ObjectivesTo provide an overview of whether the clinical decision support system (CDSS) was effective in reducing medication error and improving medication safety and to assess the quality of available scientific evidence.MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data, VIP and CNKI databases were electronically searched to collect systematic reviews (SRs) on application of clinical decision support system in the medication error and safety from January, 1996 to November, 2018. Two reviewers independently screened literature, extracted data and then evaluated methodological quality of included SRs by using AMSTAR tool.g AMSTAR tool.ResultsA total of 20 SRs including 256 980 healthcare practitioners and 1 683 675 patients were included. Specifically, 16 studies demonstrated moderate quality and 4 demonstrated high quality. 19 SRs evaluated multiple process of care outcome: 9 were sufficient evidence, 6 were limited evidence, and 7 were insufficient evidence which proved that CDSS had a positive effect on process outcome. 13 SRs evaluated reported patient outcomes: 1 with sufficient evidence, 3 with limited evidence, and 9 without sufficient evidence.ConclusionsCDSS reduces medication error by inconsistently improving process of care measures and seldom improving patient outcomes. Larger samples and longer-term studies are required to ensure a larger and more reliable evidence base on the effects of CDSS intervention on patient outcomes.
ObjectiveTo explore the influencing factors of medication compliance in drug-resistant pulmonary tuberculosis patients.MethodsUsing phenomenological research methods, a semi-structured in-depth interview was conducted on 19 inpatients with drug-resistant pulmonary tuberculosis admitted to the Drug-resistant Tuberculosis Department of Changsha Central Hospital between April and August 2019, and the data were coded, analyzed, sorted out, summarized, and extracted.ResultsThe influencing factors of medication compliance in patients with drug-resistant pulmonary tuberculosis could be divided into two categories: promoting factors and hindering factors. The promoting factors included the patient’s own factors (emphasis on medication therapy, desire for medication knowledge, and efforts to solve medication difficulties) and social factors (family support). The hindering factors included the patient’s own factors (lack of knowledge about tuberculosis, and severe negative emotions), drug treatment factors (fear of adverse drug reactions, and complicated medication plans), and social factors (increased financial burden).ConclusionsDrug compliance of patients with drug-resistant pulmonary tuberculosis is affected by patients, family members, medical staff and social environment. Nursing staff should develop personalized drug plan to improve the patients’ drug compliance.
ObjectiveTo investigate the knowledge of drug safety among parents of some children with epilepsy in Henan Province, and to provide a basic advice for drug safety and health education for children with epilepsy.sMethodUsing a questionnaire to parents of epilepsy children from the Children's Hospital in Henan Province and the First Affiliated Hospital of Zhengzhou University in July 2019, a total of 336 questionnaire were conducted by the professionals responsible for after the training, including parents and children basic situation, drug habits and attitudes, medication safety consciousness and antibiotic drug use knowledge.Results320 questionnaire were collected, 314 of which were valid questionnaires, with an effective rate of 98.1%. 66 (21%) of parents chose juice or milk for oral administration, and 87 (27.7%) of parents chose sugar water. 104 (33.1%) of the parents chose to stop the medication immediately after the child's condition improved. 126 (40.1%) of parents believe that combination of two or more antibiotics is more effective, 178 (56.7%) of parents will give their children antibiotics when they have a cold or fever, and more than 254 (80%) of parents are not aware of adverse reactions to antibiotics.ConclusionIn the investigation, the parents of children with epilepsy in Henan Province still have insufficient knowledge of safe drug use, and there are many non-standard drug use behaviors. Local medical professionals for epilepsy should be strengthened to guide and monitor the children and their parents.
