26 results on '"Birgit, Eiermann"'
Search Results
2. Prevalence of potential drug-drug interactions in Swedish pediatric outpatients.
- Author
-
Johan Holm, Birgit Eiermann, Elin Kimland, and Buster Mannheimer
- Subjects
Medicine ,Science - Abstract
PurposeTo describe the occurrence of potential drug-drug interactions (DDIs) in prescribed drugs, dispensed to pediatric outpatients in Sweden.MethodsA cross sectional study was conducted based on data from a national register of prescribed drugs, dispensed at pharmacies, to children 0-17 years old. The study period was January 1 to April 30, 2010. Drug dispensing data was linked to the DDI database SFINX. Prevalence and frequencies of potential interactions were investigated, and drugs commonly involved in interactions were identified. The study focused on clinically relevant potential interactions, class D (should be avoided), and class C (can be handled, e.g. by dose adjustment).ResultsIn the Swedish pediatric population, 0 to 17 years of age, 12% (n = 231 078) of children had at least two dispensed drugs. In this group of patients, 0.14% had potential D-interactions and 1,3% had potential C-interactions. The number of D- and C-interactions that may lead to reduced effects were 181 (52%), and 1224 (32%) respectively. The ten most frequent drugs were involved in 78% and 65% of all potential D-, and C-interactions respectively. Furthermore, 80%, and 58% of the D-, and C-interactions respectively occurred in patients aged 12 to 17.ConclusionsWe identified a limited number of drugs that were represented in the majority of potential interactions. Interactions that can lead to a reduced treatment effect constituted approximately half of D-interactions, and a third of C-interactions. The frequency of potential interactions was higher in older children. The results may contribute to increased prescriber awareness of important potential drug interactions among pediatric outpatients.
- Published
- 2019
- Full Text
- View/download PDF
3. Discrepancies in patients' medication lists from pharmacies in Sweden : an interview study before the implementation of the Swedish National Medication List
- Author
-
Tora Hammar, Leila Mzil, and Birgit Eiermann
- Subjects
Pharmacology ,Samhällsfarmaci och klinisk farmaci ,Social and Clinical Pharmacy ,Pharmaceutical Science ,Drug-related problems ,Medication error ,Pharmacy ,Toxicology ,Farmaceutiska vetenskaper ,Pharmaceutical Sciences ,Medication reconciliation ,Pharmacology (medical) ,Medication list ,Electronic prescribing - Abstract
Background Discrepancies in medication lists are common and can contribute to drug-related problems. This study was performed before the implementation of the National Medication List in Sweden, an intervention expected to improve the accuracy of medication lists. Aim The aim of the study was to examine the number and type of discrepancies in the medication list from pharmacies in Sweden. The secondary aim was to describe the information sources Swedish patients used as their medication lists and how confident they were with the information. Method Structured interviews were conducted with patients at 13 community pharmacies in Sweden during the period October 5, 2020, to April 16, 2021. The printed medication list was reviewed together with the patient to identify any discrepancies and missing information. Results A total of 327 patients were included in the study (response rate 51%). The printed medication list from pharmacies was the most common information source for patients to know which medications to use. Two thirds (n = 215) of the patients had at least one discrepancy among their prescriptions and 32% (n = 106) were missing at least one prescription medication. Among all prescriptions (n = 2567) 10% (n = 264) were non-current prescriptions, 9% (n = 238) were duplicates and 3% (n = 88) had the wrong dose. The proportion of prescriptions with discrepancies differed between drug-groups. Conclusion The discrepancies described in this study can have serious consequences, and results provide a baseline for studies after the implementation of the National Medication List.
- Published
- 2023
4. Evaluation of usage patterns and user perception of the drug-drug interaction database SFINX.
- Author
-
Marine L. Andersson, Ylva Böttiger, Pia Bastholm-Rahmner, Marie-Louise Ovesjö, Anikó Vég, and Birgit Eiermann
- Published
- 2015
- Full Text
- View/download PDF
5. [Pharmacological knowledge bases in Sweden: successes and future in a time of information overflow]
- Author
-
Lars, Gustafsson, Birgit, Eiermann, and Mikael, Hoffmann
- Subjects
Sweden ,Knowledge Bases ,Humans ,Child ,Delivery of Health Care ,Social Media - Abstract
Skewed information about medicines in social media influence the healthcare-patient contact. Healthcare staff need situation adapted evidence that can be linked to patient data. For 20 years Sweden has provided praised Pharmacological Knowledge Bases (PKB). They include »Janusmed drug-drug interactions«, »Janusmed drugs and birth defects« and »e-Ped (electronic pediatric) instructions and drug dosage control«. PKBs need to be better integrated into digital tools adhering to a national guide for optimal interface presentation of information. They should be produced by medical editors and delivered through a national digital highway. Experts need to adhere to a policy for handling conflicts of interest and evaluate that information is appreciated and used. PKBs should be accessible as a public good for healthcare staff, students and the public to support personalized medical care.
