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JMIR MHealth and UHealth Sep 2019Pharmacotherapy remains one of the major interventional strategies in medicine. However, patients from all age groups and conditions face challenges when taking... (Review)
Review
BACKGROUND
Pharmacotherapy remains one of the major interventional strategies in medicine. However, patients from all age groups and conditions face challenges when taking medications, such as integrating them into the daily routine, understanding their effects and side effects, and monitoring outcomes. In this context, a reliable medication management tool adaptable to the patient's needs becomes critical. As most people have a mobile phone, mobile apps offer a platform for such a personalized support tool available on the go.
OBJECTIVE
This study aimed to provide an overview of available mobile apps, focusing on those that help patients understand and take their medications. We reviewed the existing apps and provided suggestions for future development based on the concept understand and manage, instead of the conventional adhere to medication. This concept aims to engage and empower patients to be in charge of their health, as well as see medication as part of a broader clinical approach, working simultaneously with other types of interventions or lifestyle changes, to achieve optimal outcomes.
METHODS
We performed a Web search in the iOS Apple App Store and Android Google Play Store, using 4 search terms: medication management, pill reminder, medication health monitor, and medication helper. We extracted information from the app store descriptions for each eligible app and categorized into the following characteristics: features, author affiliation, specialty, user interface, cost, and user rating. In addition, we conducted Google searches to obtain more information about the author affiliation.
RESULTS
A total of 328 apps (175 Android and 153 iOS) were categorized. The majority of the apps were developed by the software industry (73%, 11/15), a minority of them were codeveloped by health care professionals (15%, 3/20) or academia (2.1%; 7/328). The most prevalent specialty was diabetes (23 apps). Only 7 apps focused on mental health, but their content was highly comprehensive in terms of features and had the highest prevalence of the education component. The most prevalent features were reminder, symptom tracker, and ability to share data with a family member or doctor. In addition, we highlighted the features considered innovative and listed practical suggestions for future development and innovations.
CONCLUSIONS
We identified detailed characteristics of the existing apps, with the aim of informing future app development. Ultimately, the goal was to provide users with effective mobile health solutions, which can be expected to improve their engagement in the treatment process and long-term well-being. This study also highlighted the need for improved standards for reporting on app stores. Furthermore, it underlined the need for a platform to offer health app users an ongoing evaluation of apps by health professionals in addition to other users and to provide them with tools to easily select an appropriate and trustworthy app.
Topics: Disease Management; Female; Humans; Male; Medication Adherence; Medication Systems; Middle Aged; Mobile Applications; Self Care
PubMed: 31512580
DOI: 10.2196/13608 -
Drug Safety Nov 2013Underlying systems factors have been seen to be crucial contributors to the occurrence of medication errors. By understanding the causes of these errors, the most... (Review)
Review
BACKGROUND
Underlying systems factors have been seen to be crucial contributors to the occurrence of medication errors. By understanding the causes of these errors, the most appropriate interventions can be designed and implemented to minimise their occurrence.
OBJECTIVE
This study aimed to systematically review and appraise empirical evidence relating to the causes of medication administration errors (MAEs) in hospital settings.
DATA SOURCES
Nine electronic databases (MEDLINE, EMBASE, International Pharmaceutical Abstracts, ASSIA, PsycINFO, British Nursing Index, CINAHL, Health Management Information Consortium and Social Science Citations Index) were searched between 1985 and May 2013.
STUDY SELECTION
Inclusion and exclusion criteria were applied to identify eligible publications through title analysis followed by abstract and then full text examination. English language publications reporting empirical data on causes of MAEs were included. Reference lists of included articles and relevant review papers were hand searched for additional studies. Studies were excluded if they did not report data on specific MAEs, used accounts from individuals not directly involved in the MAE concerned or were presented as conference abstracts with insufficient detail.
DATA APPRAISAL AND SYNTHESIS METHODS
A total of 54 unique studies were included. Causes of MAEs were categorised according to Reason's model of accident causation. Studies were assessed to determine relevance to the research question and how likely the results were to reflect the potential underlying causes of MAEs based on the method(s) used.
RESULTS
Slips and lapses were the most commonly reported unsafe acts, followed by knowledge-based mistakes and deliberate violations. Error-provoking conditions influencing administration errors included inadequate written communication (prescriptions, documentation, transcription), problems with medicines supply and storage (pharmacy dispensing errors and ward stock management), high perceived workload, problems with ward-based equipment (access, functionality), patient factors (availability, acuity), staff health status (fatigue, stress) and interruptions/distractions during drug administration. Few studies sought to determine the causes of intravenous MAEs. A number of latent pathway conditions were less well explored, including local working culture and high-level managerial decisions. Causes were often described superficially; this may be related to the use of quantitative surveys and observation methods in many studies, limited use of established error causation frameworks to analyse data and a predominant focus on issues other than the causes of MAEs among studies.
LIMITATIONS
As only English language publications were included, some relevant studies may have been missed.
