age). In total, 5 sources of information were presented: primary care provider (PCP), pharmacist, AI that connects with the electronic health record (EHR) and provides advice to the PCP (?EHR-PCP?), AI with EHR access that directly provides advice (?EHR-Direct?), and AI that asks questions to provide advice (?Questions-Direct?) directly. We calculated descriptive statistics to identify participants who were extremely likely (score 6) to stop the medication and used logistic regression to identify demographic predictors of being likely (scores 4-6) as opposed to unlikely (scores 1-3) to stop a medication. Results: Older adults (n=1245) reported being extremely likely to stop a medication based on a PCP?s recommendation (n=748, 60.1% [aspirin] to n=858, 68.9% [ranitidine]) compared to a pharmacist (n=227, 18.2% [simvastatin] to n=361, 29% [ranitidine]). They were infrequently extremely likely to stop a medication when recommended by AI (EHR-PCP: n=182, 14.6% [aspirin] to n=289, 23.2% [ranitidine]; EHR-Direct: n=118, 9.5% [simvastatin] to n=212, 17% [ranitidine]; Questions-Direct: n=121, 9.7% [aspirin] to n=204, 16.4% [ranitidine]). In adjusted analyses, characteristics that increased the likelihood of following an AI recommendation included being Black or African American as compared to White (Questions-Direct: odds ratio [OR] 1.28, 95% CI 1.06-1.54 to EHR-PCP: OR 1.42, 95% CI 1.17-1.73), having higher self-reported health (EHR-PCP: OR 1.09, 95% CI 1.01-1.18 to EHR-Direct: OR 1.13 95%, CI 1.05-1.23), having higher confidence in using an EHR (Questions-Direct: OR 1.36, 95% CI 1.16-1.58 to EHR-PCP: OR 1.55, 95% CI 1.33-1.80), and having higher confidence using apps (EHR-Direct: OR 1.38, 95% CI 1.18-1.62 to EHR-PCP: OR 1.49, 95% CI 1.27-1.74). Older adults with higher health literacy were less likely to stop a medication when recommended by AI (EHR-PCP: OR 0.81, 95% CI 0.75-0.88 to EHR-Direct: OR 0.85, 95% CI 0.78-0.92). Conclusions: Older adults have reservations about following an AI recommendation to stop a medication. However, individuals who are Black or African American, have higher self-reported health, or have higher confidence in using an EHR or apps may be receptive to AI-based medication recommendations. UR - https://www.jmir.org/2024/1/e60794 UR - http://dx.doi.org/10.2196/60794 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60794 ER - TY - JOUR AU - Youn, G. Christopher AU - Kim, Yeon Joo AU - Yang, B. Vivian AU - Bae, H. Gordon PY - 2024/12/13 TI - Improving Affordability in Dermatology: Cost Savings in Mark Cuban Cost Plus Drug Company Versus GoodRx JO - JMIR Dermatol SP - e64300 VL - 7 KW - dermatology KW - cost KW - affordability KW - drug company KW - United States KW - US KW - financial burden KW - prescription KW - medication KW - pharmaceutical KW - dermatologic KW - burden KW - financial distress KW - health outcomes KW - pharmacist KW - pharmacy KW - convenience UR - https://derma.jmir.org/2024/1/e64300 UR - http://dx.doi.org/10.2196/64300 ID - info:doi/10.2196/64300 ER - TY - JOUR AU - Smith, N. Shawna AU - Lanham, M. Michael S. AU - Seagull, Jacob F. AU - Fabbri, Morris AU - Dorsch, P. Michael AU - Jennings, Kathleen AU - Barnes, Geoffrey PY - 2024/11/8 TI - System-Wide, Electronic Health Record?Based Medication Alerts for Appropriate Prescribing of Direct Oral Anticoagulants: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e64674 VL - 8 KW - direct oral anticoagulants KW - electronic health record KW - medication safety KW - prescribing errors KW - pilot randomized controlled trial KW - alert system optimization KW - clinical decision support KW - EHR KW - randomized controlled trial KW - RCT KW - oral anticoagulants N2 - Background: While direct oral anticoagulants (DOACs) have improved oral anticoagulation management, inappropriate prescribing remains prevalent and leads to adverse drug events. Antithrombotic stewardship programs seek to enhance DOAC prescribing but require scalable and sustainable strategies. Objective: We present a pilot, prescriber-level randomized controlled trial to assess the effectiveness of electronic health record (EHR)?based medication alerts in a large health system. Methods: The pilot assessed prescriber responses to alerts for initial DOAC prescription errors (apixaban and rivaroxaban). A user-centered, multistage design process informed alert development, emphasizing clear indication, appropriate dosing based on renal function, and drug-drug interactions. Alerts appeared whenever a DOAC was being prescribed in a way that did not follow package label instructions. Clinician responses measured acceptability, accuracy, feasibility, and utilization of the alerts. Results: The study ran from August 1, 2022, through April 30, 2023. Only 1 prescriber requested trial exclusion, demonstrating acceptability. The error rate for false alerts due to incomplete data was 6.6% (16/243). Two scenarios with alert design and/or execution errors occurred but were quickly identified and resolved, underlining the importance of a responsive quality assurance process in EHR-based interventions. Trial feasibility issues related to alert-data capture were identified and resolved. Trial feasibility was also assessed with balanced randomization of prescribers and the inclusion of various alerts across both medications. Assessing utilization, 34.2% (83/243) of the encounters (with 134 prescribers) led to a prescription change. Conclusions: The pilot implementation study demonstrated the acceptability, accuracy, feasibility, and estimates of the utilization of EHR-based medication alerts for DOAC prescriptions and successfully established just-in-time randomization of prescribing clinicians. This pilot study sets the stage for large-scale, randomized implementation evaluations of EHR-based alerts to improve medication safety. Trial Registration: ClinicalTrials.gov NCT05351749; https://clinicaltrials.gov/study/NCT05351749 UR - https://formative.jmir.org/2024/1/e64674 UR - http://dx.doi.org/10.2196/64674 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64674 ER - TY - JOUR AU - Brunner, Loïc AU - Siebert, N. Johan AU - Ehrler, Frédéric AU - Manzano, Sergio AU - Marti, Joachim PY - 2024/10/25 TI - Evaluating the Economic Impact of the PedAMINES App in Reducing Medication Errors in Pediatric Emergency Care: Cost-Effectiveness Analysis JO - J Med Internet Res SP - e52077 VL - 26 KW - adverse drug event KW - health information technology KW - pediatric care KW - emergency care KW - ambulance care KW - economic evaluation KW - cost-effectiveness KW - epinephrine KW - norepinephrine KW - midazolam KW - dopamine KW - evidence-based KW - medical app KW - medication error KW - pediatric KW - child KW - pediatric emergency care KW - PedAMINES KW - Pediatric Accurate Medication in Emergency Situations KW - Switzerland KW - child care KW - mobile phone N2 - Background: The administration of drugs in pediatric emergency care is a time-consuming process and is associated with a higher occurrence of medication errors compared with adult care. This is attributed to the intricacies of administration, which involve calculating doses based on the child?s weight or age. To mitigate the occurrence of adverse drug events (ADEs), the PedAMINES (Pediatric Accurate Medication in Emergency Situations; Geneva University Hospitals) mobile app has been developed. This app offers a step-by-step guide for preparing and administering pediatric drugs during emergency interventions by automating the dose calculation process. Although previous simulation-based randomized controlled trials conducted in emergency care have demonstrated the efficacy of the PedAMINES app in reducing drug administration errors, there is a lack of evidence regarding its economic implications. Objective: This study aims to evaluate the cost-effectiveness of implementing the PedAMINES app for 4 emergency drugs: epinephrine, norepinephrine, dopamine, and midazolam. Methods: The economic evaluation was conducted by combining hospital data from 2019, previous trial outcomes, information extracted from existing literature, and PedAMINES maintenance costs. The cost per avoided medication error was calculated, along with the number of administrations needed to achieve a positive return on investment. Subsequently, Monte Carlo simulations were used to identify the key parameters contributing to result uncertainty. Results: The study revealed the number of preventable errors per administration for the 4 examined drugs: 0.513 for epinephrine, 0.484 for norepinephrine, 0.500 for dopamine, and 0.671 for midazolam. The cost-effectiveness ratios per ADE prevented were computed as follows: US $4808 for epinephrine, US $9705 for norepinephrine, US $6957 for dopamine, and US $2074 for midazolam. Accounting for the economic impact of ADEs, the analysis estimated that 16 administrations of epinephrine, 17 of norepinephrine and dopamine, and 13 of midazolam would be required to attain a positive return on investment. This corresponds to roughly one-third of the annual administrations at a major university hospital in Switzerland. The primary factors influencing the uncertainty in the estimated cost per ADE include the cost of maintenance of the app, the likelihood of an ADE resulting from an administration error, and the frequency of underdosing in the trial?s control group. Conclusions: A dedicated mobile app presents an economically viable solution to alleviate the health and economic burden of drug administration errors in in-hospital pediatric emergency care. The widespread adoption of this app is advocated to pool costs and extend the benefits on a national scale in Switzerland. UR - https://www.jmir.org/2024/1/e52077 UR - http://dx.doi.org/10.2196/52077 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52077 ER - TY - JOUR AU - Ashimwe, Aimerence AU - Davoody, Nadia PY - 2024/10/23 TI - Exploring Health Care Professionals? Perspectives on the Use of a Medication and Care Support System and Recommendations for Designing a Similar Tool for Family Caregivers: Interview Study Among Health Care Professionals JO - JMIR Med Inform SP - e63456 VL - 12 KW - eHealth KW - telemedicine KW - mobile health KW - mHealth KW - medication management KW - home care KW - family caregivers KW - mobile phone N2 - Background: With the aging population on the rise, the demand for effective health care solutions to address adverse drug events is becoming increasingly urgent. Telemedicine has emerged as a promising solution for strengthening health care delivery in home care settings and mitigating drug errors. Due to the indispensable role of family caregivers in daily patient care, integrating digital health tools has the potential to streamline medication management processes and enhance the overall quality of patient care. Objective: This study aims to explore health care professionals? perspectives on the use of a medication and care support system (MCSS) and collect recommendations for designing a similar tool for family caregivers. Methods: Fifteen interviews with health care professionals in a home care center were conducted. Thematic analysis was used, and 5 key themes highlighting the importance of using the MCSS tool to improve medication management in home care were identified. Results: All participants emphasized the necessity of direct communication between health care professionals and family caregivers and stated that family caregivers need comprehensive information about medication administration, patient conditions, and symptoms. Furthermore, the health care professionals recommended features and functions customized for family caregivers. Conclusions: This study underscored the importance of clear communication between health care professionals and family caregivers and the provision of comprehensive instructions to promote safe medication practices. By equipping family caregivers with essential information via a tool similar to the MCSS, a proactive approach to preventing errors and improving outcomes is advocated. UR - https://medinform.jmir.org/2024/1/e63456 UR - http://dx.doi.org/10.2196/63456 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63456 ER - TY - JOUR AU - Apte, Aditi AU - Bright, Rew Heber AU - Kadam, Sandeep AU - Sundarsanam, David Thambu AU - Chandy, J. Sujith PY - 2024/10/9 TI - Facilitators, Barriers, and Potential Impacts of Implementation of e-Pharmacy in India and its Potential Impact on Cost, Quality, and Access to Medicines: Scoping Review JO - Online J Public Health Inform SP - e51080 VL - 16 KW - online pharmacy KW - internet pharmacy KW - telepharmacy KW - ePharmacy KW - prescribing systems KW - drug prescribing KW - prescriptions KW - medications N2 - Background: e-Pharmacy can potentially solve problems related to the quality of services and products, cost, and access to medicines in low- and middle-income countries. This review aims to understand the facilitators and barriers to the implementation of e-pharmacy in India. Objective: This scoping review aimed (1) to understand the facilitators and barriers to the use of e-pharmacy in India and (2) to estimate the potential for e-pharmacy in India for improving access to medication, improving the quality of services and medicines, and decreasing costs of medications. Methods: All published and gray literature from July 1, 2011, to June 30, 2021, relating to e-pharmacy, was searched from MEDLINE, Scopus, ProQuest, and Google using a systematic search strategy. Results: In total, 1464 titles and abstracts were screened, of which 47 full-texts were included in the review. e-Pharmacy can potentially improve access to medications for remote areas, and old and debilitated individuals. e-Pharmacies can enable lean supply chain management, lower cost, and allow easy tracking of dispensed medicines. There is potential for integration of e-pharmacy services into the national program of Bhartiya Jan Aushadhi Pariyojana. However, the country is not adequately regulated to prevent the growth of illicit e-pharmacies. Lack of global accreditation and internet coverage, digital literacy, and transnational access are other challenges. Conclusions: E-pharmacy has the potential to improve universal health coverage in India by improving access to medicines and lowering the overall cost of health care. However, future growth will need specific regulations and accreditation mechanisms. Trial Registration: Open Science Forum; https://doi.org/10.17605/OSF.IO/6R9YQ UR - https://ojphi.jmir.org/2024/1/e51080 UR - http://dx.doi.org/10.2196/51080 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51080 ER - TY - JOUR AU - Loh, Yee Xin AU - Woo, Ling Ai AU - Haris, Azwa AU - Pereira, Shajini Cheryl AU - Tan, Kim Bee PY - 2024/9/18 TI - Acceptance of Electronic Labeling for Medicinal Product Information Among Malaysian Hospital Patients: Cross-Sectional Study JO - J Med Internet Res SP - e56591 VL - 26 KW - electronic labeling KW - e-labeling KW - electronic medication information KW - patient preference KW - acceptance KW - hospital ambulatory care patient N2 - Background: While perceptions of electronic labeling (e-labeling) in developed countries have been generally positive, existing data primarily come from studies involving hospital pharmacists, community pharmacy customers who may not be frequent medication users, and individuals receiving COVID-19 vaccines. Objective: This study aims to assess e-labeling acceptance, perceptions of its benefits, challenges with its implementation, and preferences among hospital ambulatory care patients in Malaysia. Additionally, the study investigates the factors influencing patients? acceptance of e-labeling. Methods: A cross-sectional study using a 28-item questionnaire was conducted at the outpatient pharmacy department of a quaternary hospital in Kuala Lumpur, Malaysia, from May to June 2023. The questionnaire was developed based on a review of published literature related to e-labeling and was guided by the Unified Theory of Acceptance and Use of Technology, second version (UTAUT2). Patients aged 18 years and above were recruited using a stratified sampling method to ensure representative age-related medication usage. A mobile tablet was provided to patients for self-completion of the e-survey in their preferred language (English, Malay, or Mandarin). Categorical data on e-labeling acceptance, perceptions, and preferences were analyzed using descriptive statistics. Qualitative content analysis was performed to characterize participants? responses to open-ended questions. Univariate and multivariate binomial logistic regression analyses were conducted to identify predictors of e-labeling acceptance. Results: Out of 462 patients approached, 387 (83.8%) participated in the survey, with 283 (73.1%) accepting e-labeling. Most participants perceived the electronic version of the package insert as beneficial, particularly for understanding their medication better through the choice of language (352/387, 91.0%). However, around half of the participants (197/387, 50.9%) expressed concerns about the potential risks of obtaining illegal medication information via e-labeling. Most participants (302/387, 78.0%) preferred to access electronic leaflets through government websites. However, 221/387 (57.1%) still wanted the option to request printed leaflets. Significant predictors of e-labeling acceptance included perceived benefits such as better understanding of medication (adjusted odds ratio [AOR] 8.02, 95% CI 2.80-22.97, P<.001), environmental protection (AOR 7.24, 95% CI 3.00-17.51, P<.001), and flexibility in information retrieval (AOR 2.66, 95% CI 1.11-6.35, P=.03). Conversely, being of Chinese ethnicity compared with Malay (AOR 0.28, 95% CI 0.13-0.60, P=.005) and perceived lack of self-efficacy in browsing electronic leaflets (AOR 0.25, 95% CI 0.11-0.56, P<.001) were associated with lower acceptance. Conclusions: The acceptance rate for e-labeling among hospital ambulatory care patients was moderately high and was significantly influenced by ethnicity as well as patients? perceived benefits and challenges related to its implementation. Future strategies to enhance e-labeling uptake should address patient concerns regarding the challenges of using the digital platform and emphasize the benefits of e-labeling. UR - https://www.jmir.org/2024/1/e56591 UR - http://dx.doi.org/10.2196/56591 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56591 ER - TY - JOUR AU - Slovis, Heritier Benjamin AU - Huang, Soonyip AU - McArthur, Melanie AU - Martino, Cara AU - Beers, Tasia AU - Labella, Meghan AU - Riggio, M. Jeffrey AU - Pribitkin, deAzevedo Edmund PY - 2024/9/9 TI - Design and Implementation of an Opioid Scorecard for Hospital System?Wide Peer Comparison of Opioid Prescribing Habits: Observational Study JO - JMIR Hum Factors SP - e44662 VL - 11 KW - opioids KW - peer comparison KW - quality KW - scorecard KW - prescribing KW - design KW - implementation KW - opioid KW - morbidity KW - mortality KW - opioid usage KW - opioid dependence KW - drug habits N2 - Background: Reductions in opioid prescribing by health care providers can lead to a decreased risk of opioid dependence in patients. Peer comparison has been demonstrated to impact providers? prescribing habits, though its effect on opioid prescribing has predominantly been studied in the emergency department setting. Objective: The purpose of this study is to describe the development of an enterprise-wide opioid scorecard, the architecture of its implementation, and plans for future research on its effects. Methods: Using data generated by the author?s enterprise vendor?based electronic health record, the enterprise analytics software, and expertise from a dedicated group of informaticists, physicians, and analysts, the authors developed an opioid scorecard that was released on a quarterly basis via email to all opioid prescribers at our institution. These scorecards compare providers? opioid prescribing habits on the basis of established metrics to those of their peers within their specialty throughout the enterprise. Results: At the time of this study?s completion, 2034 providers have received at least 1 scorecard over a 5-quarter period ending in September 2021. Poisson regression demonstrated a 1.6% quarterly reduction in opioid prescribing, and chi-square analysis demonstrated pre-post reductions in the proportion of