- Published
- 2022
6. An Adverse Drug Reaction Database for Clinical Use - Potential of and Difficulties with the Summary of Product Characteristics
- Author
-
Birgit, Eiermann, Daniel, Rodrigues, Paul, Cohen, and Lars L, Gustafsson
- Subjects
Europe ,Databases, Factual ,Drug-Related Side Effects and Adverse Reactions ,Adverse Drug Reaction Reporting Systems ,Humans - Abstract
Adverse drug reactions (ADRs) for all drugs in Europe are described in the legally approved Summary of Product Characteristics (SmPC). An overview of all ADRs of the patients' drug list can support healthcare staff to link patient symptoms to possible ADRs. We review the possibilities and challenges to extract ADR information from SmPCs and present the development of our semi-automated procedure for extraction of ADRs from the tabulated section of the SmPCs to create a database, named Bikt, which is regularly updated and used at point of care in Sweden. The existence of five major table formats for ADRs used in the SmPCs required the development of different parsing scripts. Manual checks for correctness for all content has to be performed. The quality of extraction was investigated for all SmPCs by measuring precision, recall and F1 scores (i.e. the weighted harmonic mean of precision and recall) and compared with other methods published. We conclude that it is possible to semi-automatically extract ADR information from SmPCs. However, clear technical and content guidelines and standards for ADR tables and terms from drug registration authorities would lead to improved extraction and usability of ADR information at point of care.
- Published
- 2022
7. Design and implementation of a point-of-care computerized system for drug therapy in Stockholm metropolitan health region - Bridging the gap between knowledge and practice.
- Author
-
Bengt Sjöborg, Tobias Bäckström, Lars-Bertil Arvidsson, Eva Andersén-Karlsson, L. Bengt Blomberg, Birgit Eiermann, Marie Eliasson, Kjell Henriksson, Lennart Jacobsson, Ulf Jacobsson, Margaretha Julander, Per-Olof Kaiser, Carina Landberg, Jonas Larsson, Björn Molin, and Lars L. Gustafsson
- Published
- 2007
- Full Text
- View/download PDF
8. Potential drug related problems detected by electronic expert support system in patients with multi-dose drug dispensing
- Author
-
Tora, Hammar, Bo, Hovstadius, Bodil, Lidström, Göran, Petersson, and Birgit, Eiermann
- Published
- 2014
- Full Text
- View/download PDF
9. ADR databases for on-site clinical use: Potentials of summary of products characteristics
- Author
-
Lars L. Gustafsson, Daniel A Leon Rodriguez, Birgit Eiermann, and Paul Cohen
- Subjects
Drug-Related Side Effects and Adverse Reactions ,Computer science ,Point-of-Care Systems ,Toxicology ,computer.software_genre ,030226 pharmacology & pharmacy ,Clinical decision support system ,03 medical and health sciences ,0302 clinical medicine ,Health care ,medicine ,Adverse Drug Reaction Reporting Systems ,Humans ,Summary of Product Characteristics ,Point of care ,Drug Labeling ,Pharmacology ,Database ,business.industry ,Usability ,General Medicine ,medicine.disease ,Europe ,Data extraction ,Table (database) ,business ,computer ,030217 neurology & neurosurgery ,Adverse drug reaction - Abstract
Adverse drug reactions (ADRs) for all drugs in Europe are described in the legally approved Summary of Product Characteristics (SmPC). An overview of all ADRs of the patients' drug list can support healthcare staff to link patient symptoms to possible ADRs. We review the possibilities and challenges to extract ADR information from SmPCs or American Structured Product Labels and present the development of our semi-automated procedure for extraction of ADRs from the tabulated section in the SmPCs to create a database, named Bikt, which is regularly updated and used at point of care in Sweden. The existence of five major table formats for ADRs used in the SmPCs required the development of different parsing scripts. Manual checks for correctness for all content have to be performed. The quality of extraction was investigated for all SmPCs by measuring precision, recall and F1 scores and compared with other methods published. We conclude that it is possible to semi-automatically extract ADR information from SmPCs. However, clear technical and content guidelines and standards for ADR tables and terms from drug registration authorities would lead to improved extraction and usability of ADR information at point of care.