Objective To study the medication usage in patients with severe acute respiratory syndrome (SARS). Methods The information of the medications of 680 patients with SARS in Xiao Tang Shan Hospital was collected by HIS system and classified by using computer model on the basis of disease factor. The usage time and cases, and cost of these medications were calculated. The defined daily dose (DDD) and drug utilization index (DUI) were analyzed. Results A number of 359 drugs in 17 categories were applied to 680 patients with SARS. Most cases used antibacterial agents, the DDDs of immunomodulator and vitamins were the highest, the usage duration of vitamins and infusion fluids were the longest among 17 kinds of the drugs. The cost of methylpredni-solone injection was the highest. The mortality rate, kinds of drugs and frequency of drugs were higher in type C, type D and serious SARS patients than that of type A and common SARS patients. Conclusions Many kinds of medications have been prescribed to SARS patients. The dosages of these medication are very high, especially glucocorticoids, immuneomodulator and nutrient agents. The computer model on the basis of disease factor is probably valid, rapid and easy to standardize.
Objective To analyze the costs of emergency medication in the West China Hospital within one month after Lushan earthquake based on actual medication of the victims’ disease spectrum. Methods We collected emergency medication data as evaluation index in the West China Hospital within one month after Lushan earthquake, including daily cost, cumulative percentage of pharmacology category, average cost per day/person, average cost per day/person when DUI=1, difference between average cost per day /person, and average cost per day/person when DUI=1, etc. Then, we input data using Excel software for statistically analyzing the costs of emergency medication within one month after the earthquake. Results During one month after the earthquake, the costs changed consistently with the number of victims, which implied the change of costs was rational. Injuries were classified into 6 categories and 12 kinds according to ICD-10. The costs of medication accounted for 71% of the total costs. Six kinds of illness accounted for 21%. Medication for injuries was classified into 3 categories and 18 kinds; average cost per day was 186.87 yuan and average cost per person was 1 702.70 yuan. Medication for illness was classified into 5 categories and 28 kinds; average cost per day was 38.96 yuan and average cost per person was 185.13 yuan. The mean value of average cost per day/person of injection was 14.52/5.08 times more than that of non-injection. Meanwhile, the mean value of average cost per day/person of imported medication was 7.10/5.28 times more than that of domestic medication. Conclusion The factors that impact the medication costs include: a) disease burden and traumatic conditions of the sick and wound; b) administration pathway (injection vs. non-injection); c) imported or domestic medication; and d) the rationality of taking DUI as evaluation index. When DUIgt;1, injection through the vein and imported medication take a larger share which increase the costs of medication. Emergency rescue package should mainly prepare for the injury. In order to ensure the timely, safe and effective medication, injection should be given priority to. We also should take into consideration crash-resistance/anti-quake package, reasonable dosage, convenience-to-use of drugs as well as the needs of the illness.
Objective To explore the service contents of medication therapy management (MTM) for outpatient epileptic children by analyzing drug related problems (DRPs). Methods A cross-sectional study was adopted to analyze the status of DRPs in outpatient epileptic children in West China Second Hospital of Sichuan University. The focus group discussion method was adopted to formulate the specific service contents of MTM in outpatient epileptic children. Results A total of 2 754 cases of antiepileptic drug treatment were received in the pediatric clinic of West China Second Hospital of Sichuan University from October 1st, 2018 to December 31st, 2018, including 2 018 cases of monotherapy and 736 cases of combination therapy, involving 7 drugs and 10 specifications. The specifications in descending order of frequency of drug use were levetiracetam oral solution, levetiracetam tablets, sodium valproate oral solution, oxcarbazepine oral suspension, oxcarbazepine tablets, topiramate capsules, sodium valproate sustained-release tablets, lamotrigine tablets, magnesium valproate sustained-release tablets and carbamazepine tablets. We applied the Pharmaceutical Care Network Europe (PCNE) classification and found 718 DRPs, mainly focusing on drug selection and improper course of treatment. The specific service contents of MTM for children with epilepsy in the clinic included hospital pharmacy information services, medical teams established by pharmacists, doctors and nurses, child education and medication consultation, and medication follow-up for discharged children. In addition, specific measures to solve DRPs in outpatient epileptic children were designed from 2 aspects of disease management and medication education, and 3 aspects of drug prescription, dispensing, and usage. Conclusions There are various types of antiepileptic medications and treatment schemes for children, and DRPs are complicated. Therefore, MTM for children with epilepsy requires to be strengthened. In this study, the specific intervention contents of MTM for outpatient epileptic children are designed to carry out the follow-up empirical study to verify the effectiveness of MTM.
