Computerized reminders to monitor liver function to improve the use of etretinate

被引:11
作者
Koide, D
Ohe, K
Ross-Degnan, D
Kaihara, S
机构
[1] Univ Tokyo, Fac Med, Dept Pharmacoepidemiol, Bunkyo Ku, Tokyo 1138655, Japan
[2] Tokyo Univ Hosp, Hosp Comp Ctr, Bunkyo Ku, Tokyo 1138655, Japan
[3] Dept Ambulatory Care & Prevent, Boston, MA 02215 USA
[4] Natl Okura Hosp, Setagaya Ku, Tokyo 1570074, Japan
关键词
quality of care; drug utilization; hospital computer system; intervention; computerized alert;
D O I
10.1016/S1386-5056(99)00055-6
中图分类号
TP [自动化技术、计算机技术];
学科分类号
0812 ;
摘要
Objective: to determine whether computerized reminders during the process of prescribing can improve the use of drugs requiring prior laboratory testing according to the indications listed in the Drug Package Insert. Measures: Change in proportion of appropriate prescribing and frequency of severe hepatotoxicity between pre- and post-intervention. Methods: etretinate, a medication indicated for psoriasis, was selected as a monitored drug because it was the most prescribed of all the identified drugs that require specific prior laboratory tests. Computerized reminders are designed to alert a physician who is about to prescribe etretinate either without the alanine aminotranceferase (ALT) test or the aspartate aminotransferase (AST) test within 3 months or despite abnormality in ALT or AST. Data on alerts were gathered by using electronic mail whenever alerts occurred. Results: prescriptions of etretinate with normal ALT or AST results within the previous three months increased suddenly from 25.9% (127/491) in the pre-intervention period to 66.2% (353/533) in the post-intervention period (P < 0.0001). Moreover, three patients who used etretinate had markedly abnormal tests in the pre-intervention period, but none of the patients were classified in this way in the post-intervention period. Conclusions: the computerized reminders appear to improve physicians' use of a drug requiring specific prior laboratory tests. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.
引用
收藏
页码:11 / 19
页数:9
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