- Published
- 2021
10. Model-Informed Precision Dosing: Background, Requirements, Validation, Implementation, and Forward Trajectory of Individualizing Drug Therapy
- Author
-
Thomas M. Polasek, Birgit Eiermann, Brahim Achour, Lawrence J. Lesko, Adam S. Darwich, Youssef Daali, Jean-Luc Reny, Daniel F. B. Wright, Andrew J. McLachlan, Jack Cook, Kayode Ogungbenro, Amin Rostami-Hodjegan, and Jeffrey K Aronson
- Subjects
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi ,Computer science ,Model-informed precision dosing ,Toxicology ,030226 pharmacology & pharmacy ,Clinical decision support system ,03 medical and health sciences ,0302 clinical medicine ,Drug Development ,pharmacokinetic/ pharmacodynamic modeling ,Individualized dosing ,Health care ,Humans ,Electronic health records ,030212 general & internal medicine ,Dosing ,Clinical care ,Pharmacology ,ddc:616 ,Systems pharmacology ,Health economics ,ddc:617 ,Pharmacokinetic/pharmacodynamic modeling ,business.industry ,Clinical decision support systems ,Requirements validation ,Health Care Service and Management, Health Policy and Services and Health Economy ,MIPD ,Drug development ,Risk analysis (engineering) ,Other Clinical Medicine ,Annan klinisk medicin ,business - Abstract
Model-informed precision dosing (MIPD) has become synonymous with modern approaches for individualizing drug therapy, in which the characteristics of each patient are considered as opposed to applying a one-size-fits-all alternative. This review provides a brief account of the current knowledge, practices, and opinions on MIPD while defining an achievable vision for MIPD in clinical care based on available evidence. We begin with a historical perspective on variability in dose requirements and then discuss technical aspects of MIPD, including the need for clinical decision support tools, practical validation, and implementation of MIPD in health care. We also discuss novel ways to characterize patient variability beyond the common perceptions of genetic control. Finally, we address current debates on MIPD from the perspectives of the new drug development, health-care economics, and drug regulations. Expected final online publication date for the Annual Review of Pharmacology and Toxicology, Volume 61 is January 7, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
- Published
- 2021
11. Adherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study.
- Author
-
Jennifer Settergren, Birgit Eiermann, and Buster Mannheimer
- Subjects
Medicine ,Science - Abstract
PurposeTo investigate the extent to which clinicians avoid well-established drug-drug interactions that cause statin-induced myopathy. We hypothesised that clinicians would avoid combining erythromycin or verapamil/diltiazem respectively with atorvastatin or simvastatin. In patients with statin-fibrate combination therapy, we hypothesised that gemfibrozil was avoided to the preference of bezafibrate or fenofibrate. When combined with verapamil/diltiazem or fibrates, we hypothesized that the dispensed doses of atorvastatin/simvastatin would be decreased.MethodsCross-sectional analysis of nationwide dispensing data. Odds ratios of interacting erythromycin, verapamil/diltiazem versus respective prevalence of comparator drugs doxycycline, amlodipine/felodipine in patients co-dispensed interacting statins simvastatin/atorvastatin versus patients unexposed (pravastatin/fluvastatin/rosuvastatin) was calculated. For fibrates, OR of gemfibrozil versus fenofibrate/bezafibrate in patients co-dispensed any statin was assessed.ResultsOR of interacting erythromycin versus comparator doxycycline did not differ between patients on interacting and comparator statins either in patients dispensed high or low statin doses (adjusted OR 0.87; 95% CI 0.60-1.25 and 0.92; 95% CI 0.69-1.23). Interacting statins were less common among patients dispensed verapamil/diltiazem as compared to patients on amlodipine/felodipine (OR high dose 0.62; CI 0.56-0.68 and low dose 0.63; CI 0.58-0.68). Patients on any statin were to a lesser extent dispensed gemfibrozil compared to patients not dispensed a statin (OR high dose 0.65; CI 0.55-0.76 and low dose 0.70; CI 0.63-0.78). Mean DDD (SD) for any statin was substantially higher in patients co-dispensed gemfibrozil 178 (149) compared to patients on statin monotherapy 127 (93), (pConclusionsPrescribers may to some extent avoid co-prescription of statins with calcium blockers and fibrates with an increased risk of myopathy. We found no evidence for avoiding co-prescriptions of statins and antibiotics with an increased risk of statin-induced adverse drug reactions. Co-prescription of statins and gemfibrozil is paradoxically associated with a marked increased statin dose, further aggravating the risk for severe myopathy.
- Published
- 2013
- Full Text
- View/download PDF
12. High Prevalence of Drug-Drug Interactions in Primary Health Care is Caused by Prescriptions from other Healthcare Units
- Author
-
Birgit Eiermann, Henrik Kockum, Marine L. Andersson, and Ylva Böttiger
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Prescription Drugs ,Time Factors ,Drug-Related Side Effects and Adverse Reactions ,Toxicology ,Drug Prescriptions ,Clinical decision support system ,03 medical and health sciences ,Drug Utilization Review ,0302 clinical medicine ,Risk Factors ,Health care ,Prevalence ,medicine ,Humans ,Drug Interactions ,030212 general & internal medicine ,Medical prescription ,Aged ,Retrospective Studies ,Sweden ,Pharmacology ,Polypharmacy ,Primary Health Care ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,030220 oncology & carcinogenesis ,Family medicine ,Female ,business ,Medication list ,Cohort study - Abstract
Drug-drug interactions are increasingly common, as patients are getting older and the number of drugs per patient is increasing. In this study, we investigated to which extent potential drug-drug interactions originated from single or multiple prescribers. All patients attending any of 20 primary healthcare centres were included in a retrospective observational cohort study. Data on all prescriptions to these patients, irrespectively of the prescriber, were collected for two 4-month periods. Potential drug interactions were identified using the drug-drug interaction database SFINX. Interactions were classified with respect to the workplace of the prescriber, and the prevalence of interactions according to origin was analysed. We found that the drug interactions were significantly more common when the drugs were prescribed from different healthcare centres, compared with drugs prescribed from the patients' primary healthcare centre only. One explanation for this increased risk of drug interactions could be that the prescribers at different primary healthcare centres do not share the same information concerning the total medication list of the patient.