Objective To study the medication usage in children with crush syndrome in Wenchuan Earthquake. Methods The information of the medications of 7 children with crush syndrome in West China Second University Hospital, Sichuan University was collected by medical history. The cases and times of medication, the total number of drugs, the drug cost per capita and the drug cost per day were calculated by Excel. Results A total of 113 drugs in 19 categories were appl ied to 7 children with crush syndrome. Most children used Vitamins and antibacterial agents. The cost of gamma globul in injection was the highest. Conclusions The rational ity valuation for children medication lacks international vulgate index and needs more basic research.
ObjectiveTo adapt existing clinical practice guidelines to the management of medication adherence to highly active antiretroviral therapy (HAART) in China, so as to provide evidence to support the development of practice guidelines that meet China's actual conditions. MethodsAccording to ADAPTE methodology and status of HAART in China, we searched, appraised, selected and adapted current clinical practice guidelines on the management of medication adherence to HAART. ResultsA total of 10 guidelines were included, and the final clinical practice guidelines for the management of medication adherence to HAART involved 3 aspects, including influential factors, assessment methods, and interventions. High quality evidence resources had been formed, and the quality of final clinical practice guidelines was higher. ConclusionIt is feasible to develop clinical practice guidelines according to the ADAPTE method, and reliable evidence support has been provided for the development of clinical practice guidelines based on guideline adaption.
ObjectiveTo systematically evaluate the effects of cognitive behavioural therapy (CBT) on improving depression, medication adherence and quality of life in people living with HIV/AIDS (PLHIV). MethodsWe searched The Cochrane Library (Issue 4, 2013), Ovid-JBI, PubMed, EMbase, PsycARTICLES, CBM and CNKI to collect randomized controlled trials (RCTs) on improving depression, medication adherence and quality of life in PLHIV from the establishment dates to April 30th 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Meta-analysis was conducted using RevMan 5.2. ResultsA total of 17 RCTs were included, involving 2 163 patients. The results of meta-analysis showed that CBT significantly improved PLHIV's depression (SMD=-0.26, 95%CI-0.41 to-0.10, P=0.001), and quality of life (SMD=-0.57, 95%CI-1.04 to-0.11, P=0.02) in 6 months. Meanwhile, CBT significantly improved PLHIV's medication adherence (WMD=3.98, 95%CI 1.67 to 6.30, P=0.000 8) in the long term. ConclusionCBT is efficacious in improving PLHIV's depression and quality of life in the short term, and improving medication adherence in the long term, compared to standard care.
ObjectiveTo explore the personalistic characteristics of patients with migraine and medication-overuse headache (MOH), and to provide scientific evidence for mental treatment of these patients. MethodsThe subjects were divided into three groups:migraine group, MOH group, and health group.Patients with migraine or MOH, admitted to the Deyang People's Hospital from March 2012 to March 2014, were selected in this study.In addition, healthy volunteers were selected as controls at the same time.Data were collected through the Minnesota multiphasic personality inventory computer testing software, and differences of personalistic characteristics were compared among patients with migraine, MOH and controls. ResultsPatients with migraine and MOH had mental problems and the occurrence rate of psychological problems of MOH patients was significantly higher than that of migraine patients (χ2=6.055, P=0.014).Migraine patients showed higher scores of hypochondriasis, depression, hysteria, psychasthenia, hypomania than controls (P < 0.01).Compared with migraine patients, the scales of hypochondriasis, depression, hysteria, paranoia, schizophrenia were higher in MOH patients (P < 0.01). ConclusionsPatients with migraine and MOH have personalistic and psychological problems.Early screening of personalistic characteristics and mental interventions may improve the clinical outcome of patients with migraine or MOH.