Ten health conditions were found in the included studies. Seven of these ten health conditions had at least one study reporting benefit from the use of a PHR: asthma, diabetes, fertility, glaucoma, HIV, hyperlipidemia, and hypertension. Diabetes was the most studied condition with eleven of twelve studies showing benefit. Three conditions had studies that meth the criteria but did not show benefit of the PHR: cancer, idiopathic thrombocytopenic purpura (ITP), and multiple sclerosis.
70% of studies (16/23) reported benefits associated with PHR use.
However, there is no evidence that any study of the above provided evidence of better medication adherence or at least persistence.
Self-Manage Care – Using the PHR to make day-to- day decisions about care management, such as medication dosing, food choice.
This is the only grounds that medication intake was improved.
These conditions include: diabetes, hypertension, asthma, HIV, fertility management, glaucoma, and hyperlipidemia. Benefits were seen in care quality, access, and/or productivity. These conditions share several common characteristics: Each of these conditions is chronic. They have a significant benefit from self-management through behavioral changes. Many have an aspect of monitoring, either from the clinician or the patient (self-monitoring). Self-management is present in all. The seven conditions were conditions where the self-management behaviors could be suitably tracked in a PHR and were tightly linked to the feedback of monitoring/self-monitoring of indicators (Figure 3). For ex- ample, self-monitoring blood pressure in hypertension or glucose levels in diabetes allowed for more specific and direct feedback to patients using a PHR.
this is a well written literature review.
A key question across domains is, “how are patients/health agents/consumers persuaded to acquire certain drugs and take them as directed?”
The introduction of “concordance” to the literature on medication compliance and adherence—“adherence” is the most neutral, non-ideological, term for patient behavior, in use at least since the mid 1990s.
The question that concordance theorists have really asked is not, “how do we treat patients’ health beliefs more respectfully?” but rather, “how do we persuade patients to follow the advice of their doctors?”
We can frame a rhetorical question across domains: how are people persuaded to take drugs?
Several authors have written even-handedly about concordance and make clear that cooperation between physicians and patients is likely to lead to better, and more appropriate, use of medications. Elwyn, Edwards, and Britten write, “Concordance describes the process whereby the patient and doctor reach an agreement on how a drug will be used, if at all. In this process doctors identify and understand patients’ views and explain the importance of treatment, while patients gain an understanding of the consequences of keeping (or not keeping) to treatment.” Ferner writes, “Usually…the patient, who has most to gain by success and the most to lose from harm, should decide whether to have treatment, and the prescriber should provide information on the risks and benefits to help make the decision.”
It is easy to agree that cooperative, better-informed, and realistically-prepared patients are more likely to adhere to recommended treatments than those who are resistant, ill- informed, and unprepared.
So, “concordance,” with its egalitarian rhetoric, not only portrays physicians and patients as equals but also portrays all patients as equals—while, in truth and in practice, patients are not all equally well-equipped for consensual decision-making, and, certainly, not all physicians believe that they are. When one exits the concordance literature to enter other literature about patients, what becomes clear is that the respect for patients that is invoked as the key resource of concordance is not always available to be tapped.
The more consumers are aware of a drug, the more they will request it; arguably, if they request it, then, being in agreement with their physician on its prescription, they are more likely to adhere to treatment.
The traditional model of adherence (also known as compliance) does not value patients’ beliefs, concerns and preferences about medicines. The concordance model, a new approach to the process of prescribing and medicine-taking, was originally conceived and has most commonly been used to define a process of prescribing and medicine-taking based on partnership. In a concordant consultation the patient and the health care professional participate as partners to reach an agreement on when, how and why to use medicines, drawing on the expertise of the health care professional as well as the experiences, beliefs and wishes of the patient.
Providing patients access to their medical records may facilitate a more collaborative relationship between provider and patient. Existing literature suggests that patient-accessible records can improve patient–provider communication, self- management and patient satisfaction.
The IOM (institue of medicine) has recommended six major aims for improving the quality of healthcare delivery: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.
The effect of e-prescribing on patient safety and
quality of patient care in hospital settings:
Generally, the research findings on the effect of e-prescribing on medication errors were partially attributed to their settings, the system design features, or the nature of prescribers’ work. Studies conducted on homegrown systems (vs. commercial products/systems) or on systems with manual chart review show a higher ability to detect medication errors with e-prescribing. One study stated that design features of e-prescribing such as poor drop-down menu, poor screen design, or inaccurate or incomplete patient medication lists especially in certain diseases can pose a threat to patient safety. Another study that examined the relationship between prescribing errors, use of e- prescribing technology, complexity of tasks and interruptions in healthcare settings reported that common errors that occurred include: selection of incorrect medication, dose, route, and formulation. When prescribers were interrupted when performing tasks on e-prescribing systems, they required almost three times longer to complete complex tasks when compared to simple tasks. Interruptions when using e-prescribing systems were suggested to be a possible contributing factor to medications errors when using this technology possibly due to loss of concentration by the user.
On the receiving end: community pharmacies
Patient safety is commonly thought of in health-
care settings as the freedom from medication errors and patient harm.
Studies on safety of e-prescribing in community
pharmacies are particularly important as they are the recipients of the product (e-prescriptions) of e-prescribing systems. The literature on the safety issues related to e-prescribing use in community pharmacies is sparse when compared to studies that have been conducted in hospital settings. Unlike hospital settings, community pharmacies do not have access to real-time patient information that may help them detect when incorrect information is present on the e-prescription.
Pharmacists need to understand the new kinds of prescribing errors generated using new technologies used in healthcare delivery, especially related to e-prescribing technol- ogy use, for them to be better equipped to detect and prevent errors.
Issues associated with e-prescriptions in pharmacies have been reported to be caused by omission of vital information by prescribers, poor design in pharmacies and physician office and other inherent technology limitations. E- prescribing, like other types of HIT, has the potential to improve patient safety in pharmacies but if poorly designed or implemented can pose a risk to patient safety. Issues arising from using such HIT safely are increasingly being recognized as more healthcare organizations across the health system implement these technologies.
Using HFE to improve safety in technology use in pharmacy
Human Factors Engineering(HFE) is a science focused on studying the interactions between people, work systems, environment and how all these important elements might affect safety and human performance.
Pharmacies can also proactively reduce safety
risks related to using e-prescribing technology. This can be achieved by using HFE methods to identify underlying causes of e-prescribing errors and improve shared situational awareness about issues related to using e-prescribing technology.
HFE approaches are currently being applied to
evaluate the benefits and challenges with HIT in hospital settings but have not been widely used in pharmacies or ambulatory care. Patient safety experts are increasingly obtaining guidance from HFE on how to improve usability of e-prescribing design in hospital settings but no research has looked into community pharmacy. It is clear that usability testing of any HIT is a necessity. A fundamental design principle of technology usability is transparency and visibility. Qualitative studies of use of computerized provider order entry systems in hospital settings applying HFE approaches have uncovered challenges with usability involving physicians and nurses which lead to errors. Application of HFE concepts and techniques to improve e-prescribing safety will require collaborative effort from e-prescribing vendors, prescribers, and pharmacists.
This paper has a very interesting inclusion criteria chapter.
This is an important paper
Based on: The majority of the included studies were conducted in North America (almost 64% in the United States and 4% in Canada), 16% addressed e-prescribing systems in European centuries, 9% in the Asian context, and the remaining 7% discussed e-prescribing issues in Australia.
Should we have an inclusion criteria like the studies should be conducted in UK and if there is any other country with similar to NHS system?