- Published
- 2017
13. Prevalence of potential drug-drug interactions in Swedish pediatric outpatients
- Author
-
Buster Mannheimer, Birgit Eiermann, Johan Holm, and Elin Kimland
- Subjects
Male ,Cross-sectional study ,Toxicology ,Pathology and Laboratory Medicine ,Pediatrics ,Geographical locations ,0302 clinical medicine ,Outpatients ,Medicine and Health Sciences ,Prevalence ,Drug Interactions ,030212 general & internal medicine ,Child ,media_common ,Multidisciplinary ,Europe ,Research Design ,Child, Preschool ,Medicine ,Female ,Research Article ,Drug ,medicine.medical_specialty ,Patients ,Adolescent ,Drug-Related Side Effects and Adverse Reactions ,Clinical Research Design ,media_common.quotation_subject ,Science ,Pharmacy ,Drug-Drug Interactions ,Research and Analysis Methods ,03 medical and health sciences ,Adverse Reactions ,Dose adjustment ,030225 pediatrics ,Internal medicine ,medicine ,Humans ,In patient ,Treatment effect ,European Union ,Adverse effect ,Pharmacology ,Sweden ,Toxicity ,business.industry ,Biology and Life Sciences ,Infant ,Health Care ,Cross-Sectional Studies ,Adverse Events ,People and places ,business ,Pediatric population - Abstract
PurposeTo describe the occurrence of potential drug-drug interactions (DDIs) in prescribed drugs, dispensed to pediatric outpatients in Sweden.MethodsA cross sectional study was conducted based on data from a national register of prescribed drugs, dispensed at pharmacies, to children 0-17 years old. The study period was January 1 to April 30, 2010. Drug dispensing data was linked to the DDI database SFINX. Prevalence and frequencies of potential interactions were investigated, and drugs commonly involved in interactions were identified. The study focused on clinically relevant potential interactions, class D (should be avoided), and class C (can be handled, e.g. by dose adjustment).ResultsIn the Swedish pediatric population, 0 to 17 years of age, 12% (n = 231 078) of children had at least two dispensed drugs. In this group of patients, 0.14% had potential D-interactions and 1,3% had potential C-interactions. The number of D- and C-interactions that may lead to reduced effects were 181 (52%), and 1224 (32%) respectively. The ten most frequent drugs were involved in 78% and 65% of all potential D-, and C-interactions respectively. Furthermore, 80%, and 58% of the D-, and C-interactions respectively occurred in patients aged 12 to 17.ConclusionsWe identified a limited number of drugs that were represented in the majority of potential interactions. Interactions that can lead to a reduced treatment effect constituted approximately half of D-interactions, and a third of C-interactions. The frequency of potential interactions was higher in older children. The results may contribute to increased prescriber awareness of important potential drug interactions among pediatric outpatients.
- Published
- 2019
14. On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshop.
- Author
-
Jamie J. Coleman, Heleen van der Sijs, Walter E. Haefeli, Sarah P. Slight, Sarah E. McDowell, Hanna M. Seidling, Birgit Eiermann, Jos Aarts, Elske Ammenwerth, Robin E. Ferner, and Ann Slee
