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Objectives: The objective of this paper was to describe primary care prescribers' perspectives on electronic prescribing drug alerts at the point of prescribing.Design: We used a mixed-method study which included clinician surveys (web-based and paper) and focus groups with prescribers and staff.Participants: Prescribers (n = 157) working in one of 64 practices using 1 of 6 e-prescribing technologies in 6 US states completed the quantitative survey and 276 prescribers and staff participated in focus groups.Measurements: The study measures self-reported frequency of overriding of drug alerts; open-ended responses to: "What do you think of the drug alerts your software generates for you?"Results: More than 40% of prescribers indicated they override drug-drug interactions most of the time or always (range by e-prescribing system, 25% to 50%). Participants indicated that the software and the interaction alerts were beneficial to patient safety and valued seeing drug-drug interactions for medications prescribed by others. However, they noted that alerts are too sensitive and often unnecessary. Participant suggestions included: (1) run drug alerts on an active medication list and (2) allow prescribers to set the threshold for severity of alerts.Conclusions: Primary care prescribers recognize the patient safety value of drug prescribing alerts embedded within electronic prescribing software. Improvements to increase specificity and reduce alert overload are needed. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the influence of the pharmacological profile of a patient (PPP) on quality of drug prescribing, treatment effectiveness, safety, and health services utilization in a group of outpatients. Methods: The study was designed as an open, nonrandomized trial of an intervention in health care. The outpatient intervention group ( n = 39) received the PPP, and the control group ( n = 36) did not. In all cases, the outcomes were observed for a 2-year period in total; in the intervention group 1 year of observation was allocated before and another year after the introduction of the PPP. Results: The PPPs reduced multiple prescriptions by 1.08 ± 1.13 drugs per patient, whereas in those who did not receive the PPP, an increase of 1.44 ± 1.48 drugs per patient occurred ( P < 0.001, 95% CI 1.91-3.13). A decrease in the medication appropriateness index score of 0.81 ± 0.51 per drug per patient in the intervention group was observed ( P = 0.001, 95% CI 0.63-0.93), and in the control group an increase was noted (0.13 ± 0.40; P = 0.063). The majority of patients with PPP experienced fewer adverse drug reactions (0.96 ± 0.58 fewer, P < 0.001 vs. controls, 95% CI 1.39-2.13), and they were more likely to have an improvement in health status (OR 22.0, 95% CI 5.87-82.41). Finally, the PPPs decreased both the number of examinations and the number of diagnostic investigations, on average by 2.15 and 2.26 services per patient, respectively. Conclusions: Use of a pharmacological profile of a patient in primary care practice could improve not only prescribing behavior of general practitioners, but also effectiveness and safety of therapy, while reducing utilization of health services. [ABSTRACT FROM AUTHOR]

Background: This study aimed to develop and provide a psychometric and feasibility pilot evaluation of the Heart Failure (HF) Symptom Tracker (HFaST), a new patient-reported tool designed to facilitate communication between patients and health care providers (HCPs) in routine clinical care. The HFaST enables patients to identify worsening HF symptoms, with a long-term goal of preventing hospitalizations or emergency room visits. Methods: The HFaST was developed drawing on evidence from the literature, qualitatively with cognitive interviews (12 patient/caregiver and 8 HCPs), and evaluated quantitatively (psychometric, feasibility assessment). The HFaST was administered for 7 consecutive days to 100 individuals diagnosed with HF during a multisite, non-interventional US pilot study. Health care providers then completed a survey assessing the feasibility and importance of the HFaST in clinical practice. Qualitative development included a literature review and cognitive interviews with patients, caregivers, and HCPs. The psychometric properties of the HFaST were evaluated using classical test theory methods. Descriptive statistics provided insight into HCPs' perceptions of the feasibility of using the HFaST in clinical practice. Results: A preliminary set of 40 items was developed for the symptom tracker and iteratively reduced to 10 items based on the qualitative phase. Test-retest reliability (weighted kappa 0.71–0.97), discriminating validity, and construct validity of the HFaST were acceptable. HCPs rated the HFaST as a good (70%) or excellent (30%) means of tracking HF symptoms. Six HFaST items were ultimately retained, covering concepts of fatigue, shortness of breath (3 items), swelling, and rapid weight gain. Conclusions: The 6-item HFaST is an easy-to-use tool designed to raise patients' awareness of HF symptoms and facilitate communication with HCPs. Future research should evaluate HFaST implementation in clinical practice and effectiveness as an intervention to potentially prevent hospitalizations and emergency room visits. [ABSTRACT FROM AUTHOR]