prescriptions longer than 5 days? duration and a morphine equivalent daily dose of >50. Conclusions: To our knowledge, this is the first peer comparison effort with high-quality evidence-based metrics of this scale published in the literature. By sharing this process for designing the metrics and the process of distribution, the authors hope to influence other health systems to attempt to curb the opioid pandemic through peer comparison. Future research examining the effects of this intervention could demonstrate significant reductions in opioid prescribing, thus potentially reducing the progression of individual patients to opioid use disorder and the associated increased risk of morbidity and mortality. UR - https://humanfactors.jmir.org/2024/1/e44662 UR - http://dx.doi.org/10.2196/44662 ID - info:doi/10.2196/44662 ER - TY - JOUR AU - Dougherty, Kylie AU - Gebremariam, Abebe AU - Biza, Heran AU - Belew, Mulusew AU - Benda, Natalie AU - Tesfaye, Yihenew AU - Cranmer, John AU - Bakken, Suzanne PY - 2024/9/5 TI - Obstetric Emergency Supply Chain Dynamics and Information Flow Among Obstetric Emergency Supply Chain Employees: Key Informant Interview Study JO - JMIR Form Res SP - e59690 VL - 8 KW - basic emergency obstetric care needs KW - BEmOC KW - supply chain KW - Ethiopia KW - Sociotechnical Model N2 - Background: For the past several decades, the Ethiopian Ministry of Health has worked to decrease the maternal mortality ratio (MMR)?the number of pregnant women dying per 100,000 live births. However, with the most recently reported MMR of 267, Ethiopia still ranks high in the MMR globally and needs additional interventions to lower the MMR to achieve the sustainable development goal of 70. One factor contributing to the current MMR is the frequent stockouts of critical medications and supplies needed to treat obstetric emergencies. Objective: This study describes the obstetric emergency supply chain (OESC) dynamics and information flow in Amhara, Ethiopia, as a crucial first step in closing stockouts and gaps in supply availability. Methods: Applying qualitative descriptive methodology, the research team performed 17 semistructured interviews with employees of the OESC at the federal, regional, and facility level to describe and gain an understanding of the system in the region, communication flow, and current barriers and facilitators to consistent emergency supply availability. The team performed inductive and deductive analysis and used the ?Sociotechnical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems? to guide the deductive portion. Results: The interviews identified several locations within the OESC where barriers could be addressed to improve overall facility-level readiness, such as gaps in communication about supply needs and availability in health care facilities and regional supply hubs and a lack of data transparency at the facility level. Ordering supplies through the integrated pharmaceutical logistics system was a well-established process and a frequently noted strength. Furthermore, having inventory data in one place was a benefit to pharmacists and supply managers who would need to use the data to determine their historic consumption. The greatest concern related to the workflow and communication of the OESC was an inability to accurately forecast future supply needs. This is a critical issue because inaccurate forecasting can lead to undersupplying and stockouts or oversupplying and waste of medication due to expiration. Conclusions: As a result of these interviews, we gained a nuanced understanding of the information needs for various levels of the health system to maintain a consistent supply of obstetric emergency resources and ultimately increase maternal survival. This study?s findings will inform future work to create customized strategies that increase supply availability in facilities and the region overall, specifically the development of electronic dashboards to increase data availability at the regional and facility levels. Without comprehensive and timely data about the OESC, facilities will continue to remain in the dark about their true readiness to manage basic obstetric emergencies, and the central Ethiopian Pharmaceutical Supply Service and regional hubs will not have the necessary information to provide essential emergency supplies prospectively before stockouts and maternal deaths occur. UR - https://formative.jmir.org/2024/1/e59690 UR - http://dx.doi.org/10.2196/59690 UR - http://www.ncbi.nlm.nih.gov/pubmed/39235860 ID - info:doi/10.2196/59690 ER - TY - JOUR AU - Cresswell, Kathrin AU - Hinder, Susan AU - Sheikh, Aziz AU - Watson, Neil AU - Price, David AU - Heed, Andrew AU - Pontefract, Katie Sarah AU - Coleman, Jamie AU - Beggs, Jillian AU - Chuter, Antony AU - Slee, Ann AU - Williams, Robin PY - 2024/7/26 TI - Complex Hospital-Based Electronic Prescribing?Based Intervention to Support Antimicrobial Stewardship: Qualitative Study JO - JMIR Form Res SP - e54458 VL - 8 KW - antimicrobial stewardship KW - electronic prescribing KW - evaluation KW - healthcare KW - qualitative study KW - hospital-based KW - e-prescribing KW - prescribing KW - prescription KW - ePAMS+ KW - antimicrobial resistance KW - AMR KW - complex intervention KW - complex interventions KW - educational KW - behavioral KW - technological KW - public health KW - implementation KW - AMS KW - hospital KW - hospitals KW - development KW - in-depth KW - interview KW - interviews KW - observation KW - observations KW - prescriber KW - prescribers KW - nurse KW - nurses KW - pharmacist KW - pharmacists KW - microbiologist KW - microbiologists KW - thematic analysis KW - antimicrobial KW - antimicrobials N2 - Background: Antimicrobial resistance (AMR) represents a growing concern for public health. Objective: We sought to explore the challenges associated with development and implementation of a complex intervention designed to improve AMS in hospitals. Methods: We conducted a qualitative evaluation of a complex AMS intervention with educational, behavioral, and technological components in 5 wards of an English hospital. At 2 weeks and 7 weeks after initiating the intervention, we interviewed 25 users of the intervention, including senior and junior prescribers, a senior nurse, a pharmacist, and a microbiologist. Topics discussed included perceived impacts of different elements of the intervention and facilitators and barriers to effective use. Interviews were supplemented by 2 observations of ward rounds to gain insights into AMS practices. Data were audio-recorded, transcribed, and inductively and deductively analyzed thematically using NVivo12. Results: Tracing the adoption and impact of the various components of the intervention was difficult, as it had been introduced into a setting with competing pressures. These particularly affected behavioral and educational components (eg, training, awareness-building activities), which were often delivered ad hoc. We found that the participatory intervention design had addressed typical use cases but had not catered for edge cases that only became visible when the intervention was delivered in real-world settings (eg, variations in prescribing workflows across different specialties and conditions). Conclusions: Effective user-focused design of complex interventions to promote AMS can support acceptance and use. However, not all requirements and potential barriers to use can be fully anticipated or tested in advance of full implementation in real-world settings. UR - https://formative.jmir.org/2024/1/e54458 UR - http://dx.doi.org/10.2196/54458 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54458 ER - TY - JOUR AU - Sharma, Videha AU - McDermott, John AU - Keen, Jessica AU - Foster, Simon AU - Whelan, Pauline AU - Newman, William PY - 2024/7/23 TI - Pharmacogenetics Clinical Decision Support Systems for Primary Care in England: Co-Design Study JO - J Med Internet Res SP - e49230 VL - 26 KW - personalized medicine KW - genomic medicine KW - pharmacogenetics KW - user-centred design KW - medical informatics KW - clinical decision support systems KW - side effect KW - information technology KW - data KW - primary care KW - health informatic N2 - Background: Pharmacogenetics can impact patient care and outcomes through personalizing the selection of medicines, resulting in improved efficacy and a reduction in harmful side effects. Despite the existence of compelling clinical evidence and international guidelines highlighting the benefits of pharmacogenetics in clinical practice, implementation within the National Health Service in the United Kingdom is limited. An important barrier to overcome is the development of IT solutions that support the integration of pharmacogenetic data into health care systems. This necessitates a better understanding of the role of electronic health records (EHRs) and the design of clinical decision support systems that are acceptable to clinicians, particularly those in primary care. Objective: Explore the needs and requirements of a pharmacogenetic service from the perspective of primary care clinicians with a view to co-design a prototype solution. Methods: We used ethnographic and think-aloud observations, user research workshops, and prototyping. The participants for this study included general practitioners and pharmacists. In total, we undertook 5 sessions of ethnographic observation to understand current practices and workflows. This was followed by 3 user research workshops, each with its own topic guide starting with personas and early ideation, through to exploring the potential of clinical decision support systems and prototype design. We subsequently analyzed workshop data using affinity diagramming and refined the key requirements for the solution collaboratively as a multidisciplinary project team. Results: User research results identified that pharmacogenetic data must be incorporated within existing EHRs rather than through a stand-alone portal. The information presented through clinical decision support systems must be clear, accessible, and user-friendly as the service will be used by a range of end users. Critically, the information should be displayed within the prescribing workflow, rather than discrete results stored statically in the EHR. Finally, the prescribing recommendations should be authoritative to provide confidence in the validity of the results. Based on these findings we co-designed an interactive prototype, demonstrating pharmacogenetic clinical decision support integrated within the prescribing workflow of an EHR. Conclusions: This study marks a significant step forward in the design of systems that support pharmacogenetic-guided prescribing in primary care settings. Clinical decision support systems have the potential to enhance the personalization of medicines, provided they are effectively implemented within EHRs and present pharmacogenetic data in a user-friendly, actionable, and standardized format. Achieving this requires the development of a decoupled, standards-based architecture that allows for the separation of data from application, facilitating integration across various EHRs through the use of application programming interfaces (APIs). More globally, this study demonstrates the role of health informatics and user-centered design in realizing the potential of personalized medicine at scale and ensuring that the benefits of genomic innovation reach patients and populations effectively. UR - https://www.jmir.org/2024/1/e49230 UR - http://dx.doi.org/10.2196/49230 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49230 ER - TY - JOUR AU - Wallman, Andy AU - Svärdsudd, Kurt AU - Bobits, Kent AU - Wallman, Thorne PY - 2024/6/26 TI - Antibiotic Prescribing by Digital Health Care Providers as Compared to Traditional Primary Health Care Providers: Cohort Study Using Register Data JO - J Med Internet Res SP - e55228 VL - 26 KW - telehealth prescribing KW - physical-primary health care KW - internet-primary health care KW - antibiotics KW - prescription KW - infectious disease KW - antibiotic KW - prescriptions KW - prescribing KW - telehealth KW - health care KW - traditional KW - digital KW - telemedicine KW - virtual care KW - Swedish KW - Sweden KW - primary care KW - quality of care KW - online setting KW - ePrescription KW - ePrescriptions KW - ePrescribing KW - eHealth KW - compare KW - comparison KW - online consultation KW - digital care KW - patient record KW - patient records KW - mobile phone N2 - Background:  ?Direct-to-consumer (DTC) telemedicine? is increasing worldwide and changing the map of primary health care (PHC). Virtual care has increased in the last decade and with the ongoing COVID-19 pandemic, patients? use of online care has increased even further. In Sweden, online consultations are a part of government-supported health care today, and there are several digital care providers on the Swedish market, which makes it possible to get in touch with a doctor within a few minutes. The fast expansion of this market has raised questions about the quality of primary care provided only in an online setting without any physical appointments. Antibiotic prescribing is a common treatment in PHC. Objective:  This study aimed to compare antibiotic prescribing between digital PHC providers (internet-PHC) and traditional physical PHC providers (physical-PHC) and to determine whether prescriptions for specific diagnoses differed between internet-PHC and physical-PHC appointments, adjusted for the effects of attained age at the time of appointment, gender, and time relative to the COVID-19 pandemic. Methods:  Antibiotic prescribing data based on Anatomical Therapeutic Chemical (ATC) codes were obtained for Region Sörmland residents from January 2020 until March 2021 from the Regional Administrative Office. In total, 160,238 appointments for 68,332 Sörmland residents were included (124,398 physical-PHC and 35,840 internet-PHC appointments). Prescriptions issued by internet-PHC or physical-PHC physicians were considered. Information on the appointment date, staff category serving the patient, ICD-10 (International Statistical Classification of Diseases, Tenth Revision) diagnosis codes, ATC codes of prescribed medicines, and patient-attained age and gender were used. Results:  A total of 160,238 health care appointments were registered, of which 18,433 led to an infection diagnosis. There were large differences in gender and attained age distributions among physical-PHC and internet-PHC appointments. Physical-PHC appointments peaked among patients aged 60-80 years while internet-PHC appointments peaked at 20-30 years of age for both genders. Antibiotics with the ATC codes J01A-J01X were prescribed in 9.3% (11,609/124,398) of physical-PHC appointments as compared with 6.1% (2201/35,840) of internet-PHC appointments. In addition, 61.3% (6412/10,454) of physical-PHC infection appointments resulted in antibiotic prescriptions, as compared with only 25.8% (2057/7979) of internet-PHC appointments. Analyses of the prescribed antibiotics showed that internet-PHC followed regional recommendations for all diagnoses. Physical-PHC also followed the recommendations but used a wider spectrum of antibiotics. The odds ratio of receiving an antibiotic prescription (after adjustments for attained age at the time of appointment, patient gender, and whether the prescription was issued before or during the COVID-19 pandemic) during an internet-PHC appointment was 0.23-0.39 as compared with a physical-PHC appointment. Conclusions:  Internet-PHC appointments resulted in a significantly lower number of antibiotics prescriptions than physical-PHC appointments, adjusted for the large differences in the characteristics of patients who consult internet-PHC and physical-PHC. Internet-PHC prescribers showed appropriate prescribing according to guidelines. UR - https://www.jmir.org/2024/1/e55228 UR - http://dx.doi.org/10.2196/55228 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55228 ER - TY - JOUR AU - Zheng, Yifan AU - Rowell, Brigid AU - Chen, Qiyuan AU - Kim, Yong Jin AU - Kontar, Al Raed AU - Yang, Jessie X. AU - Lester, A. Corey PY - 2023/12/25 TI - Designing Human-Centered AI to Prevent Medication Dispensing Errors: Focus Group Study With Pharmacists JO - JMIR Form Res SP - e51921 VL - 7 KW - artificial intelligence KW - communication KW - design methods KW - design KW - development KW - engineering KW - focus groups KW - human-computer interaction KW - medication errors KW - morbidity KW - mortality KW - patient safety KW - safety KW - SEIPS KW - Systems Engineering Initiative for Patient Safety KW - tool KW - user-centered design methods KW - user-centered KW - visualization N2 - Background: Medication errors, including dispensing errors, represent a substantial worldwide health risk with significant implications in terms of morbidity, mortality, and financial costs. Although pharmacists use methods like barcode scanning and double-checking for dispensing verification, these measures exhibit limitations. The application of artificial intelligence (AI) in pharmacy verification emerges as a potential solution, offering precision, rapid data analysis, and the ability to recognize medications through computer vision. For AI to be embraced, it must be designed with the end user in mind, fostering trust, clear communication, and seamless collaboration between AI and pharmacists. Objective: This study aimed to gather pharmacists? feedback in a focus group setting to help inform the initial design of the user interface and iterative designs of the AI prototype. Methods: A multidisciplinary research team engaged pharmacists in a 3-stage process to develop a human-centered AI system for medication dispensing verification. To design the AI model, we used a Bayesian neural network that predicts the dispensed pills? National Drug Code (NDC). Discussion scripts regarding how to design the system and feedback in focus groups were collected through audio recordings and professionally transcribed, followed by a content analysis guided by the Systems Engineering Initiative for Patient Safety and Human-Machine Teaming theoretical frameworks. Results: A total of 8 pharmacists participated in 3 rounds of focus groups to identify current challenges in medication dispensing verification, brainstorm solutions, and provide feedback on our AI prototype. Participants considered several teaming scenarios, generally favoring a hybrid teaming model where the AI assists in the verification process and a pharmacist intervenes based on medication risk level and the AI?s confidence level. Pharmacists highlighted the need for improving the interpretability of AI systems, such as adding stepwise checkmarks, probability scores, and details about drugs the AI model frequently confuses with the target drug. Pharmacists emphasized the need for simplicity and accessibility. They favored displaying only essential information to prevent overwhelming users with excessive data. Specific design features, such as juxtaposing pill images with their packaging for quick comparisons, were requested. Pharmacists preferred accept, reject, or unsure options. The final prototype interface included (1) checkmarks to compare pill characteristics between the AI-predicted NDC and the prescription?s expected NDC, (2) a histogram showing predicted probabilities for the AI-identified NDC, (3) an image of an AI-provided ?confused? pill, and (4) an NDC match status (ie, match, unmatched, or unsure). Conclusions: In partnership with pharmacists, we developed a human-centered AI prototype designed to enhance AI interpretability and foster trust. This initiative emphasized human-machine collaboration and positioned AI as an augmentative tool rather than a replacement. This study highlights the process of designing a human-centered AI for dispensing verification, emphasizing its interpretability, confidence visualization, and collaborative human-machine teaming styles. UR - https://formative.jmir.org/2023/1/e51921 UR - http://dx.doi.org/10.2196/51921 UR - http://www.ncbi.nlm.nih.gov/pubmed/38145475 ID - info:doi/10.2196/51921 ER - TY - JOUR AU - Fossouo Tagne, Joel AU - Yakob, Amin Reginald AU - Mcdonald, Rachael AU - Wickramasinghe, Nilmini PY - 2023/9/29 TI - A Web-Based Tool to Report Adverse Drug Reactions by Community Pharmacists in Australia: Usability Testing Study JO - JMIR Form Res