- Published
- 2013
- Full Text
- View/download PDF
15. Correction: On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshop.
- Author
-
Jamie J. Coleman, Heleen van der Sijs, Walter E. Haefeli, Sarah P. Slight, Sarah E. McDowell, Hanna M. Seidling, Birgit Eiermann, Jos Aarts, Elske Ammenwerth, Ann Slee, and Robin E. Ferner
- Published
- 2013
- Full Text
- View/download PDF
16. Physicians' reported needs of drug information at point of care in Sweden
- Author
-
Seher Korkmaz, Lars L. Gustafsson, Birgit Eiermann, Magnus Gruvén, Simon Maxwell, Hans-Georg Eichle, Pia Bastholm Rahmner, and Anikó Vég
- Subjects
Pharmacology ,Decision support system ,business.industry ,media_common.quotation_subject ,medicine.disease ,Clinical decision support system ,Focus group ,Health informatics ,medicine ,Pharmacology (medical) ,Quality (business) ,Medical emergency ,Summary of Product Characteristics ,business ,Adverse effect ,Point of care ,media_common - Abstract
AIMS Relevant and easily accessible drug information at point-of-care is essential for physicians' decision making when prescribing. However, the information available by using Clinical Decision Support Systems (CDSSs) often does not meet physicians' requirements. The Summary of Product Characteristics (SmPC) is statutory information about drugs. However, the current structure, content and format of SmPCs make it difficult to incorporate them into CDSSs and link them to relevant patient information from the Electronic Health Records. The aim of the study was to evaluate the perceived needs for drug information among physicians in Sweden. METHODS We recruited three focus group discussions with 18 physicians covering different specialities. The information from the groups was combined with a questionnaire administered at the beginning of the group discussions. RESULTS Physicians reported their needs for knowledge databases at the point of drug prescribing. This included more consistent information about existing and new drugs. They also wished to receive automatically generated alerts for severe drug-drug interactions and adverse effects, and to have functions for calculating glomerular filtration rate to enable appropriate dose adjustments to be made for elderly patients and those with impaired renal function. Additionally, features enhancing electronic communication with colleagues and making drug information more searchable were suggested. CONCLUSIONS The results from the current study showed the need for knowledge databases which provide consistent information about new and existing drugs. Most of the required information from physicians appeared to be possible to transfer from current SmPCs to CDSSs. However, inconsistencies in the SmPC information have to be reduced to enhance their utility.
- Published
- 2011
17. Design and implementation of a point-of-care computerized system for drug therapy in Stockholm metropolitan health region—Bridging the gap between knowledge and practice
- Author
-
Margaretha Julander, Birgit Eiermann, L. Bengt Blomberg, Kjell Henriksson, Bengt Sjöborg, Per-Olof Kaiser, Tobias Bäckström, Marie Eliasson, Eva Andersén-Karlsson, Björn Molin, Lennart Jacobsson, Lars-Bertil Arvidsson, Ulf Jacobsson, Jonas T. Larsson, Lars L. Gustafsson, and Carina Landberg
- Subjects
Sweden ,Health Knowledge, Attitudes, Practice ,Decision support system ,education.field_of_study ,business.industry ,Point-of-Care Systems ,Population ,Health Informatics ,medicine.disease ,Metropolitan area ,Clinical decision support system ,Medical Order Entry Systems ,State Medicine ,Work (electrical) ,Nursing ,Knowledge base ,Health care ,medicine ,Humans ,Medical emergency ,Diffusion of Innovation ,Medical prescription ,business ,education ,Delivery of Health Care - Abstract
Introduction Stockholm County Council is the largest health care provider in Sweden with an annual budget of US$ 5 billion and catering the needs of a metropolitan population of 2 million people. About 10% of health care costs are used on drugs. In 1996 Stockholm County Council decided to address the main problems associated with the process and the quality of drug prescribing. Methods A multiyear strategy was designed, including the establishment of a strong evidence-based organisation, Drug and Therapeutics Committees and editorial resources to adapt information to the IT-media and the development of the IT-architecture. The development and implementation of computerized tools such as a physician drug order entry system including decision support, a drug information website and electronic transmission of prescriptions were started in 1996. Results The implementation was slow at the point-of-care units. It took about 6 years before the implementation process gained speed. In September 2005 almost 1000 doctors could use the decision support system for prescribing drugs and more than 70% of all prescriptions were transmitted electronically in our region. Conclusions The work with the strategy has shown that improvements in drug use can be accomplished by providing access to simple, rapid and safe electronic tools, but the information provided has to be associated with well-recognized regional and national expert organisations.
- Published
- 2007
18. [Few drugs dominate among clinically important interactions. Swedish register study lists problem drugs]
- Author
-
Johan, Holm, Birgit, Eiermann, Erik, Eliasson, and Buster, Mannheimer
- Subjects
Sweden ,Sex Factors ,Databases, Factual ,Drug-Related Side Effects and Adverse Reactions ,Age Factors ,Humans ,Drug Interactions ,Registries ,Decision Support Systems, Clinical - Abstract
In a recent Swedish register study, a limited number of specific drugs explained a large part of clinically relevant, potential drug-drug interactions (DDI), as defined and detected by the DDI database SFINX. Regarding interactions that should be avoided according to the definition in the database (class D), 15 drug combinations accounted for as much as 80 % of the prevalence in the Swedish population. Ten specific drugs were involved in 94 % of all detected class D interactions. About half of the clinically relevant interactions detected during the four-month study period were associated with an increased risk of adverse drug reactions, whereas the other half has a potential to cause therapeutic failure. An increased awareness among prescribers of these interacting drugs could contribute to safer and more effective drug use.
