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At least 433 records · Page 24Linked to original sources
PubMedDate not supplied

Achieving blood pressure control in patients with diabetes: a case study in primary care.

This article presents a case study from a primary care practice that achieves blood pressure control (ie, less than 130/85 mm Hg) in a majority of patients with diabetes. Fifty-three percent of the last blood pressures measured in 2001 were controlled and 38% of patients achieved blood pressure control without medications or with a single agent. Blood pressure control is achieved in a majority of patients in this practice secondary to their focus on guidelines, involvement of nursing staff in case management, and medication use consistent with recommendations.

Adult↗
PubMed2003

Clinical decision support provided within physician order entry systems: a systematic review of features effective for changing clinician behavior.

Computerized physician order entry (CPOE) systems represent an important tool for providing clinical decision support. In undertaking this systematic review, our objective was to identify the features of CPOE-based clinical decision support systems (CDSSs) most effective at modifying clinician behavior. For this review, two independent reviewers systematically identified randomized controlled trials that evaluated the effectiveness of CPOE-based CDSSs in changing clinician behavior. Furthermore, each included study was assessed for the presence of 14 CDSS features. We screened 10,023 citations and included 11 studies. Of the 10 studies comparing a CPOE-based CDSS intervention against a non-CDSS control group, 7 reported a significant desired change in professional practice. Moreover, meta-regression analysis revealed that automatic provision of the decision support was strongly associated with improved professional practice (adjusted odds ratio, 23.72; 95% confidence interval, 1.75-infiniti). Thus, we conclude that automatic provision of decision support is a critical feature of successful CPOE-based CDSS interventions.

Decision Making, Computer-Assisted↗
PubMed1998

Augmentation of Pap smear screening of high risk aboriginal women. Use of a computerised process tool within the Broome Aboriginal Medical Service.

OBJECTIVE: The Broome Regional Aboriginal Medical Service (BRAMS) in Broome, Western Australia, conducted a 4 month program to augment the Pap smear screening of Aboriginal women. The emphasis was on those with a past history of abnormal smears, aged greater than 40 years, living in remote communities and very (more than 5 years) overdue. METHOD: Continuation of existing opportunistic recall processes supplemented by three components: the development of an Aboriginal Health Worker (AHW) run Pap smear clinic; the provision of Aboriginal outstation screening; and active recruitment of targeted women (by AHW staff) using worklists. All components used Healthplanner, a computerised process tool to facilitate targeting and recall. MAIN OUTCOME MEASURES: The number of Pap smears taken from the target groups before and after intervention and the proportion screened from the women eligible in each target group at the start of the program. RESULTS: There was statistically significant increase in the coverage of Aboriginal women overall, those over the age of 40 years, and those from remote communities when compared with the same period the previous years. In 4 months, 21-30% of Aboriginal women eligible for Pap smears in these high risk categories including those with past abnormal smears were screened. Over-screening of women did not occur as only 4% of smears taken were from women screened less than 12 months previously. Smears taken by AHW staff were of high quality. CONCLUSION: Use of a computerised process tool in a remote setting can facilitate selective recruitment of high risk women overdue for Pap smears.

Adult↗
PubMed2006

Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial.

OBJECTIVE: Many hospitals utilize antimicrobial management teams (AMTs) to improve patient care. However, most function with minimal computer support. We evaluated the effectiveness and cost-effectiveness of a computerized clinical decision support system for the management of antimicrobial utilization. DESIGN: A randomized controlled trial in adult inpatients between May 10 and August 3, 2004. Antimicrobial utilization was managed by an existing AMT using the system in the intervention arm and without the system in the control arm. The system was developed to alert the AMT of potentially inadequate antimicrobial therapy. MEASUREMENTS: Outcomes assessed were hospital antimicrobial expenditures, mortality, length of hospitalization, and time spent managing antimicrobial utilization. RESULTS: The AMT intervened on 359 (16%) of 2,237 patients in the intervention arm and 180 (8%) of 2,270 in the control arm, while spending approximately one hour less each day on the intervention arm. Hospital antimicrobial expenditures were $285,812 in the intervention arm and $370,006 in the control arm, for a savings of $84,194 (23%), or $37.64 per patient. No significant difference was observed in mortality (3.26% vs. 2.95%, p = 0.55) or length of hospitalization (3.84 vs. 3.99 days, p = 0.38). CONCLUSION: Use of the system facilitated the management of antimicrobial utilization by allowing the AMT to intervene on more patients receiving inadequate antimicrobial therapy and to achieve substantial time and cost savings for the hospital. This is the first study that demonstrates in a patient-randomized controlled trial that computerized clinical decision support systems can improve existing antimicrobial management programs.

Adult↗
PubMed1997

Effect of selected in-vehicle route guidance systems on driver reaction times.

Experiments were conducted in a fixed-base, high-fidelity simulator to evaluate selected in-vehicle route guidance systems. Drivers navigated a simulated network using five route guidance systems: paper map, head-down turn-by-turn display, head-down electronic route map, head-up turn-by-turn display, and an audio guidance system. The primary measure of driving performance was the reaction time to a scanning task. Other measures included navigation errors, workload, and perception ratings. Censored regression models were developed to study the effect of route guidance type on reaction times. Results indicated that the drivers responded the fastest while using the audio system and the slowest while using the paper map. The head-up turn-by-turn display was associated with lower reaction times compared with an identically designed head-down turn-by-turn display. The head-down electronic map, despite its complexity, performed better than the head-down turn-by-turn display.