SP - e48976 VL - 7 KW - ADR KW - adverse drug reaction KW - pharmacovigilance KW - community pharmacy KW - digital health evaluation KW - usability testing N2 - Background: Adverse drug reactions (ADRs) are unintended and harmful events associated with medication use. Despite their significance in postmarketing surveillance, quality improvement, and drug safety research, ADRs are vastly underreported. Enhanced digital-based communication of ADR information to regulators and among care providers could significantly improve patient safety. Objective: This paper presents a usability evaluation of the commercially available GuildCare Adverse Event Recording system, a web-based ADR reporting system widely used by community pharmacists (CPs) in Australia. Methods: We developed a structured interview protocol encompassing remote observation, think-aloud moderating techniques, and retrospective questioning to gauge the overall user experience, complemented by the System Usability Scale (SUS) assessment. Thematic analysis was used to analyze field notes from the interviews. Results: A total of 7 CPs participated in the study, who perceived the system to have above-average usability (SUS score of 68.57). Nonetheless, the structured approach to usability testing unveiled specific functional and user interpretation issues, such as unnecessary information, lack of system clarity, and redundant data fields?critical insights not captured by the SUS results. Design elements like drop-down menus, free-text entry, checkboxes, and prefilled or auto-populated data fields were perceived as useful for enhancing system navigation and facilitating ADR reporting. Conclusions: The user-centric design of technology solutions, like the one discussed herein, is crucial to meeting CPs? information needs and ensuring effective ADR reporting. Developers should adopt a structured approach to usability testing during the developmental phase to address identified issues comprehensively. Such a methodological approach may promote the adoption of ADR reporting systems by CPs and ultimately enhance patient safety. UR - https://formative.jmir.org/2023/1/e48976 UR - http://dx.doi.org/10.2196/48976 UR - http://www.ncbi.nlm.nih.gov/pubmed/37773620 ID - info:doi/10.2196/48976 ER - TY - JOUR AU - Yang, Dong-Wook AU - Son, Kyung-Bok PY - 2023/7/13 TI - Impact of the COVID-19 Pandemic on the Public Perceptions of the Roles and Functions of Community Pharmacies in South Korea: Updated Cross-Sectional Self-Reported Web-Based Survey JO - JMIR Public Health Surveill SP - e46723 VL - 9 KW - community pharmacy KW - pharmaceutical practice KW - COVID-19 KW - South Korea KW - pandemic KW - survey KW - pharmacists KW - pharmacy KW - primary care KW - medicine-centered services N2 - Background: Community pharmacists confronted dual burdens in response to the COVID-19 pandemic by expanding the scope of pharmaceutical practices. Objective: This study aimed to assess the perceived roles and functions of community pharmacies during the pandemic and to explore their updated roles after the pandemic began. Methods: We conducted a self-reported web-based survey in October 2022. Based on Korean census data, we recruited the study participants (n=1000) through quota sampling stratified by age, sex, and region, yielding a 7.45% (1000/13,423) response rate. The questionnaires were composed of 3 sections: demographics, the roles and functions of community pharmacies during the pandemic, and the updated roles of community pharmacies during disasters. Each question in the second and third sections was rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree), and each item?s mean scores and SDs were reported. The study participants were categorized into 2 groups: individuals who had a family pharmacy and those who did not. A chi-square test and ordered logistic regression analyses were conducted. Results: Out of 1000 respondents, 418 (41.8%) had a history of COVID-19, and 639 (63.9%) had a family pharmacy. Assigning specific roles and functions to community pharmacies during the pandemic contributed to positive assessments. Respondents gave higher scores to community pharmacies that had responded appropriately (a mean Likert score of 3.66, SD .077 out of 5) and provided continuous pharmaceutical services (mean 3.67, SD 0.87) during the pandemic. The pandemic served as an opportunity to positively recognize the role of community pharmacies (mean 3.59, SD 0.83). In the ordered logistic model, having a family pharmacy was consistently associated with positive perceptions. Respondents perceived that community pharmacies collaborated with general practitioners and health authorities. However, community pharmacies need to function appropriately in terms of knowledge. The mean score of the 4 domains of community pharmacy functions was the highest for collaboration (mean 3.66, SD 0.83), followed by communication (mean 3.57, SD 0.87), responsiveness (mean 3.54, SD 0.87), and knowledge (mean 3.41, SD 0.91). Conclusions: The pandemic resulted in interprofessional collaboration between community pharmacists and general practitioners. Family pharmacies could be a valuable asset to the comprehensive case management of patients. However, community pharmacists should have the expertise to build solid interprofessional collaborations and fulfill their expanded and updated roles. UR - https://publichealth.jmir.org/2023/1/e46723 UR - http://dx.doi.org/10.2196/46723 UR - http://www.ncbi.nlm.nih.gov/pubmed/37390391 ID - info:doi/10.2196/46723 ER - TY - JOUR AU - Weinberg, Vera AU - van Haren, Eva AU - Gombert-Handoko, B. Kim PY - 2023/1/27 TI - Improving Patient Access to Hospital Pharmacists Using eConsults: Retrospective Descriptive Study JO - JMIR Form Res SP - e38518 VL - 7 KW - eConsult KW - online consultation KW - eHealth KW - electronic patient portal KW - hospital pharmacy KW - medication reconciliation N2 - Background: eConsults are increasingly used worldwide to reduce specialist referrals and increase access to medical care. An additional benefit of using an eConsult tool is a reduction of health care costs while improving the quality of health care and patient participation. Currently, shared decision making is increasingly implemented and preferred by patients. eConsults are also a promising tool to improve access to the hospital pharmacist. Patients often have questions about their medication. When medication is started during a hospital admission or outpatient visit, community pharmacists are not always sufficiently informed to answer patient questions. Direct contact with hospital pharmacists may be more appropriate and efficient. This contact is facilitated through the eConsult feature in the hospital?s patient portal. Objective: This study aims to evaluate the prevalence and contents of the eConsults sent by patients to hospital pharmacists. Methods: A first retrospective descriptive study was conducted at the Leiden University Medical Center in the Netherlands. Patients who sent at least one eConsult to a hospital pharmacist between March 2017 and December 2021 were included. Patient characteristics and the number of medications taken were extracted from electronic health records. The content of eConsults was analyzed and grouped into different subjects. Time of sending of the eConsults was analyzed. A comparison was made between the number of eConsults sent to the hospital pharmacy and the number sent to the medical center. Finally, the appropriateness for evaluation by the hospital pharmacist was assessed in all eConsults. Results: During the study period, 983 eConsults (from 808 patients) were sent to the hospital pharmacist. The average patient age was 56 (SD 15.9) years, and 51.4% (415/808) were male; 47.8% (386/808) of the patients used 0 to 4 medications, 33.0% (267/808) used 5 to 9 medications, and 19.2% (155/808) used ?10 medications. Of the eConsults, 10.9% (107/983) were excluded due to not being medication-related or not intended for the hospital pharmacist. Patients being treated in 31 medical specialties sent eConsults to the hospital pharmacist. The most common medical specialty was cardiology with 22.5% (197/876) of the eConsults. Most eConsults were sent during office hours (614/876, 70.2%). eConsult subjects were medication verification (372/876, 42.5%), logistics (243/876, 27.7%), therapeutic effect and adverse events (100/876, 11.4%), use of medication (87/876, 9.9%), and other subjects (74/876, 8.4%). Conclusions: Introducing eConsults allows patients to ask medication-related questions directly to hospital pharmacists. Our study shows that patients send medication reconciliation?related eConsults most often. Use of the eConsult tool leads to fast, direct, and documented communication between patient and hospital pharmacist. This can reduce medication-related errors, improve patient empowerment, and increase access to the hospital pharmacist. UR - https://formative.jmir.org/2023/1/e38518 UR - http://dx.doi.org/10.2196/38518 UR - http://www.ncbi.nlm.nih.gov/pubmed/36705957 ID - info:doi/10.2196/38518 ER - TY - JOUR AU - Donovan, Gemma AU - Hall, Nicola AU - Smith, Felicity AU - Ling, Jonathan AU - Wilkes, Scott PY - 2022/12/21 TI - Two-way Automated Text Messaging Support From Community Pharmacies for Medication Taking in Multiple Long-term Conditions: Human-Centered Design With Nominal Group Technique Development Study JO - JMIR Form Res SP - e41735 VL - 6 IS - 12 KW - medication adherence KW - text messaging KW - human-centered design KW - complex interventions KW - community pharmacy N2 - Background: Reviews of digital communication technologies suggest that they can be effective in supporting medication use; however, their use alongside nondigital components is unclear. We also explored the delivery of a digital communication intervention in a relatively novel setting of community pharmacies and how such an intervention might be delivered to patients with multiple long-term conditions. This meant that despite the large number of intervention examples available in the literature, design questions remained, which we wanted to explore with key stakeholders. Examples of how to involve stakeholders in the design of complex health care interventions are lacking; however, human-centered design (HCD) has been suggested as a potential approach. Objective: This study aimed to design a new community pharmacy text messaging intervention to support medication use for multiple long-term conditions, with patient and health care professional stakeholders in primary care. Methods: HCD was used to map the intervention ?journey? and identify design questions to explore with patients and health care professionals. Six prototypes were developed to communicate the intervention concept, and a modified version of the Nominal Group Technique was used to gather feedback. Nominal group meetings generated qualitative data using questions about the aspects that participants liked for each prototype and any suggested changes. The discussion was analyzed using a framework approach to transform feedback into statements. These statements were then ranked using a web-based questionnaire to establish a consensus about what elements of the design were valued by stakeholders and what changes to the design were most important. Results: A total of 30 participants provided feedback on the intervention design concept over 5 nominal group meetings (21 health care professionals and 9 patients) with a 57% (17/30) response rate to the ranking questionnaire. Furthermore, 51 proposed changes in the intervention were generated from the framework analysis. Of these 51 changes, 27 (53%) were incorporated into the next design stage, focusing on changes that were ranked highest. These included suggestions for how text message content might be tailored, patient information materials, and the structure for pharmacist consultation. All aspects that the participants liked were retained in the future design and provided evidence that the proposed intervention concept had good acceptability. Conclusions: HCD incorporating the Nominal Group Technique is an appropriate and successful approach for obtaining feedback from key stakeholders as part of an iterative design process. This was particularly helpful for our intervention, which combined digital and nondigital components for delivery in the novel setting of a community pharmacy. This approach enabled the collection and prioritization of useful multiperspective feedback to inform further development and testing of our intervention. This model has the potential to minimize research waste by gathering feedback early in the complex intervention design process. UR - https://formative.jmir.org/2022/12/e41735 UR - http://dx.doi.org/10.2196/41735 UR - http://www.ncbi.nlm.nih.gov/pubmed/36542458 ID - info:doi/10.2196/41735 ER - TY - JOUR AU - Eldridge, Ann Lori AU - Agley, Jon AU - Meyerson, E. Beth AU - Golzarri-Arroyo, Lilian PY - 2022/10/24 TI - The PharmNet Harm Reduction Intervention for Community Pharmacies: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e42373 VL - 11 IS - 10 KW - naloxone KW - opioid KW - overdose KW - pharmacy KW - randomized controlled trial KW - RCT KW - opioid use KW - digital health intervention KW - community health KW - drug use KW - prevention KW - PharmNet KW - health resources KW - health outcome N2 - Background: The overdose epidemic in the United States has continued to worsen despite substantial efforts to mitigate its harms. The opioid antagonist naloxone has been identified as a key means of reducing the prevalence of fatal overdoses. An important evidence-based approach to optimizing naloxone?s impact is to seed it throughout the community, because bystanders are often able to reverse overdoses more quickly than first responders and sometimes are the only possible means of overdose reversal. As part of a multipronged approach to distributing naloxone nationwide, community pharmacies have been identified as ideal venues for naloxone dispensing, especially under standing orders. However, dispensing rates remain surprisingly low, and there is a need to understand how best to engage community pharmacies in naloxone-based harm reduction services. Objective: The objective of this trial is to determine whether a tailored, pragmatic pharmacy intervention (PharmNet) results in greater naloxone dispensing relative to baseline (the prior 3 months) compared to a control condition. This pilot trial is intended to determine whether it is appropriate to invest the substantial resources that would be required to conduct a full-scale, randomized controlled study of PharmNet. Methods: We will conduct a 3-month randomized controlled pilot trial consisting of 2 parallel groups with a 4:3 allocation ratio. A group of 7 independent pharmacies from rural areas in Indiana will be randomly assigned to either the PharmNet intervention arm (n=4) or the control arm (n=3). The primary outcome will be overall naloxone dispensing (both at cost and free), and secondary outcomes will include the distribution of referral cards and multiple variables at the level of individual staff members. Dispensing data will be collected for the 3 months prior to the intervention and the 3 months of the intervention, and all other data will be collected using a pretest-posttest design. The primary analysis will be a generalized linear mixed model with a Poisson distribution with fixed effects for group, time, and their interaction and a random effect for pharmacy ID to account for repeated measures within pharmacies. Results: This study was approved by the Indiana University institutional review board in 2 phases (August 2, 2021, and April 26, 2022) and was funded by the Indiana University Grand Challenge: Responding to the Addictions Crisis. Conclusions: If this study produces evidence that the PharmNet intervention results in increased naloxone dispensing relative to control pharmacies, it will be both appropriate and important to study it in a large, full-scale randomized controlled trial. International Registered Report Identifier (IRRID): PRR1-10.2196/42373 UR - https://www.researchprotocols.org/2022/10/e42373 UR - http://dx.doi.org/10.2196/42373 UR - http://www.ncbi.nlm.nih.gov/pubmed/36279161 ID - info:doi/10.2196/42373 ER - TY - JOUR AU - Al Nemari, Manal AU - Waterson, James PY - 2022/10/11 TI - The Introduction of Robotics to an Outpatient Dispensing and Medication Management Process in Saudi Arabia: Retrospective Review of a Pharmacy-led Multidisciplinary Six Sigma Performance Improvement Project JO - JMIR Hum Factors SP - e37905 VL - 9 IS - 4 KW - inventory waste KW - mislabeling events KW - no-show returns KW - inventory stock levels KW - staff education KW - task realignment KW - outpatient KW - Six Sigma KW - medication management KW - medication adherence KW - risk KW - pharmacy KW - health care professional KW - dispensing KW - robotics KW - automation KW - pharmaceuticals KW - inventory N2 - Background: Outpatient pharmacy management aims for improved patient safety, improved quality of service, and cost reduction. The Six Sigma method improves quality by eliminating variability, with the goal of a nearly error-free process. Automation of pharmacy tasks potentially offers greater efficiency and safety. Objective: The goal was to measure the impact that integration of automation made to service, safety and efficiency, staff reallocation and reorientation, and workflow in the outpatient pharmacy department. The Six Sigma problem definition to be resolved was as follows: The current system of outpatient dispensing denies quality to patients in terms of waiting time and contact time with pharmacy professionals, incorporates risks to the patient in terms of mislabeling of medications and the incomplete dispensing of prescriptions, and is potentially wasteful in terms of time and resources. Methods: We described the process of introducing automation to a large outpatient pharmacy department in a university hospital. The Six Sigma approach was used as it focuses on continuous improvement and also produces a road map that integrates tracking and monitoring into its process. A review of activity in the outpatient department focused on non-value-added (NVA) pharmacist tasks, improving the patient experience and patient safety. Metrics to measure the impact of change were established, and a process map analysis with turnaround times (TATs) for each stage of service was created. Discrete events were selected for correction, improvement, or mitigation. From the review, the team selected key outcome metrics, including storage, picking and delivery dispensing rates, patient and prescription load per day, average packs and lines per prescription, and lines held. Our goal was total automation of stock management. We deployed 2 robotic dispensing units to feed 9 dispensing desks. The automated units were integrated with hospital information technology (HIT) that supports appointments, medication records, and prescriptions. Results: Postautomation, the total patient time in the department, including the time interacting with the pharmacist for medication education and counseling, dropped from 17.093 to 11.812 digital minutes, with an appreciable increase in patient-pharmacist time. The percentage of incomplete prescriptions dispensed versus orders decreased from 3.0% to 1.83%. The dispensing error rate dropped from 1.00% to 0.24%. Assessed via a ?basket? of medications, wastage cost was reduced by 83.9%. During implementation, it was found that NVA tasks that were replaced by automated processes were responsible for an extensive loss of pharmacist time. The productivity ratio postautomation was 1.26. Conclusions: The Six Sigma methodology allowed for rapid transformation of the medication management process. The risk priority numbers (RPNs) for the ?wrong patient-wrong medication error? reduced by a ratio of 5.25:1 and for ?patient leaves unit with inadequate counseling? postautomation by 2.5:1. Automation allowed for ring-fencing of patient-pharmacist time. This time needs to be structured for optimal effectiveness. UR - https://humanfactors.jmir.org/2022/4/e37905 UR - http://dx.doi.org/10.2196/37905 UR - http://www.ncbi.nlm.nih.gov/pubmed/36222805 ID - info:doi/10.2196/37905 ER - TY - JOUR AU - van Lieshout, Jan AU - Lacroix, Joyca AU - van Halteren, Aart AU - Teichert, Martina PY - 