CONCLUSIONS
Limited evidence from studies included in this systematic review suggests that MAEs are influenced by multiple systems factors, but if and how these arise and interconnect to lead to errors remains to be fully determined. Further research with a theoretical focus is needed to investigate the MAE causation pathway, with an emphasis on ensuring interventions designed to minimise MAEs target recognised underlying causes of errors to maximise their impact.
Topics: Data Collection; Databases, Factual; Drug Prescriptions; Hospitals, Teaching; Humans; Medication Errors; Models, Theoretical; Patient Care Team; Pharmaceutical Preparations; Quality Assurance, Health Care; Workload
PubMed: 23975331
DOI: 10.1007/s40264-013-0090-2 -
British Journal of Clinical Pharmacology May 2012Interest in patient adherence has increased in recent years, with a growing literature that shows the pervasiveness of poor adherence to appropriately prescribed... (Review)
Review
Interest in patient adherence has increased in recent years, with a growing literature that shows the pervasiveness of poor adherence to appropriately prescribed medications. However, four decades of adherence research has not resulted in uniformity in the terminology used to describe deviations from prescribed therapies. The aim of this review was to propose a new taxonomy, in which adherence to medications is conceptualized, based on behavioural and pharmacological science, and which will support quantifiable parameters. A systematic literature review was performed using MEDLINE, EMBASE, CINAHL, the Cochrane Library and PsycINFO from database inception to 1 April 2009. The objective was to identify the different conceptual approaches to adherence research. Definitions were analyzed according to time and methodological perspectives. A taxonomic approach was subsequently derived, evaluated and discussed with international experts. More than 10 different terms describing medication-taking behaviour were identified through the literature review, often with differing meanings. The conceptual foundation for a new, transparent taxonomy relies on three elements, which make a clear distinction between processes that describe actions through established routines ('Adherence to medications', 'Management of adherence') and the discipline that studies those processes ('Adherence-related sciences'). 'Adherence to medications' is the process by which patients take their medication as prescribed, further divided into three quantifiable phases: 'Initiation', 'Implementation' and 'Discontinuation'. In response to the proliferation of ambiguous or unquantifiable terms in the literature on medication adherence, this research has resulted in a new conceptual foundation for a transparent taxonomy. The terms and definitions are focused on promoting consistency and quantification in terminology and methods to aid in the conduct, analysis and interpretation of scientific studies of medication adherence.
Topics: Databases, Factual; Disease Management; Drug Monitoring; Humans; Medication Adherence; Patient Care Management; Pharmaceutical Preparations
PubMed: 22486599
DOI: 10.1111/j.1365-2125.2012.04167.x -
Revista Gaucha de Enfermagem Jun 2019To analyze the repercussions of using the Birth Plan in the parturition process from the national and international scientific production.
OBJECTIVE
To analyze the repercussions of using the Birth Plan in the parturition process from the national and international scientific production.
METHODS
Integrative literature review performed in the LILACS, PUBMED, CINAHL and SciELO, comprising 13 articles published in English, Spanish and Portuguese, in the period from 2008 through 2018.
RESULTS
The construction of the Birth Plan during prenatal influences positively the process of parturition and maternal-fetal outcomes. Unrealistic expectations can cause dissatisfaction with the experience of childbirth. Care providers play a central role in supporting its planning and fulfillment.
CONCLUSIONS
The analyzed publications justify the clinical implementation of the Birth Plan, once it represents an intensifying technology of humanized care and maternal satisfaction. There are still some challenges related to the use of this instrument concerning women's adherence and professional support to improve the fulfillment of the Birth Plans.
Topics: Adult; Delivery, Obstetric; Evidence-Based Medicine; Female; Humans; Medicalization; Parturition; Patient Preference; Personal Autonomy; Personal Satisfaction; Pregnancy; Prenatal Care; Qualitative Research
PubMed: 31188973
DOI: 10.1590/1983-1447.2019.20180233 -
The New England Journal of Medicine May 2010Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has... (Clinical Trial)
Clinical Trial
BACKGROUND
Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR).
METHODS
We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events.
RESULTS
We observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate)--a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the bar-code eMAR but were completely eliminated on units that did use it.
CONCLUSIONS
Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. (ClinicalTrials.gov number, NCT00243373.)
Topics: Academic Medical Centers; Drug Administration Schedule; Drug-Related Side Effects and Adverse Reactions; Electronic Data Processing; Humans; Medical Order Entry Systems; Medication Errors; Medication Systems, Hospital; Organizational Case Studies; Organizational Innovation; Pharmaceutical Preparations; United States
PubMed: 20445181
DOI: 10.1056/NEJMsa0907115 -
Journal of the American College of... Apr 2017
Topics: Cardiology; Cardiovascular Diseases; Delivery of Health Care; Disease Management; Humans; Leadership; Patient Care Team; Societies, Medical; United States
PubMed: 28385316
DOI: 10.1016/j.jacc.2017.03.007 -
BMJ Health & Care Informatics Aug 2020Electronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication...
Changes in medication administration error rates associated with the introduction of electronic medication systems in hospitals: a multisite controlled before and after study.
BACKGROUND
Electronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication administration errors (MAEs).