Adult↗
PubMed1996

Facing the next challenge of pharmaceutical care: patient noncompliance.

Medication misusage is a costly problem. Fixing the matter will not be easy because it means reshaping pharmaceutical care. Yet, the business reasons for undertaking such an action are compelling. Not only would MCOs and payers reduce expenditures, but drug companies, pharmacists, and pharmacy benefit managers could vitalize their positions in the marketplace. This article proposes how an integrated program might overcome noncompliance.

Deductibles and Coinsurance↗
PubMed2003

Minimize practice variation by focusing on 'top priority conditions'.

For years, physicians have debated--with each other and, increasingly, with health plans--the causes of variation in physician practice. Reducing variation has to be part of the institutional agenda. Plus, physicians should be given adequate resources to develop support systems that will enable them to deliver more consistent clinical practice.

Aged↗
PubMed1990

Models to promote medical health care delivery for indigent families: computerized tracking to case management.

Poor patient/parental medical compliance is one of the most important health care issues of today. Multiple interrelated factors contribute to this problem. Of prime importance is patient/parental maturity and knowledge. Reversal of this process is undoubtably harder than prevention. The cost effectiveness of various methods of intervention is discussed in relation to a large mid-south indigent population. Computerized patient tracking is cost efficient and effectively promotes compliance in a percentage of patients. Its additional utility is the identification and triage of patients, most in need of intervention, to existing social service personnel for family-centered case management. Family-centered case management holds the best hope of reversing the many factors adversely affecting patient compliance. However, this method is costly and requires a low ratio of clients to caseworkers in order to be effective. Community-centered patient management is less costly to implement and is very useful in tightly woven communities resistant to outside intervention. However, this method often has a high client to caseworker ratio and has less utility in dealing with complex medical problems.

Adolescent↗
PubMed1994

User comments on a clinical event monitor.

Columbia-Presbyterian Medical Center's health care providers have access to alerts and interpretations generated by an Arden Syntax-based clinical event monitor. They have the opportunity to send comments to the clinical information services staff. Over a period of 26 months, they sent 126 comments. The comments were analyzed using the critical incident technique, resulting in a hierarchy of categories that summarizes user concerns. The majority of comments (65) indicated that the messages were actually (8) or at least potentially useful (57). A minority (28) indicated that they were unhelpful (27) or actually harmful (1). Another group (27) made suggestions or asked questions. The comments have been very helpful for the maintenance of Medical Logic Modules (MLMs) and the clinical event monitor itself.

Academic Medical Centers↗
PubMed1995

Patient informatics: using a computerized system to monitor patient compliance in the treatment of hypertension.

A group of investigators at a major teaching hospital have prepared a study designed to test the hypothesis that patient outcomes related to hypertension will be improved by increased compliance, as defined by consistent daily compliance with prescribed medical regimen. The study will test the effectiveness of the following interventions in improving compliance: 1) improved access to medication, 2) computerized phone follow-up, and 3) one-on-one follow-up conversations concerning compliance issues. This paper is intended to describe the pending study in detail while focusing on the computerized phone system that will be used in the treatment group of the controlled study for compliance.

Computer Systems↗
PubMed2005

A programmable prompting device improves adherence to highly active antiretroviral therapy in HIV-infected subjects with memory impairment.

Background. Patients cite "forgetting" as a reason for nonadherence to highly active antiretroviral therapy (HAART). We measured the effect of a memory-prompting device on adherence to HAART in memory-intact and memory-impaired human immunodeficiency virus (HIV)-infected subjects.Methods. The study was a prospective, randomized, controlled trial involving 64 HIV-infected adults. The intervention was the Disease Management Assistance System (DMAS) device, combined with monthly adherence counseling. Control subjects received only adherence counseling. The DMAS was programmed with HAART regimen data to provide verbal reminders at dosing times. Adherence was measured for 24 weeks using electronic drug exposure monitor (eDEM) caps.Results. A total of 58 subjects completed the 24-week study period; 28 were HAART naive (12 DMAS users and 16 control subjects). Mean adherence scores did not differ significantly between DMAS users (80%) and control subjects (65%). Post hoc analysis of 31 memory-impaired subjects (14 DMAS users and 17 control subjects) revealed significantly higher adherence rates among DMAS users (77%), compared with control subjects (57%) (P=.001). However, analysis of memory-intact subjects showed that adherence was not significantly improved for DMAS users (83%), compared with control subjects (77%) (P=.25). At week twelve, 38% of the DMAS users and 14% of the control subjects had an undetectable plasma HIV RNA load (P=.014), and at week 24, the plasma HIV RNA load was undetectable for 34% of the DMAS users and 38% of the control subjects (P=.49). CD4(+) cell counts did not differ between the study arms. Virological and immunological responses were not related to DMAS use in memory-impaired subjects.Conclusion. The DMAS prompting device improved adherence for memory-impaired subjects but not for memory-intact subjects.

Anti-HIV Agents↗