2022/4/7 TI - Effectiveness of a Pharmacist-Led Web-Based Medication Adherence Tool With Patient-Centered Communication: Results of a Clustered Randomized Controlled Trial JO - J Med Internet Res SP - e16141 VL - 24 IS - 4 KW - medication adherence KW - improvement KW - intervention KW - web-based KW - tailored intervention KW - patient centered KW - barriers KW - primary care KW - cardiovascular diseases KW - diabetes N2 - Background: Growing numbers of people use medication for chronic conditions; nonadherence is common, leading to poor disease control. A web-based tool to identify an increased risk for nonadherence with related potential individual barriers might facilitate tailored interventions and improve adherence. Objective: This study aims to assess the effectiveness of a newly developed tool aimed at improving medication adherence. Methods: We performed a cluster randomized controlled trial in patients initiating cardiovascular or oral blood glucose?lowering medication. Participants were recruited from community pharmacies. They completed an online questionnaire comprising assessments of their risk for medication nonadherence and subsequently of barriers to adherence. In pharmacies belonging to the intervention group, individual barriers displayed in a graphical profile on a tablet were discussed by pharmacists and patients with high nonadherence risk in face-to-face meetings and shared with their general practitioners and practice nurses. Tailored interventions were initiated by pharmacists. Barriers of control patients were not presented nor discussed and these patients received usual care. The primary outcome was the effectiveness of the intervention on medication adherence at 8 months? follow-up between patients with an increased nonadherence risk from the intervention and control groups, calculated from dispensing data. Results: Data from 492 participants in 15 community pharmacies were available for analyses (intervention 253, 7 pharmacies; control 239, 8 pharmacies). The intervention had no effect on medication adherence (B=?0.01; 95% CI ?0.59 to 0.57; P=.96), nor in the post hoc per-protocol analysis (B=0.19; 95% CI ?0.50 to 0.89; P=.58). Conclusions: This study showed no effectiveness of a risk stratification and tailored intervention addressing personal barriers for medication adherence. Various potential explanations for lack of effectiveness were identified. These explanations relate, for instance, to high medication adherence in the control group, study power, and fidelity. Process evaluation should elicit possible improvements and inform the redesign of intervention and implementation. Trial Registration: The Netherlands National Trial Register NTR5186; https://tinyurl.com/5d8w99hk UR - https://www.jmir.org/2022/4/e16141 UR - http://dx.doi.org/10.2196/16141 UR - http://www.ncbi.nlm.nih.gov/pubmed/35389359 ID - info:doi/10.2196/16141 ER - TY - JOUR AU - Crawford, D. Natalie AU - Harrington, V. Kristin R. AU - Alohan, I. Daniel AU - Sullivan, S. Patrick AU - Holland, P. David AU - Klepser, G. Donald AU - Quamina, Alvan AU - Siegler, J. Aaron AU - Young, N. Henry PY - 2022/2/9 TI - Integrating and Disseminating Pre-Exposure Prophylaxis (PrEP) Screening and Dispensing for Black Men Who Have Sex With Men in Atlanta, Georgia: Protocol for Community Pharmacies JO - JMIR Res Protoc SP - e35590 VL - 11 IS - 2 KW - PrEP KW - MSM KW - HIV KW - prevention KW - pharmacy KW - implementation KW - pre-exposure prophylaxis KW - men who have sex with men KW - protocol KW - integration KW - dissemination KW - prophylaxis KW - screening KW - race KW - demographic KW - sex KW - sexuality KW - development KW - access N2 - Background: Black men who have sex with men (BMSM) suffer from alarmingly high rates of HIV in the United States. Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV infection by 99% among men who have sex with men, yet profound racial disparities in the uptake of PrEP persist. Low PrEP uptake in BMSM is driven by poor access to PrEP, including inconvenient locations of PrEP-prescribing physicians, distrust of physicians, and stigma, which limit communication about PrEP and its side effects. Previous work indicates that offering HIV prevention services in pharmacies located in low-income, underserved neighborhoods is feasible and can reduce stigma because pharmacies offer a host of less stigmatized health services (eg, vaccinations). We present a protocol for a pharmacy PrEP model that seeks to address challenges and barriers to pharmacy-based PrEP specifically for BMSM. Objective: We aim to develop a sustainable pharmacy PrEP delivery model for BMSM that can be implemented to increase PrEP access in low-income, underserved neighborhoods. Methods: This study design is a pilot intervention to test a pharmacy PrEP delivery model among pharmacy staff and BMSM. We will examine the PrEP delivery model?s feasibility, acceptability, and safety and gather early evidence of its impact and cost with respect to PrEP uptake. A mixed-methods approach will be performed, including three study phases: (1) a completed formative phase with qualitative interviews from key stakeholders; (2) a completed transitional pilot phase to assess customer eligibility and willingness to receive PrEP in pharmacies during COVID-19; and (3) a planned pilot intervention phase which will test the delivery model in 2 Atlanta pharmacies in low-income, underserved neighborhoods. Results: Data from the formative phase showed strong support of pharmacy-based PrEP delivery among BMSM, pharmacists, and pharmacy staff. Important factors were identified to facilitate the implementation of PrEP screening and dissemination in pharmacies. During the transitional pilot phase, we identified 81 individuals who would have been eligible for the pilot phase. Conclusions: Pharmacies have proven to be a feasible source for offering PrEP for White men who have sex with men but have failed to reach the most at-risk, vulnerable population (ie, BMSM). Increasing PrEP access and uptake will reduce HIV incidence and racial inequities in HIV. Translational studies are required to build further evidence and scale pharmacy-based PrEP services specifically for populations that are disconnected from HIV prevention resources. International Registered Report Identifier (IRRID): DERR1-10.2196/35590 UR - https://www.researchprotocols.org/2022/2/e35590 UR - http://dx.doi.org/10.2196/35590 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138252 ID - info:doi/10.2196/35590 ER - TY - JOUR AU - Gullslett, Knudsen Monika AU - Strand Bergmo, Trine PY - 2022/1/17 TI - Implementation of E-prescription for Multidose Dispensed Drugs: Qualitative Study of General Practitioners? Experiences JO - JMIR Hum Factors SP - e27431 VL - 9 IS - 1 KW - e-prescribing of multidose drug dispensing (eMDD) KW - pharmacy KW - start-up KW - general practitioner (GP) KW - Norway KW - digital health KW - digital tools KW - e-prescriptions KW - physicians KW - qualitative study N2 - Background: Increased use of pharmaceuticals challenges both capacity and safety related to medication management for patients and changes in how general practitioners (GPs) and other health personnel interact with and follow up with patients. E-prescribing of multidose drug dispensing (eMDD) is 1 of the national measures being tested in Norway. Objective: The objective of this study is to explore GPs? experiences with the challenges and benefits of implementing eMDD in Norway. Methods: Qualitative in-depth and group interviews were conducted with a total of 25 GPs between 2018 and 2020. Transcribed files were saved in NVivo to conduct a step-by-step content analysis. NVivo is a software tool for organizing, managing, and analyzing qualitative data. Results: The study revealed that eMDD offers many benefits. At the same time, there are several challenges related to information, training, and initiation, as well as to the responsibility for the medication, interactions, and the risk of incorrect medication. An important activity in the start-up phase was an information meeting with pharmacies and technology suppliers, as well as exchanging information and instructions with pharmacies on how to get started. Four analytic themes emerged through the extraction of data: (1) start-up with eMDD (?Be patient?); (2) the need for training; (3) interaction, safety, and efficiency; and (4) the working day with eMDD. Conclusions: There is a variation in different GPs? needs regarding training and information, and considerable variation in competence and motivation related to the use of digital tools. There are also different degrees of understanding the everyday work of the other actors in the medication chain. In particular, the harmonization of medication lists related to the use of time, expenditures, and challenges with technological solutions in the introduction phase was emphasized as a challenge. Overall, GPs who have started using the system report great benefits; these are largely related to an increased overview of patients? total medication lists, less time spent on prescribing prescriptions, and increased collaboration with pharmacies and nurses, both in service from providers in homes and in nursing homes. UR - https://humanfactors.jmir.org/2022/1/e27431 UR - http://dx.doi.org/10.2196/27431 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037881 ID - info:doi/10.2196/27431 ER - TY - JOUR AU - Passardi, Alessandro AU - Serra, Patrizia AU - Donati, Caterina AU - Fiori, Federica AU - Prati, Sabrina AU - Vespignani, Roberto AU - Taglioni, Gabriele AU - Farfaneti Ghetti, Patrizia AU - Martinelli, Giovanni AU - Nanni, Oriana AU - Altini, Mattia AU - Frassineti, Luca Giovanni AU - Minguzzi, Vittoria Martina PY - 2021/12/20 TI - An Integrated Model to Improve Medication Reconciliation in Oncology: Prospective Interventional Study JO - J Med Internet Res SP - e31321 VL - 23 IS - 12 KW - medication recognition KW - medication reconciliation KW - IT platform KW - community pharmacies KW - healthcare transitions KW - pharmacy KW - oncology KW - drug incompatibility KW - information technology KW - drug interactions N2 - Background: Accurate medication reconciliation reduces the risk of drug incompatibilities and adverse events that can occur during transitions in care. Community pharmacies (CPs) are a crucial part of the health care system and could be involved in collecting essential information on conventional and supplementary drugs used at home. Objective: The aim of this paper was to establish an alliance between our cancer institute, Istituto Romagnolo per lo Studio dei Tumori (IRST), and CPs, the latter entrusted with the completion of a pharmacological recognition survey. We also aimed to integrate the national information technology (IT) platform of CPs with the electronic medical records of IRST. Methods: Cancer patients undergoing antiblastic treatments were invited to select a CP taking part in the study and to complete the pharmacological recognition step. The information collected by the pharmacist was sent to the electronic medical records of IRST through the new IT platform, after which the oncologist performed the reconciliation process. Results: A total of 66 CPs completed surveys for 134 patients. An average of 5.9 drugs per patient was used at home, with 12 or more used in the most advanced age groups. Moreover, 60% (80/134) of the patients used nonconventional products or critical foods. Some potential interactions between nonconventional medications and cancer treatments were reported. Conclusions: In the PROF-1 (Progetto di Rete in Oncologia con le Farmacie di comunità della Romagna) study, an alliance was created between our cancer center and CPs to improve medication reconciliation, and a new integrated IT platform was validated. Trial Registration: ClinicalTrials.gov NCT04796142; https://clinicaltrials.gov/ct2/show/NCT04796142 UR - https://www.jmir.org/2021/12/e31321 UR - http://dx.doi.org/10.2196/31321 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932001 ID - info:doi/10.2196/31321 ER - TY - JOUR AU - Koldeweij, Charlotte AU - Clarke, Jonathan AU - Nijman, Joppe AU - Feather, Calandra AU - de Wildt, N. Saskia AU - Appelbaum, Nicholas PY - 2021/12/13 TI - CE Accreditation and Barriers to CE Marking of Pediatric Drug Calculators for Mobile Devices: Scoping Review and Qualitative Analysis JO - J Med Internet Res SP - e31333 VL - 23 IS - 12 KW - pediatric KW - drug dosage calculator KW - European regulations KW - safety KW - medical devices KW - medical errors KW - app KW - application KW - mobile health KW - pharmacy N2 - Background: Pediatric drug calculators (PDCs) intended for clinical use qualify as medical devices under the Medical Device Directive and the Medical Device Regulation. The extent to which they comply with European standards on quality and safety is unknown. Objective: This study determines the number of PDCs available as mobile apps for use in the Netherlands that bear a CE mark, and explore the factors influencing the CE marking of such devices among app developers. Methods: A scoping review of Google Play Store and Apple App Store was conducted to identify PDCs available for download in the Netherlands. CE accreditation of the sampled apps was determined by consulting the app landing pages on app stores, by screening the United Kingdom Medicines and Healthcare products Regulatory Agency?s online registry of medical devices, and by surveying app developers. The barriers to CE accreditation were also explored through a survey of app developers. Results: Of 632 screened apps, 74 were eligible, including 60 pediatric drug dosage calculators and 14 infusion rate calculators. One app was CE marked. Of the 20 (34%) respondents to the survey, 8 considered their apps not to be medical devices based on their intent of use or functionality. Three developers had not aimed to make their app available for use in Europe. Other barriers that may explain the limited CE accreditation of sampled PDC apps included poor awareness of European regulations among developers and a lack of restrictions when placing PDCs in app stores. Conclusions: The compliance of PDCs with European standards on medical devices is poor. This puts clinicians and their patients at risk of medical errors resulting from the largely unrestricted use of these apps. UR - https://www.jmir.org/2021/12/e31333 UR - http://dx.doi.org/10.2196/31333 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898456 ID - info:doi/10.2196/31333 ER - TY - JOUR AU - Tremblay, Zoë AU - Mumbere, David AU - Laurin, Danielle AU - Sirois, Caroline AU - Furrer, Daniela AU - Poisblaud, Lise AU - Carmichael, Pierre-Hugues AU - Farrell, Barbara AU - Tourigny, André AU - Giguere, Anik AU - Vedel, Isabelle AU - Morais, José AU - Kröger, Edeltraut PY - 2021/12/9 TI - Health Impacts and Characteristics of Deprescribing Interventions in Older Adults: Protocol for a Systematic Review and Meta-analysis JO - JMIR Res Protoc SP - e25200 VL - 10 IS - 12 KW - deprescribing KW - older adult KW - aging KW - medication use KW - inappropriate prescribing KW - potentially inappropriate medication KW - polypharmacy KW - comorbidity KW - multimorbidity KW - systematic review N2 - Background: Deprescribing, a relatively recent concept, has been proposed as a promising solution to the growing issues of polypharmacy and use of medications of questionable benefit among older adults. However, little is known about the health outcomes of deprescribing interventions. Objective: This paper presents the protocol of a study that aims to contribute to the knowledge on deprescribing by addressing two specific objectives: (1) describe the impact of deprescribing in adults ?60 years on health outcomes or quality of life; and (2) determine the characteristics of effective interventions in deprescribing. Methods: Primary studies targeting three concepts (older adults, deprescribing, and health or quality of life outcomes) will be included in the review. The search will be performed using key international databases (MEDLINE, EMBASE, CINAHL, Ageline, PsycInfo), and a special effort will be made to identify gray literature. Two reviewers will independently screen the articles, extract the information, and evaluate the quality of the selected studies. If methodologically feasible, meta-analyses will be performed for groups of intervention studies reporting on deprescribing interventions for similar medications, used for similar or identical indications, and reporting on similar outcomes (eg, benzodiazepines used against insomnia and studies reporting on quality of sleep or quality of life). Alternatively, the results will be presented in bottom-line statements (objective 1) and a matrix outlining effective interventions (objective 2). Results: The knowledge synthesis may be limited by the availability of high-quality clinical trials on deprescribing and their outcomes in older adults. Additionally, analyses will likely be affected by studies on the deprescribing of different types of molecules within the same indication (eg, different pharmacological classes and medications to treat hypertension) and different measures of health and quality of life outcomes for the same indication. Nevertheless, we expect the review to identify which deprescribing interventions lead to improved health outcomes among seniors and which of their characteristics contribute to these outcomes. Conclusions: This systematic review will contribute to a better understanding of the health outcomes of deprescribing interventions among seniors. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42015020866; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015020866 International Registered Report Identifier (IRRID): PRR1-10.2196/25200 UR - https://www.researchprotocols.org/2021/12/e25200 UR - http://dx.doi.org/10.2196/25200 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889771 ID - info:doi/10.2196/25200 ER - TY - JOUR AU - Mercer, Kathryn AU - Carter, Caitlin AU - Burns, Catherine AU - Tennant, Ryan AU - Guirguis, Lisa AU - Grindrod, Kelly PY - 2021/11/25 TI - Including the Reason for Use on Prescriptions Sent to Pharmacists: Scoping Review JO - JMIR Hum Factors SP - e22325 VL - 8 IS - 4 KW - patient safety KW - human factors KW - patient engagement KW - multidisciplinary N2 - Background: In North America, although pharmacists are obligated to ensure prescribed medications are appropriate, information about a patient?s reason for use is not a required component of a legal prescription. The benefits of prescribers including the reason for use on prescriptions is evident in the current literature. However, it is not standard practice to share this information with pharmacists. Objective: Our aim was to characterize the research on how including the reason for use on a prescription impacts pharmacists. Methods: We performed an interdisciplinary scoping review, searching literature in the fields of health care, informatics, and engineering. The following databases were searched between December 2018 and January 2019: PubMed, Institute of Electrical and Electronics Engineers (IEEE), Association for Computing Machinery (ACM), International Pharmaceutical Abstracts (IPA), and EMBASE. Results: A total of 3912 potentially relevant articles were identified, with 9 papers meeting the inclusion criteria. The studies used different terminology (eg, indication, reason for use) and a wide variety of study methodologies, including prospective and retrospective observational studies, randomized controlled trials, and qualitative interviews and focus groups. The results suggest that including the reason for use on a prescription can help the pharmacist catch more errors, reduce the need to contact prescribers, support patient counseling, impact communication, and improve patient safety. Reasons that may prevent prescribers from adding the reason for use information are concerns about workflow and patient privacy. Conclusions: More research is needed to understand how the reason for use information should be provided to pharmacists. In the limited literature to date, there is a consensus that the addition of this information to prescriptions benefits patient safety and enables pharmacists to be more effective. Future research should use an implementation science or theory-based approach to improve prescriber buy-in and, consequently, adoption. UR - https://humanfactors.jmir.org/2021/4/e22325 UR - http://dx.doi.org/10.2196/22325 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842545 ID - info:doi/10.2196/22325 ER - TY - JOUR AU - Dahlhausen, Florian AU - Zinner, Maximillian AU - Bieske, Linn AU - Ehlers, P. Jan AU - Boehme, Philip AU - Fehring, Leonard PY - 2021/11/23 TI - Physicians? Attitudes Toward Prescribable mHealth Apps and Implications for Adoption in Germany: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e33012 VL - 9 IS - 11 KW - mobile health KW - mHealth KW - digital health KW - apps KW - physicians KW - general practitioners KW - technology acceptance KW - adoption N2 - Background: In October 2020, Germany became the first country, worldwide, to approve certain mobile health (mHealth) apps, referred to as DiGA (Digitale Gesundheitsanwendungen, in German, meaning digital health applications), for prescription with costs covered by standard statutory health insurance. Yet, this option has only been used to a limited extent so far. Objective: The aim of this study was to investigate physicians? and psychotherapists? current attitudes toward mHealth apps, barriers to adoption, and potential remedies. Methods: We conducted a two-stage sequential mixed methods study. In phase one, semistructured interviews were conducted with physicians and psychotherapists for questionnaire design. In phase two, an online survey was conducted among general practitioners, physicians, and psychotherapists. Results: A total of 1308 survey responses by mostly outpatient-care general practitioners, physicians, and psychotherapists from across Germany who could prescribe DiGA were recorded, making this the largest study on mHealth prescriptions to date. A total of 62.1% (807/1299) of respondents supported the opportunity to prescribe DiGA. Improved adherence (997/1294, 77.0%), health literacy (842/1294, 65.1%), and disease management (783/1294, 60.5%) were most frequently seen as benefits of DiGA. However, only 30.3% (393/1299) of respondents planned to prescribe DiGA, varying greatly by medical specialty. Professionals are still facing substantial barriers, such as insufficient information (1135/1295, 87.6%), reimbursement for DiGA-related medical services (716/1299, 55.1%), medical evidence (712/1298, 54.9%), legal uncertainties (680/1299, 52.3%), and technological uncertainties (658/1299, 50.7%). To support professionals who are unsure of prescribing DiGA, extended information campaigns (1104/1297, 85.1%) as well as recommendations from medical associations (1041/1297, 80.3%) and medical colleagues (1024/1297, 79.0%) were seen as the most impactful remedies. Conclusions: To realize the benefits from DiGA through increased adoption, additional information sharing about DiGA from trusted bodies, reimbursement for DiGA-related medical services, and further medical evidence are recommended. UR - https://mhealth.jmir.org/2021/11/e33012 UR - http://dx.doi.org/10.2196/33012 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817385 ID - info:doi/10.2196/33012 ER - TY - JOUR AU - Baumgartner, L. Susan AU - Buffkin Jr, Eric D. AU - Rukavina, Elise AU - Jones, Jason AU - Weiler, Elizabeth AU - Carnes, C. Tony PY - 2021/11/8 TI - A Novel Digital Pill System for Medication Adherence Measurement and Reporting: Usability Validation Study JO - JMIR Hum Factors SP - e30786 VL - 8 IS - 4 KW - digital pills KW - digital medication KW - ingestible event marker KW - ingestible sensor KW - human factors KW - usability KW - validation study KW - medication adherence KW - medication nonadherence KW - remote patient monitoring KW - mobile phone N2 - Background: Medication nonadherence is a costly problem that is common in clinical use and clinical trials alike, with significant adverse consequences. Digital pill systems have proved to be effective and safe solutions to the challenges of nonadherence, with documented success in improving adherence and health outcomes. Objective: The aim of this human factors validation study is to evaluate a novel digital pill system, the ID-Cap System from etectRx, for usability among patient users in a simulated real-world use environment. Methods: A total of 17 patients with diverse backgrounds who regularly take oral prescription medications were recruited. After training and a period of training decay, the participants were asked to complete 12 patient-use scenarios during which errors or difficulties were logged. The participants were also interviewed about their experiences with the ID-Cap System. Results: The participants ranged in age from 27 to 74 years (mean 51 years, SD 13.8 years), and they were heterogeneous in other demographic factors as well, such as education level, handedness, and sex. In this human factors validation study, the patient users completed 97.5% (196/201) of the total use scenarios successfully; 75.1% (151/201) were completed without any failures or errors. The participants found the ID-Cap System easy to use, and they were able to accurately and proficiently record ingestion events using the device. Conclusions: The participants demonstrated the ability to safely and effectively use the ID-Cap System for its intended use. The ID-Cap System has great potential as a useful tool for encouraging medication adherence and can be easily implemented by patient users. UR - https://humanfactors.jmir.org/2021/4/e30786 UR - http://dx.doi.org/10.2196/30786 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747709 ID - info:doi/10.2196/30786 ER - TY - JOUR AU - Meren, Helena Ülle AU - Waterson, James PY - 2021/11/2 TI - Evaluating An Automated Compounding Workflow Software for Safety and Efficiency: Implementation Study JO - JMIR Hum Factors SP - e29180 VL - 8 IS - 4 KW - compounding KW - medication safety KW - positive patient identification KW - gravimetric KW - automation KW - closed loop N2 - Background: The forms of automation available to the oncology pharmacy range from compounding robotic solutions through to combination workflow software, which can scale-up to cover the entire workflow from prescribing to administration. A solution that offers entire workflow management for oncology is desirable because (in terms of cytotoxic delivery of a regimen to a patient) the chain that starts with prescription and the assay of the patient?s laboratory results and ends with administration has multiple potential safety gaps and choke points. Objective: The aim of this study was to show how incremental change to a core compounding workflow software solution has helped an organization meet goals of improved patient safety; increasing the number of oncology treatments; improving documentation; and improving communication between oncologists, pharmacists, and nurses. We also aimed to illustrate how using this technology flow beyond the pharmacy has extended medication safety to the patient?s bedside through the deployment of a connected solution for confirming and documenting right patient?right medication transactions. Methods: A compounding workflow software solution was introduced for both preparation and documentation, with pharmacist verification of the order, gravimetric checks, and step-by-step on-screen instructions displayed in the work area for the technician. The software supported the technician during compounding by proposing the required drug vial size, diluents, and consumables. Out-of-tolerance concentrations were auto-alerted via an integrated gravimetric scale. A patient-medication label was created. Integration was undertaken between a prescribing module and the compounding module to reduce the risk of transcription errors. The deployment of wireless-connected handheld barcode scanners was then made to allow nurses to use the patient-medication label on each compounded product and to scan patient identification bands to ensure right patient?right prescription. Results: Despite an increase in compounding, with a growth of 12% per annum and no increase in pharmacy headcount, we doubled our output to 14,000 medications per annum through the application of the compounding solution. The use of a handheld barcode scanning device for nurses reduced the time for medication administration from ?6 minutes per item to 41 seconds, with a mean average saving of 5 minutes and 19 seconds per item. When calculated against our throughput of 14,000 items per annum (current production rate via pharmacy), this gives a saving of 3 hours and 24 minutes of nursing time per day, equivalent to 0.425 full-time nurses per annum. Conclusions: The addition of prescribing, compounding, and administration software solutions to our oncology medication chain has increased detection and decreased the risk of error at each stage of the process. The double-checks that the system has built in by virtue of its own systems and through the flow of control of drugs and dosages from physician to pharmacist to nurse allow it to integrate fully with our human systems of risk management. UR - https://humanfactors.jmir.org/2021/4/e29180 UR - http://dx.doi.org/10.2196/29180 UR - http://www.ncbi.nlm.nih.gov/pubmed/34456182 ID - info:doi/10.2196/29180 ER - TY - JOUR AU - Wang, Yi-Chen AU - Tsan, Chin-Yuan AU - Chen, Meng-Chun PY - 2021/9/17 TI - Implementation of an Automated Dispensing Cabinet System and Its Impact on Drug Administration: Longitudinal Study JO - JMIR Form Res SP - e24542 VL - 5 IS - 9 KW - automated dispensing cabinets KW - medication administration system KW - medication errors KW - dispensing KW - medication KW - nursing KW - Taiwan N2 - Background: A technology that has been widely implemented in hospitals in the United States is the automated dispensing cabinet (ADC), which has been shown to reduce nurse drug administration errors and the time nurses spend administering drugs. Objective: This study aimed to determine the impact of an ADC system on medication administration by nurses as well as safety before and after ADC implementation. Methods: We conducted a 24-month-long longitudinal study at the National Taiwan University Hospital in Taipei, Taiwan. Clinical observations and questionnaires were used to evaluate the time differences in drug preparation, delivery, and returns in the inpatient ward by nurses before and after using the ADC. Drug errors recorded in the Medical Incident Events system were assessed the year before and after ADC implementation. Results: The drug preparation time of the wards increased significantly (all P<.005). On average, 2 minutes of preparation time is needed for each patient. Only 1 unit showed an increase in the drug return time, but this was not significant. There were 9 (45%) adverse events during the drug administration phase, and 11 (55%) events occurred during the drug-dispensing phase. Although a decrease in the mean number of events reported was observed during the ADC implementation period, this difference was not significant. As for the questionnaire that were administered to the nurses, the overall mean score was 3.90; the highest score was for the item ?I now spend less time waiting for medications that come from the pharmacy than before the ADC was implemented? (score=4.24). The item with the lowest score was ?I have to wait in line to get my patient medications? (score=3.32). Conclusions: The nurses were generally satisfied with ADC use over the 9 months following complete implementation and integration of the system. It was acknowledged that the ADC offers benefits in terms of pharmaceutical stock management; however, this comes at the cost of increased nursing time. In general, the nurses remained supportive of the benefits for their patients, despite consequences to their workflows. Their acceptance of the ADC system in this study demonstrates this. UR - https://formative.jmir.org/2021/9/e24542 UR - http://dx.doi.org/10.2196/24542 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533467 ID - info:doi/10.2196/24542 ER - TY - JOUR AU - Momattin, Hisham AU - Arafa, Shokry AU - Momattin, Shahad AU - Rahal, Rayan AU - Waterson, James PY - 2021/9/1 TI - Robotic Pharmacy Implementation and Outcomes in Saudi Arabia: A 21-Month Usability Study JO - JMIR Hum Factors SP - e28381 VL - 8 IS - 3 KW - patient satisfaction KW - automation KW - integration KW - medication error KW - outpatient KW - medication management KW - usability KW - medication dispensing KW - robotics KW - pharmacy KW - medication records KW - error KW - record KW - implementation KW - outcome N2 - Background: We describe the introduction, use, and evaluation of an automation and integration pharmacy development program in a private facility in Saudi Arabia. The project was specifically undertaken to increase throughput, reduce medication dispensing error rates, improve patient satisfaction, and free up pharmacists? time to allow for increased face-to-face consultations with patients. Objective: We forecasted growth of our outpatient service at 25% per annum over 5- and 10-year horizons and set out to prepare our outpatient pharmacy service to meet this demand. Initial project goals were set as a 50% reduction in the average patient wait time, a 15% increase in patient satisfaction regarding pharmacy wait time and pharmacy services, a 25% increase in pharmacist productivity, and zero dispensing errors. This was expected to be achieved within 10 months of go-live. Realignment of pharmacist activity toward counseling and medication review with patients was a secondary goal, along with the rapid development of a reputation in the served community for patient-centered care. Methods: Preimplementation data for patient wait time for dispensing of prescribed medications as a specific measure of patient satisfaction was gathered as part of wider ongoing data collection in this field. Pharmacist activity and productivity in terms of patient interaction time were gathered. Reported and discovered dispensing errors per 1000 prescriptions were also aggregated. All preimplementation data was gathered over an 11-month period. Results: From go-live, data were gathered on the above metrics in 1-month increments. At the 10-month point, there had been a 53% reduction in the average wait time, a 20% increase in patient satisfaction regarding pharmacy wait time, with a 22% increase in overall patient satisfaction regarding pharmacy services, and a 33% increase in pharmacist productivity. A zero dispensing error rate was reported. Conclusions: The robotic pharmacy solution studied was highly effective, but a robust upstream supply chain is vital to ensure stock levels, particularly when automated filling is planned. The automation solution must also be seamlessly and completely integrated into the facility?s software systems for appointments, medication records, and prescription generation in order to garner its full benefits. Overall patient satisfaction with pharmacy services is strongly influenced by wait time and follow-up studies are required to identify how to use this positive effect and make optimal use of freed-up pharmacist time. The extra time spent by pharmacists with patients and the opportunity for complete overview of the patient?s medication history, which full integration provides, may allow us to address challenging issues such as medication nonadherence. Reduced wait times may also allow for smaller prescription fill volumes, and more frequent outpatient department visits, allowing patients to have increased contact time with pharmacists. UR - https://humanfactors.jmir.org/2021/3/e28381 UR - http://dx.doi.org/10.2196/28381 UR - http://www.ncbi.nlm.nih.gov/pubmed/34304149 ID - info:doi/10.2196/28381 ER - TY - JOUR AU - Sääskilahti, Maria AU - Ahonen, Riitta AU - Timonen, Johanna PY - 2021/7/16 TI - Pharmacy Customers? Experiences of Use, Usability, and Satisfaction of a Nationwide Patient Portal: Survey Study JO - J Med Internet Res SP - e25368 VL - 23 IS - 7 KW - patient portal KW - electronic prescription KW - electronic health records KW - usability KW - pharmacy customer KW - perception KW - experience KW - survey N2 - Background: Patient portals have been introduced in several countries in the last few decades. Despite worldwide objectives of introducing patient portals, nationwide portals are rare, and studies about their use are limited. Finland is one of the forerunners in developing nationwide health data systems. A nationwide patient portal, My Kanta, for viewing electronic prescriptions and health data has been phased in, starting in 2010. Objective: The aim of this study was to investigate what functions Finnish pharmacy customers use in My Kanta, their perceptions of the service?s usability, and how satisfied users are with My Kanta overall. Methods: In spring 2019, questionnaires (N=2866) were distributed from 18 pharmacies of varying size across mainland Finland to adult pharmacy customers purchasing prescription medications for themselves or for their child under 18 years of age. Questions were asked about the use and usability of the patient portal by means of structured and Likert-scale questions. Statistical analyses included frequencies, means, medians, chi-square tests, Fisher exact tests, and Kruskal-Wallis tests. Results: In total, 994 completed questionnaires of 2866 delivered questionnaires (34.68%) were returned. The most-used My Kanta functions were browsing prescription information (781/802, 97.4%), records of health care visits (772/802, 96.3%), and results of laboratory tests and x-ray examinations (722/804, 89.8%). Most users (558/793, 70.4%) had also requested a prescription renewal using the service. My Kanta was perceived as easy to log into (772/816, 94.6%) and clear to view (709/808, 87.7%). Most users considered the service useful for monitoring their health information (753/813, 92.6%) and felt that it provides a good overall picture of the medications prescribed to them (711/813, 87.5%). The majority of users found the information recorded about them easy to understand (684/800, 85.5%). Of the users, 16.7% (135/807) disagreed with the statement that the information they were looking for was easy to find. Approximately two-thirds (501/814, 61.5%) of users did not know whether it is easy to view in which pharmacies and health care units their prescription information has been viewed, and over one-third (306/805, 38.0%) did not know whether it is easy to view in which health care units their health information has been processed. Approximately one-fifth of participants (181/805, 22.5%) feared that unauthorized persons might view their information and that their electronically saved prescription and health information might disappear (180/810, 22.2%). In addition, 16.1% (129/799) expressed interest in receiving guidance on My Kanta use. The vast majority of users (719/804, 89.4%) were satisfied with the service overall. Conclusions: Pharmacy customers were satisfied with the nationwide patient portal. It was mostly used for browsing e-prescriptions and medical records. Overall, the usability of the service was good. However, users need to be better informed about data privacy and security issues, and guidance on using the portal needs to be improved. UR - https://www.jmir.org/2021/7/e25368 UR - http://dx.doi.org/10.2196/25368 UR - http://www.ncbi.nlm.nih.gov/pubmed/34269687 ID - info:doi/10.2196/25368 ER - TY - JOUR AU - Rindal, Brad D. AU - Asche, E. Stephen AU - Gryczynski, Jan AU - Kane, M. Sheryl AU - Truitt, R. Anjali AU - Shea, L. Tracy AU - Ziegenfuss, Y. Jeanette AU - Schwartz, P. Robert AU - Worley, C. Donald AU - Mitchell, G. Shannon PY - 2021/4/12 TI - De-Implementing Opioid Use and Implementing Optimal Pain Management Following Dental Extractions (DIODE): Protocol for a Cluster Randomized Trial JO - JMIR Res Protoc SP - e24342 VL - 10 IS - 4 KW - analgesics KW - opioid KW - prescriptions KW - tooth extraction KW - pain, postoperative KW - dentistry KW - oral surgery KW - shared decision-making KW - health communications KW - implementation science N2 - Background: Overdose deaths from prescription opioid analgesics are a continuing crisis in the United States. Opioid analgesics are among the most frequently prescribed drugs by dentists. An estimated 5 million people undergo third-molar extractions in the United States each year, resulting in postoperative pain. Studies show that, in most cases, the combination of ibuprofen and acetaminophen is an effective alternative to commonly prescribed