- Published
- 2015
19. Potential drug-related problems detected by electronic expert support system: physicians' views on clinical relevance
- Author
-
Yngve Gustafson, Bodil Lidström, Tora Hammar, Göran Petersson, and Birgit Eiermann
- Subjects
Drug ,Male ,medicine.medical_specialty ,Attitude of Health Personnel ,media_common.quotation_subject ,Pharmaceutical Science ,Pharmacy ,Toxicology ,Clinical decision support system ,Health informatics ,Medical Order Entry Systems ,Physicians ,medicine ,Humans ,Medication Errors ,Pharmacology (medical) ,Clinical significance ,Medical prescription ,media_common ,Aged ,Pharmacology ,Geriatrics ,Aged, 80 and over ,business.industry ,Emergency medicine ,Female ,business ,Biomedical sciences - Abstract
Background Drug-related problems cause suffering for patients and substantial costs. Multi-dose drug dispensing is a service in which patients receive their medication packed in bags with one unit for each dose occasion. The electronic expert support system (EES) is a clinical decision support system that provides alerts if potential drug-related problems are detected among a patients’ current prescriptions, including drug–drug interactions, therapy duplications, high doses, drug-disease interactions, drug gender warnings, and inappropriate drugs and doses for geriatric or pediatric patients. Objective The aim of the study was to explore physicians’ views on the clinical relevance of alerts provided by EES. Furthermore we investigated if physicians performed any changes in drug treatment following the alerts and if there were any differences in perceived relevance and performed changes between different types of alerts and drugs. Setting Two geriatric clinics and three primary care units in Sweden. Method Prescribed medications for patients (n = 254) with multi-dose drug dispensing were analyzed for potential drug-related problems using EES. For each alert, a physician assessed clinical relevance and indicated any intended action. A total of 15 physicians took part in the study. Changes in drug treatment following the alerts were later measured. The relationship between variables was analyzed using Chi square test. Main outcome measure Physicians’ perceived clinical relevance of each alert, and changes in drug treatment following the alerts. Results Physicians perceived 68 % (502/740) of EES alerts as clinically relevant and 11 % of all alerts were followed by a change in drug treatment. Clinical relevance and likelihood to make changes in drug treatment was related to the alert category and substances involved in the alert. Conclusion In most patients with multi-dose drug dispensing, EES detected potential drug-related problems, with the majority of the alerts regarded as clinically relevant and some followed by measurable changes in drug treatment.
- Published
- 2015
20. Evaluation of usage patterns and user perception of the drug-drug interaction database SFINX
- Author
-
Pia Bastholm-Rahmner, Marie-Louise Ovesjö, Marine L. Andersson, Aniko Vég, Ylva Böttiger, and Birgit Eiermann
- Subjects
Adult ,Male ,Medication Systems, Hospital ,medicine.medical_specialty ,Databases, Factual ,Attitude of Health Personnel ,education ,Drug-drug interaction ,Health Informatics ,Pharmacists ,computer.software_genre ,Drug Prescriptions ,Medical Order Entry Systems ,Pharmacovigilance ,Clinical work ,Drug interactions ,Decision support systems ,Clinical ,Questionnaires ,Medical order entry systems ,Physicians ,Surveys and Questionnaires ,Patient Handling ,medicine ,Adverse Drug Reaction Reporting Systems ,Humans ,Medication Errors ,Statistical analysis ,Practice Patterns, Physicians' ,Finland ,Aged ,Sweden ,Response rate (survey) ,Database ,Descriptive statistics ,business.industry ,User perception ,Klinisk medicin ,Middle Aged ,Family medicine ,Female ,Clinical Medicine ,business ,Relevant information ,computer - Abstract
Purpose: The aim of the present study was to investigate how prescribers and pharmacists use and perceive the drug-drug interaction database SFINX in their clinical work. Methods: A questionnaire was developed with questions aimed at the usage of SFINX, and the perceptions of the database. The questionnaire was sent out to all registered users of the web application of SFINX. The anonymous answers from the target users, prescribers and pharmacists were summarized using descriptive statistics. Statistical analysis was performed on age and gender differences for some questions regarding different usage patterns. Results: The questionnaire was sent to 11,763 registered SFINX users. The response rate was 23%, including 1871 answers from prescribers or pharmacists. SFINX was reported to be used at least weekly or more often by 45% of the prescribers and 51% of the pharmacists. Many prescribers reported using the database during the patient consultation (60%) or directly before or after (56%). Among the prescribers, 74% reported that the information received made them change their action at least sometimes. About 20% of the prescribers and 25% of the pharmacists considered the information as irrelevant sometimes or more often. Conclusion: Most prescribers and pharmacists reported using SFINX in direct association with a patient consultation. Information received by using SFINX makes prescribers and pharmacists change their handling of patients. DDI databases with relevant information about patient handling might improve drug treatment outcome. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