OBJECTIVE
To assess changes in MAE rates and types associated with EMS implementation.
METHODS
This was a controlled before and after study (three intervention and three control wards) at two adult teaching hospitals. Intervention wards used an EMS with no bar-coding. Independent, trained observers shadowed nurses and recorded medications administered and compliance with 10 safety procedures. Observational data were compared against medication charts to identify errors (eg, wrong dose). Potential error severity was classified on a 5-point scale, with those scoring ≥3 identified as serious. Changes in MAE rates preintervention and postintervention by study group, accounting for differences at baseline, were calculated.
RESULTS
7451 administrations were observed (4176 pre-EMS and 3275 post-EMS). At baseline, 30.2% of administrations contained ≥1 MAE, with wrong intravenous rate, timing, volume and dose the most frequent. Post-EMS, MAEs decreased on intervention wards relative to control wards by 4.2 errors per 100 administrations (95% CI 0.2 to 8.3; p=0.04). Wrong timing errors alone decreased by 3.4 per 100 administrations (95% CI 0.01 to 6.7; p<0.05). EMS use was associated with an absolute decline in potentially serious MAEs by 2.4% (95% CI 0.8 to 3.9; p=0.003), a 56% reduction in the proportion of potentially serious MAEs. At baseline, 74.1% of administrations were non-compliant with ≥1 of 10 procedures and this rate did not significantly improve post-EMS.
CONCLUSIONS
Implementation of EMS was associated with a modest, but significant, reduction in overall MAE rate, but halved the proportion of MAEs rated as potentially serious.
Topics: Drug Administration Schedule; Efficiency, Organizational; Hospitals, Teaching; Humans; Medication Errors; Medication Systems, Hospital; Pharmaceutical Preparations
PubMed: 32796084
DOI: 10.1136/bmjhci-2020-100170 -
Journal of the National Medical... Oct 1978Self-medication and drug interaction have been a problem in recent years. Pharmacists in ethical pharmacies and neighborhood establishments can best monitor these...
Self-medication and drug interaction have been a problem in recent years. Pharmacists in ethical pharmacies and neighborhood establishments can best monitor these problems through use of patient profile records and consultations. The pharmacist should advise the public on over-the-counter (OTC) purchases. Auxiliary labels are recommended for use on containers to prevent drug interactions. Members of the black community have some specific problems with respect to self medications. These are addressed in this article. Self-medication, under supervision, is proper and can be controlled.
Topics: Drug Interactions; Drug Labeling; Health Education; Humans; Pharmaceutical Preparations; Pharmacists; Referral and Consultation; Self Medication
PubMed: 712861
DOI: No ID Found -
Journal of Hospital Medicine Dec 2015We review the literature on the use of point-of-care ultrasound to evaluate and manage pleural effusions. Point-of-care ultrasound is more sensitive than physical exam... (Review)
Review
We review the literature on the use of point-of-care ultrasound to evaluate and manage pleural effusions. Point-of-care ultrasound is more sensitive than physical exam and chest radiography to detect pleural effusions, and avoids many negative aspects of computerized tomography. Additionally, point-of-care ultrasound can assess pleural fluid volume and character, revealing possible underlying pathologies and guiding management. Thoracentesis performed with ultrasound guidance has lower risk of pneumothorax and bleeding complications. Future research should focus on the clinical effectiveness of point-of-care ultrasound in the routine management of pleural effusions and how new technologies may expand its clinical utility.
Topics: Disease Management; Humans; Pleural Effusion; Point-of-Care Systems; Ultrasonography
PubMed: 26218493
DOI: 10.1002/jhm.2434 -
JACC. Clinical Electrophysiology Oct 2019Education has long been recognized as an important component of chronic condition management. Whereas education has been evaluated in atrial fibrillation (AF)... (Review)
Review
Education has long been recognized as an important component of chronic condition management. Whereas education has been evaluated in atrial fibrillation (AF) populations as part of multifaceted interventions, it has never been tested as a single entity. The aim of this review is to describe the rationale for and role of education as part of comprehensive AF management. The development and use of educational material as part of the intervention of a randomized controlled trial, the HELP-AF (Home-Based Education and Learning Program in AF) study, will be described. This study was designed to determine the impact of a home-based structured educational program on outcomes in individuals with AF. An educational resource was developed to facilitate delivery of 4 key messages targeted at empowering individuals to self-manage their condition. The key messages focused on strategies for managing future AF episodes, the role of pharmacotherapy in the treatment of AF, the appropriate use of medicines to manage stroke risk and the role of cardiovascular risk factor management in AF. To support structured educational visiting, an educational booklet titled Living Well With Atrial Fibrillation (AF) was developed by a multidisciplinary team and was further refined following input from expert clinicians and patient interviews. Using a structured educational visiting approach, education was delivered by trained clinicians within the patient's home.
Topics: Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Disease Management; Health Literacy; House Calls; Humans; Pamphlets; Patient Education as Topic; Patient Medication Knowledge; Patient-Centered Care; Self-Management; Stroke; Teaching Materials
PubMed: 31648734
DOI: 10.1016/j.jacep.2019.08.007