opioid analgesics for the management of postextraction pain. Nevertheless, many dentists routinely prescribe opioids after dental extractions. Objective: We describe the rationale, design, and methods for a randomized trial of interventions designed to de-implement opioid prescribing by dentists while implementing effective nonopioid analgesics following dental extractions. Methods: Using a prospective, 3-arm, cluster randomized trial design with dentists as the unit randomized and patient-level prescribing data as the primary outcome, we will compare different strategies to reduce the reliance on opioids and increase the use of alternative pain management approaches utilizing information support tools aimed at both providers and their patients. The study will test the efficacy of 2 interventions to decrease opioid prescribing following dental extractions: clinical decision support with (CDS-E) and without patient education (CDS). Providers will be randomized to CDS, CDS-E, or standard practice. Patient-level outcomes will be determined via review of comprehensive electronic health records. We will compare study arms on differential change in prescribing patterns from pre- to postimplementation of the intervention. The primary outcome of interest is a binary indicator of whether or not the patient received an opioid prescription on the day of the extraction encounter. We will also examine recommendations or prescriptions for nonopioid analgesics, patients? perceptions of shared decision making, and patients? pain experiences following the extraction. Results: The HealthPartners Institutional Review Board approved the study. All study materials including the CDS and patient education materials have been developed and pilot tested, and the protocol has been approved by the National Institute of Dental and Craniofacial Research. The intervention was implemented in February 2020, with 51 dentists who were randomized to 1 of the 3 arms. Conclusions: If the intervention strategies are shown to be effective, they could be implemented more broadly in dental settings with high levels of opioid prescribing. Trial Registration: ClinicalTrials.gov NCT03584789, https://clinicaltrials.gov/ct2/show/NCT03584789 International Registered Report Identifier (IRRID): DERR1-10.2196/24342 UR - https://www.researchprotocols.org/2021/4/e24342 UR - http://dx.doi.org/10.2196/24342 UR - http://www.ncbi.nlm.nih.gov/pubmed/33843594 ID - info:doi/10.2196/24342 ER - TY - JOUR AU - Yang, Lin-Ya AU - Lyons, G. Jennifer AU - Erickson, R. Steven AU - Wu, Chung-Hsuen PY - 2021/3/16 TI - Trends and Characteristics of the US Adult Population?s Behavioral Patterns in Web-Based Prescription Filling: National Survey Study JO - J Med Internet Res SP - e23662 VL - 23 IS - 3 KW - internet KW - prescription KW - online pharmacy KW - National Health Interview Survey KW - trend N2 - Background: Filling a prescription on the web has become an alternative to in-person pharmacies for individuals to access their medications. However, the adoption of web-based filling has been gradual, and the use patterns remain to be unclear. Objective: This study aims to estimate the trend and prevalence of web-based prescription-filling behavior and identify associated factors among adults in the United States. Methods: We used data from the US National Health Interview Survey (NHIS) from 2009 to 2018. Adult respondents (aged ?18 years and over) self-reported their behavior of web-based prescription filling, which was defined as having filled a prescription using the internet in the past 12 months during the survey year. We reported trends using weighted percentages adjusted by the NHIS complex sampling design. We used descriptive statistics and multivariable logistic regression models to examine trends and identify factors associated with web-based prescription-filling behavior. Results: The estimated number of adults reporting web-based prescription-filling behavior significantly increased from 13,319,877 (13,319,877/225,217,942, 5.91%) in 2009 to 28,308,262 (28,308,262/246,611,125, 11.48%) in 2018 (P<.001). Those who were more likely to report filling a prescription on the web were aged between 35 and 74 years, female, White, and frequent users of the computer or internet; these adults also reported higher education, higher income, insurance coverage, and poorer health status. Conclusions: Web-based prescription-filling behavior among US adults has increased significantly from 2009 to 2018. Health care providers should be aware of the upward trend in the use of web-based pharmacies and ensure the clinical safety of web-based prescriptions. UR - https://www.jmir.org/2021/3/e23662 UR - http://dx.doi.org/10.2196/23662 UR - http://www.ncbi.nlm.nih.gov/pubmed/33724193 ID - info:doi/10.2196/23662 ER - TY - JOUR AU - So, Hong Kei AU - Ting, Wun Cheuk AU - Lee, Ping Chui AU - Lam, Tai-Ning Teddy AU - Chiang, Chu Sau AU - Cheung, Ting Yin PY - 2021/2/10 TI - Medication Management Service for Old Age Homes in Hong Kong Using Information Technology, Automation Technology, and the Internet of Things: Pre-Post Interventional Study JO - JMIR Med Inform SP - e24280 VL - 9 IS - 2 KW - medication management KW - old age homes KW - information technology KW - automation KW - Internet of Things N2 - Background: Innovation in technology and automation has been increasingly used to improve conventional medication management processes. In Hong Kong, the current practices of medication management in old age homes (OAHs) are time consuming, labor intensive, and error prone. To address this problem, we initiated an integrated medication management service combining information technology, automation technology, and the Internet of Things in a cluster network of OAHs. Objective: This pilot study aimed to evaluate the impact of the medication management program on (1) medication management efficiency, (2) medication safety, and (3) drug wastage in OAHs. We compared the time efficiency and the reductions in medication errors and medication wastage in OAHs before and at least 2 weeks after the implementation of the program. Methods: From November 2019 to February 2020, we recruited 2 OAHs (serving 178 residents) in Hong Kong into the prospective, pre-post interventional study. The interventional program consisted of electronic medication profiles, automated packaging, and electronic records of medication administration. Using 3-way analysis of variance, we compared the number of doses prepared and checked in 10-minute blocks before and after implementation. We received anonymous reports of medication errors from OAH staff and analyzed the results with the Fisher exact test. We also calculated the quantity and cost of wasted medications from drug disposal reports. Results: The number of doses prepared and checked in 10-minute blocks significantly increased postimplementation (pre: 41.3, SD 31.8; post: 70.6, SD 22.8; P<.001). There was also a significant reduction in medication errors (pre: 10/9504 doses, 0.1%; post: 0/5731 doses; P=.02). The total costs of wasted medications during January 2020 in OAH 1 (77 residents) and OAH 2 (101 residents) were HK $2566.03 (US $328.98) and HK $5249.48 (US $673.01), respectively. Conclusions: Our pilot study suggested that an innovative medication management program with information technology, automation technology, and Internet of Things components improved the time efficiency of medication preparation and medication safety for OAHs. It is a promising solution to address the current limitations in medication management in OAHs in Hong Kong. UR - http://medinform.jmir.org/2021/2/e24280/ UR - http://dx.doi.org/10.2196/24280 UR - http://www.ncbi.nlm.nih.gov/pubmed/33565993 ID - info:doi/10.2196/24280 ER - TY - JOUR AU - Chin, Harvey Yen Po AU - Song, Wenyu AU - Lien, En Chia AU - Yoon, Ho Chang AU - Wang, Wei-Chen AU - Liu, Jennifer AU - Nguyen, Anh Phung AU - Feng, Ting Yi AU - Zhou, Li AU - Li, Jack Yu Chuan AU - Bates, Westfall David PY - 2021/1/27 TI - Assessing the International Transferability of a Machine Learning Model for Detecting Medication Error in the General Internal Medicine Clinic: Multicenter Preliminary Validation Study JO - JMIR Med Inform SP - e23454 VL - 9 IS - 1 KW - electronic health records KW - patient safety KW - clinical decision support KW - medication alert systems KW - machine learning N2 - Background: Although most current medication error prevention systems are rule-based, these systems may result in alert fatigue because of poor accuracy. Previously, we had developed a machine learning (ML) model based on Taiwan?s local databases (TLD) to address this issue. However, the international transferability of this model is unclear. Objective: This study examines the international transferability of a machine learning model for detecting medication errors and whether the federated learning approach could further improve the accuracy of the model. Methods: The study cohort included 667,572 outpatient prescriptions from 2 large US academic medical centers. Our ML model was applied to build the original model (O model), the local model (L model), and the hybrid model (H model). The O model was built using the data of 1.34 billion outpatient prescriptions from TLD. A validation set with 8.98% (60,000/667,572) of the prescriptions was first randomly sampled, and the remaining 91.02% (607,572/667,572) of the prescriptions served as the local training set for the L model. With a federated learning approach, the H model used the association values with a higher frequency of co-occurrence among the O and L models. A testing set with 600 prescriptions was classified as substantiated and unsubstantiated by 2 independent physician reviewers and was then used to assess model performance. Results: The interrater agreement was significant in terms of classifying prescriptions as substantiated and unsubstantiated (?=0.91; 95% CI 0.88 to 0.95). With thresholds ranging from 0.5 to 1.5, the alert accuracy ranged from 75%-78% for the O model, 76%-78% for the L model, and 79%-85% for the H model. Conclusions: Our ML model has good international transferability among US hospital data. Using the federated learning approach with local hospital data could further improve the accuracy of the model. UR - http://medinform.jmir.org/2021/1/e23454/ UR - http://dx.doi.org/10.2196/23454 UR - http://www.ncbi.nlm.nih.gov/pubmed/33502331 ID - info:doi/10.2196/23454 ER - TY - JOUR AU - Chen, Zhuo-Jia AU - Liang, Wei-Ting AU - Liu, Qing AU - He, Rong AU - Chen, Qian-Chao AU - Li, Qiu-Feng AU - Zhang, Yao AU - Du, Xiao-Dong AU - Pan, Ying AU - Liu, Shu AU - Li, Xiao-Yan AU - Wei, Xue AU - Huang, He AU - Huang, Hong-Bing AU - Liu, Tao PY - 2021/1/21 TI - Use of a Remote Oncology Pharmacy Service Platform for Patients With Cancer During the COVID-19 Pandemic: Implementation and User Acceptance Evaluation JO - J Med Internet Res SP - e24619 VL - 23 IS - 1 KW - COVID-19 KW - cancer patients KW - remote pharmacy KW - service platform KW - implementation KW - oncology KW - pharmacy KW - online platform KW - cancer KW - health management KW - app KW - online hospital KW - acceptance KW - impact N2 - Background: The COVID-19 outbreak has increased challenges associated with health management, especially cancer management. In an effort to provide continuous pharmaceutical care to cancer patients, Sun Yat-sen University Cancer Center (SYSUCC) implemented a remote pharmacy service platform based on its already existing web-based hospital app known as Cloud SYSUCC. Objective: The aim of this study was to investigate the characteristics, acceptance, and initial impact of the Cloud SYSUCC app during a COVID-19 outbreak in a tertiary cancer hospital in China. Methods: The total number of online prescriptions and detailed information on the service were obtained during the first 6 months after the remote service platform was successfully set up. The patients? gender, age, residence, primary diagnosis, drug classification, weekly number of prescriptions, and prescribed drugs were analyzed. In addition, a follow-up telephonic survey was conducted to evaluate patients? satisfaction in using the remote prescription service. Results: A total of 1718 prescriptions, including 2022 drugs for 1212 patients, were delivered to 24 provinces and municipalities directly under the Central Government of China between February 12, 2020, and August 11, 2020. The majority of patients were female (841/1212, 69.39%), and 90.18% (1093/1212) of them were aged 31-70 years old. The top 3 primary diagnoses for which remote medical prescriptions were made included breast cancer (599/1212, 49.42%), liver cancer (249/1212, 20.54%), and thyroid cancer (125/1212, 10.31%). Of the 1718 prescriptions delivered, 1435 (83.5%) were sent to Guangdong Province and 283 (16.5%) were sent to other provinces in China. Of the 2022 drugs delivered, 1012 (50.05%) were hormonal drugs. The general trend in the use of the remote prescription service declined since the 10th week. A follow-up telephonic survey found that 88% (88/100) of the patients were very satisfied, and 12% (12/100) of the patients were somewhat satisfied with the remote pharmacy service platform. Conclusions: The remote pharmacy platform Cloud SYSUCC is efficient and convenient for providing continuous pharmaceutical care to patients with cancer during the COVID-19 crisis. The widespread use of this platform can help to reduce person-to-person transmission as well as infection risk for these patients. Further efforts are needed to improve the quality and acceptance of the Cloud SYSUCC platform, as well as to regulate and standardize the management of this novel service. UR - http://www.jmir.org/2021/1/e24619/ UR - http://dx.doi.org/10.2196/24619 UR - http://www.ncbi.nlm.nih.gov/pubmed/33395398 ID - info:doi/10.2196/24619 ER - TY - JOUR AU - Sragow, Michael Howard AU - Bidell, Eileen AU - Mager, Douglas AU - Grannis, Shaun PY - 2020/11/20 TI - Universal Patient Identifier and Interoperability for Detection of Serious Drug Interactions: Retrospective Study JO - JMIR Med Inform SP - e23353 VL - 8 IS - 11 KW - patient identification KW - pharmacy benefit manager KW - interoperability KW - adverse drug event KW - identity management KW - identifier KW - pharmacy KW - pharmaceuticals KW - drug N2 - Background: The United States, unlike other high-income countries, currently has no national unique patient identifier to facilitate health information exchange. Because of security and privacy concerns, Congress, in 1998, prevented the government from promulgating a unique patient identifier. The Health and Human Services funding bill that was enacted in 2019 requires that Health and Human Services report their recommendations on patient identification to Congress. While there are anecdotes of incomplete health care data due to patient misidentification, to date there have been insufficient large-scale analyses measuring improvements to patient care that a unique patient identifier might provide. This lack of measurement has made it difficult for policymakers to balance security and privacy concerns against the value of potential improvements. Objective: We sought to determine the frequency of serious drug-drug interaction alerts discovered because a pharmacy benefits manager uses a universal patient identifier and estimate undiscovered serious drug-drug interactions because pharmacy benefit managers do not yet fully share patient records. Methods: We conducted a retrospective study of serious drug-drug interaction alerts provided from September 1, 2016 to August 31, 2019 to retail pharmacies by a national pharmacy benefit manager that uses a unique patient identifier. We compared each alert to the contributing prescription and determined whether the unique patient identifier was necessary in order to identify the crossover alert. We classified each alert?s disposition as override, abandonment, or replacement. Using the crossover alert rate and sample population size, we inferred a rate of missing serious drug-drug interaction alerts for the United States. We performed logistic regression in order to identify factors correlated with crossover and alert outcomes. Results: Among a population of 49.7 million patients, 242,646 serious drug-drug interaction alerts occurred in 3 years. Of these, 2388 (1.0%) crossed insurance and were discovered because the pharmacy benefit manager used a unique patient identifier. We estimate that up to 10% of serious drug-drug alerts in the United States go undetected by pharmacy benefit managers because of unexchanged information or pharmacy benefit managers that do not use a unique patient identifier. These information gaps may contribute, annually, to up to 6000 patients in the United States receiving a contraindicated medication. Conclusions: Comprehensive patient identification across disparate data sources can help protect patients from serious drug-drug interactions. To better safeguard patients, providers should (1) adopt a comprehensive patient identification strategy and (2) share patient prescription history to improve clinical decision support. UR - http://medinform.jmir.org/2020/11/e23353/ UR - http://dx.doi.org/10.2196/23353 UR - http://www.ncbi.nlm.nih.gov/pubmed/33216009 ID - info:doi/10.2196/23353 ER - TY - JOUR AU - Fung, To Eunice Wing AU - Au-Yeung, Fung Gordon Tsz AU - Tsoi, Mei Lo AU - Qu, Lili AU - Cheng, Wa Tommy Kwan AU - Chong, Wing-Kit Donald AU - Lam, Ning Teddy Tai AU - Cheung, Ting Yin PY - 2020/11/10 TI - Pharmacists? Perceptions of the Benefits and Challenges of Electronic Product Information System Implementation in Hong Kong: Mixed-Method Study JO - J Med Internet Res SP - e20765 VL - 22 IS - 11 KW - electronic product information KW - drug information system KW - electronic health information KW - health care professionals KW - retrieval of health information N2 - Background: With the advancement of technology, more countries are now adopting the use of electronic product information (ePI), which refer to an electronic version of physical product inserts in a semistructured format optimized for electronic manipulation. The successful implementation of ePI has led to advantages and convenience to patients, health care professionals, and pharmaceutical companies in many regions and countries. In the Hong Kong Special Administrative Region (SAR), there is currently no citywide implementation of ePI. The SAR exhibits conditions that would favor the implementation of an ePI system, as well as existing barriers hindering its implementation. However, no study has been performed to examine the specific situation in Hong Kong. Objective: The objective of this study is to explore working pharmacists? overall perception of ePI and to identify potential challenges to the implementation of an ePI system in Hong Kong. Methods: This mixed-method study involved a structured survey and interview with practicing pharmacists in Hong Kong. Pharmacists were eligible if they were licensed to practice in Hong Kong, and currently working locally in any pharmacy-related sectors and institutions. Respondents completed a survey to indicate their level of agreement with statements regarding the potential advantages of ePI over paper PI. A structured interview was conducted to gather respondents? perceived advantages of ePI over paper PI in different aspects, such as professionalism, usability, presentation, and environment, as well as challenges of citywide ePI implementation in Hong Kong. Thematic analysis was adopted to analyze the qualitative data. Grounded theory was used to generate themes and identify specific outcomes. Results: A total of 16 pharmacists were recruited, comprising 4 community pharmacists, 5 hospital pharmacists, and 7 industrial pharmacists. All of them used electronic platforms at least once per month on average. Respondents identified many flaws in physical package inserts that can potentially be mitigated using ePI. The speed with which drug information can be retrieved and the degree to which the drug information can be readily updated and disseminated were considered the greatest strengths of ePI. The clarity with which ePI present drug information to patients was considered as the weakest aspect of ePI. Many respondents highlighted concerns about the security risks and high cost associated with system maintenance and that certain