- Published
- 2015
21. The involvement of CYP1A2 and CYP3A4 in the metabolism of clozapine
- Author
-
Leif Bertilsson, Inger Johansson, Ulrich M. Zanger, Georg Engel, and Birgit Eiermann
- Subjects
Cytochrome P-450 CYP1A2 Inhibitors ,CYP3A ,Desmethylclozapine ,Pharmacology ,Antibodies ,Mixed Function Oxygenases ,chemistry.chemical_compound ,Cytochrome P-450 Enzyme System ,Antibody Specificity ,Cytochrome P-450 CYP1A2 ,medicine ,Cytochrome P-450 CYP3A ,Cytochrome P-450 Enzyme Inhibitors ,Humans ,Pharmacology (medical) ,Enzyme Inhibitors ,Clozapine ,Biotransformation ,Demethylation ,biology ,CYP3A4 ,CYP1A2 ,Cytochrome P450 ,Original Articles ,Isoenzymes ,Kinetics ,chemistry ,Microsomes, Liver ,biology.protein ,Microsome ,Ketoconazole ,Antipsychotic Agents ,medicine.drug - Abstract
Clozapine (CLZ), an atypical neuroleptic with a high risk of causing agranulocytosis, is metabolized in the liver to desmethylclozapine (DCLZ) and clozapine N-oxide (CLZ-NO). This study investigated the involvement of different CYP isoforms in the formation of these two metabolites.Human liver microsomal incubations, chemical inhibitors, specific antibodies, and different cytochrome P450 expression systems were used.Km and Vmax values determined in human liver microsomes were lower for the demethylation (61 +/- 21 microM, 159 +/- 42 pmol min(-1) mg protein(-1) mean +/- s.d.; n = 4), than for the N-oxidation of CLZ (308 +/- 1.5 microM, 456 +/- 167 pmol min(-1) mg protein(-1); n = 3). Formation of DCLZ was inhibited by fluvoxamine (53 +/- 28% at 10 microM), triacetyloleandomycin (33 +/- 15% at 10 microM), and ketoconazole (51 +/- 28% at 2 microM) and by antibodies against CYP1A2 and CYP3A4. CLZ-NO formation was inhibited by triacetyloleandomycin (34 +/- 16% at 10 microM) and ketoconazole (51 +/- 13% at 2 microM), and by antibodies against CYP3A4. There was a significant correlation between CYP3A content and DCLZ formation in microsomes from 15 human livers (r=0.67; P=0.04). A high but not significant correlation coefficient was found for CYP3A content and CLZ-NO formation (r=0.59; P=0.09). Using expression systems it was shown that CYP1A2 and CYP3A4 formed DCLZ and CLZ-NO. Km and Vmax values were lower in the CYP1A2 expression system compared to CYP3A4 for both metabolic reactions.It is concluded that CYP1A2 and CYP3A4 are involved in the demethylation of CLZ and CYP3A4 in the N-oxidation of CLZ. Close monitoring of CLZ plasma levels is recommended in patients treated at the same time with other drugs affecting these two enzymes.
- Published
- 1997
22. Impact of the drug-drug interaction database SFINX on prevalence of potentially serious drug-drug interactions in primary health care
- Author
-
Ylva Böttiger, Marine L. Andersson, Jonatan D. Lindh, Björn Wettermark, and Birgit Eiermann
- Subjects
Drug ,Adult ,Male ,Time Factors ,Databases, Factual ,Drug-Related Side Effects and Adverse Reactions ,media_common.quotation_subject ,Knowledge Bases ,Drug-drug interaction ,Primary health care ,MEDLINE ,computer.software_genre ,Clinical decision support system ,Drug Prescriptions ,Medical Order Entry Systems ,Intervention (counseling) ,Health care ,Prevalence ,Medicine ,Adverse Drug Reaction Reporting Systems ,Humans ,Medication Errors ,Pharmacology (medical) ,Drug Interactions ,Medical prescription ,Practice Patterns, Physicians' ,media_common ,Aged ,Pharmacology ,Sweden ,Database ,Primary Health Care ,business.industry ,General Medicine ,Middle Aged ,Female ,business ,computer ,Program Evaluation - Abstract
To investigate the impact of the integration of the drug-drug interaction database SFINX into primary health care records on the prevalence of potentially serious drug-drug interactions.The study was a controlled before-and-after study on the prevalence of potential drug-drug interactions before and after the implementation of SFINX at 15 primary healthcare centres compared with 5 centres not receiving the intervention. Data on dispensed prescriptions from health care centres were retrieved from the Swedish prescribed drug register and analysed for September-December 2006 (pre-intervention) and September-December 2007 (post-intervention). All drugs dispensed during each 4 month period were regarded as potentially interacting.Use of SFINX was associated with a 17% decrease, to 1.81 × 10(-3) from 2.15 × 10(-3) interactions per prescribed drug-drug pair, in the prevalence of potentially serious drug-drug interactions (p = 0.042), whereas no significant effect was observed in the control group. The change in prevalence of potentially serious drug-drug interactions did not differ significantly between the two study groups. The majority of drug-drug interactions identified were related to chelate formation.Prescriptions resulting in potentially serious drug-drug interactions were significantly reduced after integration of the drug-drug interaction database SFINX into electronic health records in primary care. Further studies are needed to demonstrate the effectiveness of drug-drug interaction warning systems.
