Article type
Year
Abstract
Background: Enthusiasm for the implementation of e-interventions for medication management to decrease adverse events is richly supported by empirical studies. However, there is concern that they can introduce new problems and facilitate or cause events harmful to patients.
Objectives: To identify and summarize empirical evidence of e-intervention outcomes in ambulatory settings that represent a risk for patient safety.
Methods: We conducted a systematic search of the literature for studies in which e-interventions, i.e., electronic patient record, clinical decision support, electronic transmission of prescriptions to pharmacies, or electronically-generated paper prescriptions, were employed in the process of medication management in the ambulatory setting. We included studies with quantifiable outcomes and a wide range of designs to increase the probability of finding seldom or previously unknown adverse outcomes in studies not necessarily designed or powered to identify them.
Results: We identified 87 studies that met inclusion criteria whereof 55 were randomized controlled trials (RCTs) and two quasi-randomised. None set out to reveal threats to patient safety. One observational study found overall worse outcomes, i.e. more new e-prescriptions needed pharmacist intervention than new paper prescriptions. Two other observational studies reported that some out-patients did not retrieve their e-prescribed drugs from pharmacies. One RCT reported more major bleeds in computer-generated anti-coagulant dosing, although computer dosing resulted in better clinical events overall. Otherwise, e-interventions did not result in overall inferior patient or process outcomes.
Conclusions: Evidence of threats to patient safety in the identified studies was scant and mainly anecdotal. Observational studies may identify previously unknown or seldom outcomes that are threats to patient safety. Studies using robust designs such as the randomized controlled trial powered to reveal seldom outcomes are needed to test hypotheses generated based on findings from observational studies.
Objectives: To identify and summarize empirical evidence of e-intervention outcomes in ambulatory settings that represent a risk for patient safety.
Methods: We conducted a systematic search of the literature for studies in which e-interventions, i.e., electronic patient record, clinical decision support, electronic transmission of prescriptions to pharmacies, or electronically-generated paper prescriptions, were employed in the process of medication management in the ambulatory setting. We included studies with quantifiable outcomes and a wide range of designs to increase the probability of finding seldom or previously unknown adverse outcomes in studies not necessarily designed or powered to identify them.
Results: We identified 87 studies that met inclusion criteria whereof 55 were randomized controlled trials (RCTs) and two quasi-randomised. None set out to reveal threats to patient safety. One observational study found overall worse outcomes, i.e. more new e-prescriptions needed pharmacist intervention than new paper prescriptions. Two other observational studies reported that some out-patients did not retrieve their e-prescribed drugs from pharmacies. One RCT reported more major bleeds in computer-generated anti-coagulant dosing, although computer dosing resulted in better clinical events overall. Otherwise, e-interventions did not result in overall inferior patient or process outcomes.
Conclusions: Evidence of threats to patient safety in the identified studies was scant and mainly anecdotal. Observational studies may identify previously unknown or seldom outcomes that are threats to patient safety. Studies using robust designs such as the randomized controlled trial powered to reveal seldom outcomes are needed to test hypotheses generated based on findings from observational studies.