subpopulations may not be sufficiently computer literate to navigate the ePI system. Respondents also voiced many concerns about the implementation and maintenance of a local ePI system. Conclusions: We conclude that an ePI system is generally supported by pharmacists but concerns about implementation process and maintenance of the system has been raised. The perceived benefits of ePI gathered from this study, as well as collective evidence from other countries with mature ePI systems, confirm that more efforts should be made to promote optimized development and implementation of an ePI system in Hong Kong. UR - http://www.jmir.org/2020/11/e20765/ UR - http://dx.doi.org/10.2196/20765 UR - http://www.ncbi.nlm.nih.gov/pubmed/33170130 ID - info:doi/10.2196/20765 ER - TY - JOUR AU - Ding, Liang AU - She, Qiuru AU - Chen, Fengxian AU - Chen, Zitong AU - Jiang, Meifang AU - Huang, Huasi AU - Li, Yujin AU - Liao, Chaofeng PY - 2020/8/6 TI - The Internet Hospital Plus Drug Delivery Platform for Health Management During the COVID-19 Pandemic: Observational Study JO - J Med Internet Res SP - e19678 VL - 22 IS - 8 KW - internet hospital KW - drug delivery KW - internet hospital plus drug delivery KW - IHDD KW - health management KW - COVID-19 N2 - Background: Widespread access to the internet has boosted the emergence of online hospitals. A new outpatient service called ?internet hospital plus drug delivery? (IHDD) has been developed in China, but little is known about this platform. Objective: The aim of this study is to investigate the characteristics, acceptance, and initial impact of IHDD during the outbreak of COVID-19 in a tertiary hospital in South China Methods: The total number of and detailed information on online prescriptions during the first 2 months after work resumption were obtained. Patients? gender, age, residence, associated prescription department, time of prescription, payment, and drug delivery region were included in the analysis. Results: A total of 1380 prescriptions were picked up or delivered between March 2 and April 20, 2020. The largest group of patients were 36-59 years old (n=680, 49.3%), followed by the 18-35 years age category (n=573, 41.5%). In total, 39.4% (n=544) of the patients chose to get their medicine by self-pickup, while 60.6% (n=836) preferred to receive their medicine via drug delivery service. The top five online prescription departments were infectious diseases (n=572, 41.4%), nephrology (n=264, 19.1%), endocrinology (n=145, 10.5%), angiocardiopathy (n=107, 7.8%), and neurology (n=42, 3%). Of the 836 delivered prescriptions, 440 (52.6%) were sent to Guangdong Province (including 363 [43.4%] to Shenzhen), and 396 (47.4%) were sent to other provinces in China. Conclusions: The IHDD platform is efficient and convenient for various types of patients during the COVID-19 crisis. Although offline visits are essential for patients with severe conditions, IHDD can help to relieve pressure on hospitals by reducing an influx of patients with mild symptoms. Further efforts need to be made to improve the quality and acceptance of IHDD, as well as to regulate and standardize the management of this novel service. UR - http://www.jmir.org/2020/8/e19678/ UR - http://dx.doi.org/10.2196/19678 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716892 ID - info:doi/10.2196/19678 ER - TY - JOUR AU - Poly, Nasrin Tahmina AU - Islam, Md.Mohaimenul AU - Yang, Hsuan-Chia AU - Li, (Jack) Yu-Chuan PY - 2020/7/20 TI - Appropriateness of Overridden Alerts in Computerized Physician Order Entry: Systematic Review JO - JMIR Med Inform SP - e15653 VL - 8 IS - 7 KW - clinical decision system KW - computerized physician order entry KW - alert fatigue KW - override KW - patient safety N2 - Background: The clinical decision support system (CDSS) has become an indispensable tool for reducing medication errors and adverse drug events. However, numerous studies have reported that CDSS alerts are often overridden. The increase in override rates has raised questions about the appropriateness of CDSS application along with concerns about patient safety and quality of care. Objective: The aim of this study was to conduct a systematic review to examine the override rate, the reasons for the alert override at the time of prescribing, and evaluate the appropriateness of overrides. Methods: We searched electronic databases, including Google Scholar, PubMed, Embase, Scopus, and Web of Science, without language restrictions between January 1, 2000 and March 31, 2019. Two authors independently extracted data and crosschecked the extraction to avoid errors. The quality of the included studies was examined following Cochrane guidelines. Results: We included 23 articles in our systematic review. The range of average override alerts was 46.2%-96.2%. An average of 29.4%-100% of the overrides alerts were classified as appropriate, and the rate of appropriateness varied according to the alert type (drug-allergy interaction 63.4%-100%, drug-drug interaction 0%-95%, dose 43.9%-88.8%, geriatric 14.3%-57%, renal 27%-87.5%). The interrater reliability for the assessment of override alerts appropriateness was excellent (kappa=0.79-0.97). The most common reasons given for the override were ?will monitor? and ?patients have tolerated before.? Conclusions: The findings of our study show that alert override rates are high, and certain categories of overrides such as drug-drug interaction, renal, and geriatric were classified as inappropriate. Nevertheless, large proportions of drug duplication, drug-allergy, and formulary alerts were appropriate, suggesting that these groups of alerts can be primary targets to revise and update the system for reducing alert fatigue. Future efforts should also focus on optimizing alert types, providing clear information, and explaining the rationale of the alert so that essential alerts are not inappropriately overridden. UR - https://medinform.jmir.org/2020/7/e15653 UR - http://dx.doi.org/10.2196/15653 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706721 ID - info:doi/10.2196/15653 ER - TY - JOUR AU - KC, Bhuvan AU - Lim, Dorothy AU - Low, Chia Chia AU - Chew, Connie AU - Blebil, Qais Ali AU - Dujaili, Abdulelah Juman AU - Alrasheedy, A. Alian PY - 2020/7/8 TI - Positioning and Utilization of Information and Communication Technology in Community Pharmacies of Selangor, Malaysia: Cross-Sectional Study JO - JMIR Med Inform SP - e17982 VL - 8 IS - 7 KW - information and communication technology KW - community pharmacy KW - Malaysia KW - pharmacy services N2 - Background: Information and communication technology (ICT) is an essential element of modern ?smart? cities. These smart cities have integrated housing, marketplace, public amenities, services, business, and transportation via ICT. ICT is also now widely used in urban health care delivery. Objective: The aim of this study was to determine the positioning and roles of ICT in community pharmacies in the state of Selangor, Malaysia. Methods: A cross-sectional study was conducted from November 2018 to January 2019 across 9 different subdistricts in the state of Selangor, including Subang Jaya, Cheras, Puchong, Port Klang, Kota Kemuning, Selayang, Chow Kit, Ampang, and Seri Kembangan. A total of 90 community pharmacists were approached from the 9 subdistricts and invited to participate in the study. Results: Of the 90 community pharmacies approached, 60 agreed to participate in the study, representing a response rate of 67%. The majority (36/60, 60%) of the respondents were women, and more than half (32/60, 53%) of the community pharmacies were run by young adults (ie, 30 years old and younger). More than three-quarters of the community pharmacies (46/60, 77%) used electronic health records. Half of the community pharmacies used online social media platforms for advertising and promoting their pharmacies. The vast majority of the community pharmacies (55/60, 92%) were using modern electronic payment systems, and some were also using other new electronic payment methods. Moreover, most of the community pharmacies (41/60, 68%) were using software and programs for accounting and logistics purposes. In addition, 47/60 (78%) of the community pharmacies used a barcode reading system for medicines/health products, and 16/60 (27%) of the pharmacies had online stores, and consumers could buy medicines and health products from these pharmacies via their online portal. In addition, 20/60 (33%) of the community pharmacies used at least one of the common online business platforms available in Southeast Asia to sell products/medicines. The telephone was the most commonly used means of communication with patients, although some pharmacies also used email, WhatsApp, SMS text messaging, and other communication platforms. Conclusions: This study showed that the majority of community pharmacies in Selangor, Malaysia are using ICT for different purposes. However, there is still limited use of mobile apps to provide health services. Overall, community pharmacies have been adopting ICT apps for pharmacy services but the rate of adoption is relatively slower than that in other sectors of Malaysia. UR - https://medinform.jmir.org/2020/7/e17982 UR - http://dx.doi.org/10.2196/17982 UR - http://www.ncbi.nlm.nih.gov/pubmed/32463787 ID - info:doi/10.2196/17982 ER - TY - JOUR AU - Downie, Simon Aron AU - Hancock, Mark AU - Abdel Shaheed, Christina AU - McLachlan, J. Andrew AU - Kocaballi, Baki Ahmet AU - Williams, M. Christopher AU - Michaleff, A. Zoe AU - Maher, G. Chris PY - 2020/5/11 TI - An Electronic Clinical Decision Support System for the Management of Low Back Pain in Community Pharmacy: Development and Mixed Methods Feasibility Study JO - JMIR Med Inform SP - e17203 VL - 8 IS - 5 KW - low back pain KW - community pharmacy KW - decision support systems, clinical N2 - Background: People with low back pain (LBP) in the community often do not receive evidence-based advice and management. Community pharmacists can play an important role in supporting people with LBP as pharmacists are easily accessible to provide first-line care. However, previous research suggests that pharmacists may not consistently deliver advice that is concordant with guideline recommendations and may demonstrate difficulty determining which patients require prompt medical review. A clinical decision support system (CDSS) may enhance first-line care of LBP, but none exists to support the community pharmacist?client consultation. Objective: This study aimed to develop a CDSS to guide first-line care of LBP in the community pharmacy setting and to evaluate the pharmacist-reported usability and acceptance of the prototype system. Methods: A cross-platform Web app for the Apple iPad was developed in conjunction with academic and clinical experts using an iterative user-centered design process during interface design, clinical reasoning, program development, and evaluation. The CDSS was evaluated via one-to-one user-testing with 5 community pharmacists (5 case vignettes each). Data were collected via video recording, screen capture, survey instrument (system usability scale), and direct observation. Results: Pharmacists? agreement with CDSS-generated self-care recommendations was 90% (18/20), with medicines recommendations was 100% (25/25), and with referral advice was 88% (22/25; total 70 recommendations). Pharmacists expressed uncertainty when screening for serious pathology in 40% (10/25) of cases. Pharmacists requested more direction from the CDSS in relation to automated prompts for user input and page navigation. Overall system usability was rated as excellent (mean score 92/100, SD 6.5; 90th percentile compared with similar systems), with acceptance rated as good to excellent. Conclusions: A novel CDSS (high-fidelity prototype) to enhance pharmacist care of LBP was developed, underpinned by clinical practice guidelines and informed by a multidisciplinary team of experts. User-testing revealed a high level of usability and acceptance of the prototype system, with suggestions to improve interface prompts and information delivery. The small study sample limits the generalizability of the findings but offers important insights to inform the next stage of system development. UR - https://medinform.jmir.org/2020/5/e17203 UR - http://dx.doi.org/10.2196/17203 UR - http://www.ncbi.nlm.nih.gov/pubmed/32390593 ID - info:doi/10.2196/17203 ER - TY - JOUR AU - Ramirez, Magaly AU - Chen, Kimberly AU - Follett, W. Robert AU - Mangione, M. Carol AU - Moreno, Gerardo AU - Bell, S. Douglas PY - 2020/4/17 TI - Impact of a ?Chart Closure? Hard Stop Alert on Prescribing for Elevated Blood Pressures Among Patients With Diabetes: Quasi-Experimental Study JO - JMIR Med Inform SP - e16421 VL - 8 IS - 4 KW - decision support systems, clinical KW - diabetes mellitus KW - hypertension KW - drug prescriptions N2 - Background: University of California at Los Angeles Health implemented a Best Practice Advisory (BPA) alert for the initiation of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) for individuals with diabetes. The BPA alert was configured with a ?chart closure? hard stop, which demanded a response before closing the chart. Objective: The aim of the study was to evaluate whether the implementation of the BPA was associated with changes in ACEI and ARB prescribing during primary care encounters for patients with diabetes. Methods: We defined ACEI and ARB prescribing opportunities as primary care encounters in which the patient had a diabetes diagnosis, elevated blood pressure in recent encounters, no active ACEI or ARB prescription, and no contraindications. We used a multivariate logistic regression model to compare the change in the probability of an ACEI or ARB prescription during opportunity encounters before and after BPA implementation in primary care sites that did (n=30) and did not (n=31) implement the BPA. In an additional subgroup analysis, we compared ACEI and ARB prescribing in BPA implementation sites that had also implemented a pharmacist-led medication management program. Results: We identified a total of 2438 opportunity encounters across 61 primary care sites. The predicted probability of an ACEI or ARB prescription increased significantly from 11.46% to 22.17% during opportunity encounters in BPA implementation sites after BPA implementation. However, in the subgroup analysis, we only observed a significant improvement in ACEI and ARB prescribing in BPA implementation sites that had also implemented the pharmacist-led program. Overall, the change in the predicted probability of an ACEI or ARB prescription from before to after BPA implementation was significantly greater in BPA implementation sites compared with nonimplementation sites (difference-in-differences of 11.82; P<.001). Conclusions: A BPA with a ?chart closure? hard stop is a promising tool for the treatment of patients with comorbid diabetes and hypertension with an ACEI or ARB, especially when implemented within the context of team-based care, wherein clinical pharmacists support the work of primary care providers. UR - http://medinform.jmir.org/2020/4/e16421/ UR - http://dx.doi.org/10.2196/16421 UR - http://www.ncbi.nlm.nih.gov/pubmed/32301741 ID - info:doi/10.2196/16421 ER - TY - JOUR AU - Lester, A. Corey AU - Tu, Liyun AU - Ding, Yuting AU - Flynn, J. Allen PY - 2020/3/11 TI - Detecting Potential Medication Selection Errors During Outpatient Pharmacy Processing of Electronic Prescriptions With the RxNorm Application Programming Interface: Retrospective Observational Cohort Study JO - JMIR Med Inform SP - e16073 VL - 8 IS - 3 KW - patient safety KW - RxNorm KW - electronic prescription KW - pharmacy KW - pharmacists KW - automation N2 - Background: Medication errors are pervasive. Electronic prescriptions (e-prescriptions) convey secure and computer-readable prescriptions from clinics to outpatient pharmacies for dispensing. Once received, pharmacy staff perform a transcription task to select the medications needed to process e-prescriptions within their dispensing software. Later, pharmacists manually double-check medications selected to fulfill e-prescriptions before dispensing to the patient. Although pharmacist double-checks are mostly effective for catching medication selection mistakes, the cognitive process of medication selection in the computer is still prone to error because of heavy workload, inattention, and fatigue. Leveraging health information technology to identify and recover from medication selection errors can improve patient safety. Objective: This study aimed to determine the performance of an automated double-check of pharmacy prescription records to identify potential medication selection errors made in outpatient pharmacies with the RxNorm application programming interface (API). Methods: We conducted a retrospective observational analysis of 537,710 pairs of e-prescription and dispensing records from a mail-order pharmacy for the period January 2017 to October 2018. National Drug Codes (NDCs) for each pair were obtained from the National Library of Medicine?s (NLM?s) RxNorm API. The API returned RxNorm concept unique identifier (RxCUI) semantic clinical drug (SCD) identifiers associated with every NDC. The SCD identifiers returned for the e-prescription NDC were matched against the corresponding SCD identifiers from the pharmacy dispensing record NDC. An error matrix was created based on the hand-labeling of mismatched SCD pairs. Performance metrics were calculated for the e-prescription-to-dispensing record matching algorithm for both total pairs and unique pairs of NDCs in these data. Results: We analyzed 527,881 e-prescription and pharmacy dispensing record pairs. Four clinically significant cases of mismatched RxCUI identifiers were detected (ie, three different ingredient selections and one different strength selection). A total of 546 less significant cases of mismatched RxCUIs were found. Nearly all of the NDC pairs had matching RxCUIs (28,787/28,817, 99.90%-525,270/527,009, 99.67%). The RxNorm API had a sensitivity of 1, a false-positive rate of 0.00104 to 0.00312, specificity of 0.99896 to 0.99688, precision of 0.00727 to 0.04255, and F1 score of 0.01444 to 0.08163. We found 872 pairs of records without an RxCUI. Conclusions: The NLM?s RxNorm API can perform an independent and automatic double-check of correct medication selection to verify e-prescription processing at outpatient pharmacies. RxNorm has near-comprehensive coverage of prescribed medications and can be used to recover from medication selection errors. In the future, tools such as this may be able to perform automated verification of medication selection accurately enough to free pharmacists from having to perform manual double-checks of the medications selected within pharmacy dispensing software to fulfill e-prescriptions. UR - http://medinform.jmir.org/2020/3/e16073/ UR - http://dx.doi.org/10.2196/16073 UR - http://www.ncbi.nlm.nih.gov/pubmed/32044760 ID - info:doi/10.2196/16073 ER - TY - JOUR AU - Monteiro, Luís AU - Maricoto, Tiago AU - Solha, Isabel AU - Ribeiro-Vaz, Inês AU - Martins, Carlos AU - Monteiro-Soares, Matilde PY - 2019/11/14 TI - Reducing Potentially Inappropriate Prescriptions for Older Patients Using Computerized Decision Support Tools: Systematic Review JO - J Med Internet Res SP - e15385 VL - 21 IS - 11 KW - deprescriptions KW - medical informatics applications KW - potentially inappropriate prescription KW - potentially inappropriate medication KW - computerized decision support N2 - Background: Older adults are more vulnerable to polypharmacy and prescriptions of potentially inappropriate medications. There are several ways to address polypharmacy to prevent its occurrence. We focused on computerized decision support tools. Objective: The available literature was reviewed to understand whether computerized decision support tools reduce potentially inappropriate prescriptions or potentially inappropriate medications in older adult patients and affect health outcomes. Methods: Our systematic review was conducted by searching the literature in the MEDLINE, CENTRAL, EMBASE, and Web of Science databases for interventional studies published through February 2018 to assess the impact of computerized decision support tools on potentially inappropriate medications and potentially inappropriate prescriptions in people aged 65 years and older. Results: A total of 3756 articles were identified, and 16 were included. More than half (n=10) of the studies were randomized controlled trials, one was a crossover study, and five were pre-post intervention studies. A total of 266,562 participants were included; of those, 233,144 participants were included and assessed in randomized controlled trials. Intervention designs had several different features. Computerized decision support tools consistently reduced the number of potentially inappropriate prescriptions started and mean number of potentially inappropriate prescriptions per patient. Computerized decision support tools also increased potentially inappropriate prescriptions discontinuation and drug appropriateness. However, in several studies, statistical significance was not achieved. A meta-analysis was not possible due to the significant heterogeneity among the systems used and the definitions of outcomes. Conclusions: Computerized decision support tools may reduce potentially inappropriate prescriptions and potentially inappropriate medications. More randomized controlled trials assessing the impact of computerized decision support tools that could be used both in primary and secondary health care are needed to evaluate the use of medication targets defined by the Beers or STOPP (Screening Tool of Older People?s Prescriptions) criteria, adverse drug reactions, quality of life measurements, patient satisfaction, and professional satisfaction with a reasonable follow-up, which could clarify the clinical usefulness of these tools. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42017067021; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017067021 UR - https://www.jmir.org/2019/11/e15385 UR - http://dx.doi.org/10.2196/15385 UR - http://www.ncbi.nlm.nih.gov/pubmed/31724956 ID - info:doi/10.2196/15385 ER - TY - JOUR AU - Li, Yan AU - Guo, Xitong AU - Hsu, Carol AU - Liu, Xiaoxiao AU - Vogel, Doug PY - 2019/6/14 TI - Exploring the Impact of the Prescription Automatic Screening System in Health Care Services: Quasi-Experiment JO - JMIR Med Inform SP - e11663 VL - 7 IS - 2 KW - prescription drug monitoring programs KW - hospital information system KW - quality of health care KW - medical errors N2 - Background: Hospitals have deployed various types of technologies to alleviate the problem of high medical costs. The cost of pharmaceuticals is one of the main drivers of medical costs. The Prescription Automatic Screening System (PASS) aims to monitor physicians? prescribing behavior, which has the potential to decrease prescription errors and medical treatment costs. However, a substantial number of cases with unsatisfactory results related to the effects of PASS have been noted. Objective: The objectives of this study were to systematically explore the imperative role of PASS on hospitals? prescription errors and medical treatment costs and examine its contingency factors to clarify the various factors associated with the effective use of PASS. Methods: To systematically examine the various effects of PASS, we adopted a quasi-experiment methodology by using a 2-year observation dataset from 2 hospitals in China. We then analyzed the data related to physicians? prescriptions both before and after the deployment of PASS and eliminated influences from a variety of perplexing factors by utilizing a control hospital that did not use a PASS system. In total, 754 physicians were included in this experiment comprising 11,054 patients: 400 physicians in the treatment group and 354 physicians in the control group. This study was also preceded by a series of interviews, which were employed to identify moderators. Thereafter, we adopted propensity score matching integrated with difference-in-differences to isolate the effects of PASS. Results: The effects of PASS on prescription errors and medical treatment costs were all significant (error: 95% CI ?0.40 to ?0.11, P=.001; costs: 95% CI ?0.75 to ?0.12, P=.007). Pressure from organizational rules and workload decreased the effect of PASS on prescription errors (95% CI 0.18-0.39; P<.001) and medical treatment costs (95% CI 0.07-0.55; P=.01), respectively. We also suspected that other pressures (eg, clinical title and risk categories of illness) also impaired physicians? attention to alerts from PASS. However, the effects of PASS did not change among physicians with a higher clinical title or when treating diseases demonstrating high risk. This may be attributed to the fact that these physicians will focus more on their patients in these situations, regardless of having access to an intelligent system. Conclusions: Although implementation of PASS decreases prescription errors and medical treatment costs, workload and organizational rules remain problematic, as they tend to impair the positive effects of auxiliary diagnosis systems on performance. This again highlights the importance of considering both technical and organizational issues to obtain the highest level of effectiveness when deploying information technology in hospitals. UR - http://medinform.jmir.org/2019/2/e11663/ UR - http://dx.doi.org/10.2196/11663 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199314 ID - info:doi/10.2196/11663 ER - TY - JOUR AU - Kuipers, Esther AU - Poot, C. Charlotte AU - Wensing, Michel AU - Chavannes, H. Niels AU - de Smet, AGM Peter AU - Teichert, Martina PY - 2019/05/30 TI - Self-Management Maintenance Inhalation Therapy With eHealth (SELFIE): Observational Study on the Use of an Electronic Monitoring Device in Respiratory Patient Care and Research JO - J Med Internet Res SP - e13551 VL - 21 IS - 5 KW - eHealth KW - pharmacy KW - inhalation therapy KW - asthma KW - COPD KW - pharmacy practice research N2 - Background: Electronic inhalation monitoring devices (EIMDs) are available to remind patients with respiratory diseases to take their medication and register inhalations for feedback to patients and health care providers as well as for data collection in research settings. Objective: This study aimed to assess the validity as well as the patient-reported usability and acceptability of an EIMD. Methods: This observational study planned to include 21 community pharmacies in the Netherlands. Patient-reported inhalations were collected and compared to EIMD registrations to evaluate the positive predictive value of these registrations as actual patient inhalations. Patients received questionnaires on their experiences and acceptance. Results: A convenience sample of 32 patients was included from across 18 pharmacies, and 932 medication doses were validated. Of these, 796 registrations matched with patient-reported use (true-positive, 85.4%), and 33 inhalation registrations did not match with patient-reported use (false-positive, 3.5%). The positive predictive value was 96.0%, and 103 patient-reported inhalations were not recorded in the database (false-negative, 11.1%). Overall, patients considered the EIMD to be acceptable and easy to use, but many hesitated to continue its use. Reminders and motivational messages were not appreciated by all users, and more user-tailored features in the app were desired. Conclusions: Patients? interaction with the device in real-world settings is critical for objective measurement of medication adherence. The positive predictive value of this EIMD was found to be acceptable. However, patients reported false-negative registrations and a desire to include more user-tailored features to increase the usability and acceptability of the EIMD. UR - http://www.jmir.org/2019/5/e13551/ UR - http://dx.doi.org/10.2196/13551 UR - http://www.ncbi.nlm.nih.gov/pubmed/31148542 ID - info:doi/10.2196/13551 ER - TY - JOUR AU - Fleming, N. James AU - Treiber, Frank AU - McGillicuddy, John AU - Gebregziabher, Mulugeta AU - Taber, J. David PY - 2018/03/02 TI - Improving Transplant Medication Safety Through a Pharmacist-Empowered, Patient-Centered, mHealth-Based Intervention: TRANSAFE Rx Study Protocol JO - JMIR Res Protoc SP - e59 VL - 7 IS - 3 KW - telemedicine KW - mhealth KW - transplant KW - clinical trial KW - errors KW - adherence N2 - Background: Medication errors, adverse drug events, and nonadherence are the predominant causes of graft loss in kidney transplant recipients and lead to increased healthcare utilization. Research has demonstrated that clinical pharmacists have the unique education and training to identify these events early and develop strategies to mitigate or prevent downstream sequelae. In addition, studies utilizing mHealth interventions have demonstrated success in improving the control of chronic conditions that lead to kidney transplant deterioration. Objective: The goal of the prospective, randomized TRANSAFE Rx study is to measure the clinical and economic effectiveness of a pharmacist-led, mHealth-based intervention, as compared to usual care, in kidney transplant recipients. Methods: TRANSAFE Rx is a 12-month, parallel, two-arm, 1:1 randomized controlled clinical trial involving 136 participants (68 in each arm) and measuring the clinical and economic effectiveness of a pharmacist-led intervention which utilizes an innovative mobile health application to improve medication safety and health outcomes, as compared to usual posttransplant care. Results: The primary outcome measure of this study will be the incidence and severity of MEs and ADRs, which will be identified, categorized, and compared between the intervention and control cohorts. The exploratory outcome measures of this study are to compare the incidence and severity of acute rejections, infections, graft function, graft loss, and death between research cohorts and measure the association between medication safety issues and these events. Additional data that will be gathered includes sociodemographics, health literacy, depression, and support. Conclusions: With this report we describe the study design, methods, and outcome measures that will be utilized in the ongoing TRANSAFE Rx clinical trial. Trial Registration: ClinicalTrials.gov NCT03247322: https://clinicaltrials.gov/ct2/show/NCT03247322 (Archived by WebCite at http://www.webcitation.org/6xcSUnuzW) UR - https://www.researchprotocols.org/2018/3/e59/ UR - http://dx.doi.org/10.2196/resprot.9078 UR - http://www.ncbi.nlm.nih.gov/pubmed/29500161 ID - info:doi/10.2196/resprot.9078 ER - TY - JOUR AU - Lämsä, Elina AU - Timonen, Johanna AU - Ahonen, Riitta PY - 2018/02/23 TI - Pharmacy Customers? Experiences With Electronic Prescriptions: Cross-Sectional Survey on Nationwide Implementation in Finland JO - J Med Internet Res SP - e68 VL - 20 IS - 2 KW - electronic prescribing KW - pharmacies KW - patient satisfaction KW - surveys and questionnaires N2 - Background: One of the forerunners in electronic health, Finland has introduced electronic prescriptions (ePrescriptions) nationwide by law. This has led to significant changes for pharmacy customers. Despite the worldwide ambition to develop ePrescription services, there are few reports of nationally adopted systems and particularly on the experiences of pharmacy customers. Objective: The aim of this study was to investigate Finnish pharmacy customers? (1) experiences with purchasing medicines with ePrescriptions; (2) experiences with renewing ePrescriptions and acting on behalf of someone else at the pharmacy; (3) ways in which customers keep up to date with their ePrescriptions; and (4) overall satisfaction with ePrescriptions. Methods: Questionnaires were distributed to 2913 pharmacy customers aged ?18 years purchasing prescription medicines for themselves with an ePrescription in 18 community pharmacies across Finland in autumn 2015. Customers? experiences were explored with 10 structured questions. The data were stored in SPSS for Windows and subjected to descriptive analysis, chi-square, Fisher exact, Kolmogorov-Smirnov, the Mann-Whitney U, and Kruskal-Wallis tests. Results: Completed questionnaires were returned by 1288 customers, a response rate of 44.19% (1288/2913). The majority of the respondents did not encounter any problems during pharmacy visits (1161/1278, 90.85%) and were informed about the current status of their ePrescriptions after their medication was dispensed (1013/1276, 79.44%). Over half of the respondents had usually received a patient instruction sheet from their physician (752/1255, 59.92%), and nearly all of them regarded its content as clear (711/724, 98.2%). Half of the respondents had renewed their ePrescriptions through the pharmacy (645/1281, 50.35%), and one-third of them had acted on behalf of someone else with ePrescriptions (432/1280, 33.75%). Problems were rarely encountered in the renewal process (49/628, 7.8%) or when acting on behalf of another person (25/418, 6.0%) at the pharmacy. The most common way of keeping up to date with ePrescriptions was to ask at the pharmacy (631/1278, 49.37%). The vast majority of the respondents were satisfied with ePrescriptions as a whole (1221/1274, 95.84%). Conclusions: Finnish pharmacy customers are satisfied with the recently implemented nationwide ePrescription system. They seldom have any difficulties purchasing medicines, renewing their ePrescriptions, or acting on behalf of someone else at the pharmacy. Customers usually keep up to date with their ePrescriptions by asking at the pharmacy. However, some customers are unaware of the practices or have difficulty keeping up to date with the status of their ePrescriptions. The provision of relevant information and assistance by health care professionals is therefore required to promote customers? adoption of the ePrescription system. UR - http://www.jmir.org/2018/2/e68/ UR - http://dx.doi.org/10.2196/jmir.9367 UR - http://www.ncbi.nlm.nih.gov/pubmed/29475826 ID - info:doi/10.2196/jmir.9367 ER - TY - JOUR AU - Keyworth, Chris AU - Hart, Jo AU - Thoong, Hong AU - Ferguson, Jane AU - Tully, Mary PY - 2017/08/01 TI - A Technological Innovation to Reduce Prescribing Errors Based on Implementation Intentions: The Acceptability and Feasibility of MyPrescribe JO - JMIR Hum Factors SP - e17 VL - 4 IS - 3 KW - drug prescribing KW - behavior and behavior mechanisms KW - clinical competence KW - qualitative research KW - mobile applications KW - pharmacists KW - patient safety KW - telemedicine N2 - Background: Although prescribing of medication in hospitals is rarely an error-free process, prescribers receive little feedback on their mistakes and ways to change future practices. Audit and feedback interventions may be an effective approach to modifying the clinical practice of health professionals, but these may pose logistical challenges when used in hospitals. Moreover, such interventions are often labor intensive. Consequently, there is a need to develop effective and innovative interventions to overcome these challenges and to improve the delivery of feedback on prescribing. Implementation intentions, which have been shown to be effective in changing behavior, link critical situations with an appropriate response; however, these have rarely been used in the context of improving prescribing practices. Objective: Semistructured qualitative interviews were conducted to evaluate the acceptability and feasibility of providing feedback on prescribing errors via MyPrescribe, a mobile-compatible website informed by implementation intentions. Methods: Data relating to 200 prescribing errors made by 52 junior doctors were collected by 11 hospital pharmacists. These errors were populated into MyPrescribe, where prescribers were able to construct their own personalized action plans. Qualitative interviews with a subsample of 15 junior doctors were used to explore issues regarding feasibility and acceptability of MyPrescribe and their experiences of using implementation intentions to construct prescribing action plans. Framework analysis was used to identify prominent themes, with findings mapped to the behavioral components of the COM-B model (capability, opportunity, motivation, and behavior) to inform the development of future interventions. Results: MyPrescribe was perceived to be effective in providing opportunities for critical reflection on prescribing errors and to complement existing training (such as junior doctors? e-portfolio). The participants were able to provide examples of how they would use ?If-Then? plans for patient management. Technology, as opposed to other methods of learning (eg, traditional ?paper based? learning), was seen as a positive advancement for continued learning. Conclusions: MyPrescribe was perceived as an acceptable and feasible learning tool for changing prescribing practices, with participants suggesting that it would make an important addition to medical prescribers? training in reflective practice. MyPrescribe is a novel theory-based technological innovation that provides the platform for doctors to create personalized implementation intentions. Applying the COM-B model allows for a more detailed understanding of the perceived mechanisms behind prescribing practices and the ways in which interventions aimed at changing professional practice can be implemented. UR - http://humanfactors.jmir.org/2017/3/e17/ UR - http://dx.doi.org/10.2196/humanfactors.7153 UR - http://www.ncbi.nlm.nih.gov/pubmed/28765104 ID - info:doi/10.2196/humanfactors.7153 ER - TY - JOUR UR - ID - ref1 ER - TY - JOUR AU - Phillips, L. Jennifer AU - Shea, M. Jennifer AU - Leung, Valerie AU - MacDonald, Don PY - 2015/01/06 TI - Impact of Early Electronic Prescribing on Pharmacists? Clarification Calls in Four Community Pharmacies Located in St John?s, Newfoundland JO - JMIR Med Inform SP - e2 VL - 3 IS - 1 KW - electronic prescribing KW - pharmacy KW - pharmacists KW - Clinical Pharmacy Information Systems N2 - Background: Electronic prescribing (e-prescribing) can potentially help prevent medication errors. As the use of e-prescribing increases across Canada, understanding the benefits and gaps of early e-prescribing can help inform deployment of future e-prescribing systems. Objective: The purpose of this exploratory study was to determine the prevalence of, reasons for, and average time taken for pharmacist clarification calls to prescribers for electronic medical record (EMR)-generated and handwritten prescriptions. Methods: Four community pharmacies in St John?s, Newfoundland, Canada prospectively collected information on clarification calls to prescribers for new prescriptions over a period of 17 to 19 weeks. Four semistructured interviews were conducted following the data collection period to gain further insight. Results: An estimated 1.33% of handwritten prescriptions required clarification compared with 0.66% of EMR-generated prescriptions. Overall, 1.11% of prescriptions required clarification with the prescriber. While illegibility was eliminated with EMR-generated prescriptions, clarification was still required for missing information (24%) and appropriateness (51%). Key themes, including errors unique to EMR-generated prescriptions, emerged from the qualitative interviews. Conclusions: Advanced e-prescribing functionality will enable secure transmission of prescriptions from prescribers to a patient?s pharmacy of choice through a provincial electronic Drug Information System (DIS)/Pharmacy Network, which will lessen the need for clarification calls, especially in the domains of missing information and appropriateness of the prescription. This exploratory study provides valuable insight into the benefits and gaps of early e-prescribing. Advanced e-prescribing systems will provide an opportunity for further realization of quality and safety benefits related to medication prescribing. UR - http://medinform.jmir.org/2015/1/e2/ UR - http://dx.doi.org/10.2196/medinform.3541 UR - http://www.ncbi.nlm.nih.gov/pubmed/25595165 ID - info:doi/10.2196/medinform.3541 ER - TY - JOUR PY - 2013// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e4423 VL - 5 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v5i1.4423 ID - info:doi/10.5210/ojphi.v5i1.4423 ER - TY - JOUR PY - 2013// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e4377 VL - 5 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v5i1.4377 ID - info:doi/10.5210/ojphi.v5i1.4377 ER - TY - JOUR PY - 2012// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e4304 VL - 4 IS - 3 UR - UR - http://dx.doi.org/10.5210/ojphi.v4i3.4304 UR - http://www.ncbi.nlm.nih.gov/pubmed/23569654 ID - info:doi/10.5210/ojphi.v4i3.4304 ER -