- Published
- 2012
23. Knowledge Bases for Clinical Decision Support in Drug Prescribing – Development, Quality Assurance, Management, Integration, Implementation and Evaluation of Clinical Value
- Author
-
Tero Shemeikka, Birgit Eiermann, Seher Korkmaz, Lars L. Gustafsson, Birgitta Lilja, Björn Wettermark, Pia Bastholm Rahmner, Anikó Vég, and Carina Landberg
- Subjects
Knowledge management ,Drug Prescribing ,business.industry ,Clinical value ,Medicine ,business ,Clinical decision support system ,Quality assurance - Abstract
Knowledge databases for clinical decision support in drug prescribing-development, quality assurance, management, integration, implementation and evaluation of clinical value
- Published
- 2010
24. SFINX-a drug-drug interaction database designed for clinical decision support systems
- Author
-
Marine L. Andersson, Lars L. Gustafsson, Kari Laine, Tuomas Korhonen, Ylva Böttiger, Tuire Tirkkonen, Marie-Louise Ovesjö, Birgit Eiermann, Anders Rane, and Björn Molin
- Subjects
Pharmacology ,Decision support system ,Database ,Computer science ,media_common.quotation_subject ,Drug-drug interaction ,MEDLINE ,General Medicine ,computer.software_genre ,Decision Support Systems, Clinical ,Clinical decision support system ,Documentation ,Key (cryptography) ,Data system ,Database Management Systems ,Pharmacology (medical) ,Quality (business) ,Drug Interactions ,computer ,media_common - Abstract
Objective The aim was to develop a drug-drug interaction database (SFINX) to be integrated into decision support systems or to be used in website solutions for clinical evaluation of interactions. Methods Key elements such as substance properties and names, drug formulations, text structures and references were defined before development of the database. Standard operating procedures for literature searches, text writing rules and a classification system for clinical relevance and documentation level were determined. ATC codes, CAS numbers and country-specific codes for substances were identified and quality assured to ensure safe integration of SFINX into other data systems. Much effort was put into giving short and practical advice regarding clinically relevant drug-drug interactions. Results SFINX includes over 8,000 interaction pairs and is integrated into Swedish and Finnish computerised decision support systems. Over 31,000 physicians and pharmacists are receiving interaction alerts through SFINX. User feedback is collected for continuous improvement of the content. Conclusion SFINX is a potentially valuable tool delivering instant information on drug interactions during prescribing and dispensing.
- Published
- 2008
25. A Limited number of prescribed Drugs account for the majority of clinically relevant Drug interactions
- Author
-
Birgit Eiermann, Erik Eliasson, Buster Mannheimer, and Johan Holm
- Subjects
Pharmacology ,Drug ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,medicine ,Pharmacology (medical) ,Intensive care medicine ,business ,Prescribed drugs ,media_common - Published
- 2015
26. On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshop
- Author
-
Robin E Ferner, Elske Ammenwerth, Sarah E McDowell, Sarah P. Slight, Heleen van der Sijs, Jos Aarts, Hanna M. Seidling, Ann Slee, Jamie J Coleman, Birgit Eiermann, Walter E. Haefeli, Pharmacy, and Health Care Governance (HCG)
- Subjects
Decision support system ,Process management ,European Regional Development Fund ,Health Informatics ,Health informatics ,Clinical decision support system ,Sensitivity and Specificity ,Medical Order Entry Systems ,Patient safety ,Electronic Prescribing ,610 Medical sciences Medicine ,Nursing ,Computerized physician order entry ,Electronic prescribing ,Medicine ,Humans ,Adaptation (computer science) ,business.industry ,Health Policy ,Decision Support Systems, Clinical ,Computer Science Applications ,Europe ,business ,Clinical Decision Support Systems ,Research Article - Abstract
Background: Clinical decision support (CDS) for electronic prescribing systems (computerized physician order entry) should help prescribers in the safe and rational use of medicines. However, the best ways to alert users to unsafe or irrational prescribing are uncertain. Specifically, CDS systems may generate too many alerts, producing unwelcome distractions for prescribers, or too few alerts running the risk of overlooking possible harms. Obtaining the right balance of alerting to adequately improve patient safety should be a priority. Methods: A workshop funded through the European Regional Development Fund was convened by the University Hospitals Birmingham NHS Foundation Trust to assess current knowledge on alerts in CDS and to reach a consensus on a future research agenda on this topic. Leading European researchers in CDS and alerts in electronic prescribing systems were invited to the workshop. Results: We identified important knowledge gaps and suggest research priorities including (1) the need to determine the optimal sensitivity and specificity of alerts; (2) whether adaptation to the environment or characteristics of the user may improve alerts; and (3) whether modifying the timing and number of alerts will lead to improvements. We have also discussed the challenges and benefits of using naturalistic or experimental studies in the evaluation of alerts and suggested appropriate outcome measures. Conclusions: We have identified critical problems in CDS, which should help to guide priorities in research to evaluate alerts. It is hoped that this will spark the next generation of novel research from which practical steps can be taken to implement changes to CDS systems that will ultimately reduce alert fatigue and improve the design of future systems.
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.