Implementation results of automated decision support system for physician’s. Process of anticoagulants prescribing for patients with deep vein thrombosis.

Open Access Open Access
Restricted Access Subscription or Fee Access

Abstract


Background: Timely inpatient antithrombotic therapy describing reduces the risk of recurrent VTE, pulmonary hypertension, fatal outcomes. Physician’s adherence to antithrombotic therapy recommendations in VTE patients reduces the risk of bleeding and the frequency of recurrent thrombosis. Decision support system (DSS) for physician’s can increase adherence to

Aims: DSS development and implementation in hospital to prevention of drug errors and adverse drug events (ADE) associated with anticoagulants using in VTE patients.

Materials and methods: In prospective cohort study we evaluated structure of drug prescriptions and errors, frequency of ADE, cost of drug therapy, physician’s adherence to antithrombotic therapy recommendations in VTE patients before and after introduction of DSS.

Results: There were detected 74 anticoagulant prescribing errors (1.35 per 1 patient) before DSS introduction and 32 anticoagulant prescribing errors adter DSS introduction (0.65 per 1 patient) ) [RS = 2.06; 95-DI: 1.17 -3.63, P = 0.0123]. After DSS introduction, the direct inpatient cost of anticoagulant therapy in VTE patients has reducde from 11 800 (IQR=7000) rubles to 5 430 (IQR=5700) rubles [p<0.005]. The number of ADE did not differ significantly.

Conclusions: DSS can increase physician’s adherence to anticoagualnts dosage  recommendations: prevention of anticoagulants doses unreasonable underestimation / overestimation, unreasonable duration of therapy.                                                                           


Anton Chernov

Russian Medical Academy of Continuing Professional Education

Author for correspondence.
Email: sbornaya1med@yandex.ru
ORCID iD: 0000-0001-6209-387X

Russian Federation

Dmitry A. Sychev

Russian Medical Academy of Continuous Professional Education

Email: dmitrysychevrmapo@gmail.com
ORCID iD: 0000-0002-4496-3680

Russian Federation

MD, PhD, Professor

E. B. Kleymenova

General Medical Center of the Bank of Russia

Email: e.kleymenova@gmail.com
ORCID iD: 0000-0002-8745-6195

Russian Federation

Moscow

S. A. Payushchik

General Medical Center of the Bank of Russia

Email: lyashina1@yandex.ru
ORCID iD: 0000-0003-1357-0056

Moscow

L. P. Yashina

General Medical Center of the Bank of Russia

Email: svetlanapay@gmail.com
ORCID iD: 0000-0002-7350-0423

Moscow

Maria D. Nigmatkulova

Email: evagrigor@yandex.ru

Vitaly A. Otdelenov

Email: vitotd@ya.ru

  • Aaron M. Wendelboe, Gary E. Raskob. Global Burden of Thrombosis; Epidemiologic Aspects. Circulation Research. 2016; 1340-1346.
  • Cohen AT, Agnelli G, Anderson FA, et al; VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98 (04):756–764.
  • STH Steering Committee for World Thrombosis Day. Thrombosis: a major contributor to global disease burden. Thromb Res 2014; 134 (05): 931–938.
  • Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis,9th ed: American College of Chest Physicians Evidence- Based Clinical Practice Guidelines. Chest 2012; 141:e419S–e496S
  • Feehan M, Walsh M, Van Duker H, et al. Prevalence and correlates of bleeding and emotional harms in a national US sample of patients with venous thromboembolism: A cross-sectional structural equation model. Thromb Res. 2018; 172:181-187
  • Smetzer JL, Cohen MR. Medication error reporting systems. In: Cohen MR, ed. Medication errors, 2nd ed. Washington, DC: American Pharmacists Association; 2007:513-50.
  • Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern. Am J Prev Med. 2010; 38: S495-S501. doi: 10.1016/j.amepre.2009.12.017.
  • Martinez K., Kosirog E., Billups S.J. et al. Clinical outcomes and adherence to guideline recommendations during the initial treatment of acute venous thromboembolism. Ann Pharmacother.2015;49(8):869-75. doi: 10.1177/1060028015583892.
  • Cajfinger F., Debourdeau P., Lamblin A. et al. Low-molecular-weight heparins for cancer-associatedthrombosis: Adherence to clinical practice guidelines and patient perception in TROPIQUE, a 409-pa-tient prospective observational study. Thromb Res. 2016;144:85-92. doi: 10.1016/j.throm-res.2016.06.005.6.
  • Mahé I., Chidiac J., Helfer H., Noble S. Factors influencing adherence to clinical guidelines in the man-agement of cancer-associated thrombosis. J Thromb Haemost. 2016;14(11):2107-13. doi: 10.1111/jth.13483.7.
  • Sevestre M.A., Belizna C., Durant C. et al. Compliance with recommendations of clinical practice in themanagement of venous thromboembolism in cancer: the CARMEN study. J Mal Vasc.2014;39(3):161-8. doi: 10.1016/j.jmv.2014.03.001. 8.
  • Beeler P.E., Kucher N., Blaser J. et al. Sustained impact of electronic alerts on rate of prophylaxisagainst venous thromboembolism. Thromb Haemost. 2011;106 (4):734-8. doi: 10.1160/TH11-04-0220. 13)
  • Nazarenko G.I., Payushik S.A., Otdelenov V.A. et. al. Optimal prevention of hospital venous thromboembolism with the information technologies. Rational Pharmacotherapy in Cardiology. 2014; 10(4):425-1. (In Russ.) [Назаренко Г.И., Пающик С.А., Отделёнов В.А. и др. Оптимизация профилактики венозных тромбозов и эмболий в стационаре с использованием информационных технологий. Рациональная Фармакотерапия в Кардиологии. 2014;10 (4):425-1]. doi: 10.3233/JRS-150709.
  • Pharmaceutical Care Network Europe Foundation (PCNE). Classification for drug related problems, V8.02. URL: http://www.pcne.org/upload/files/230_PCNE_classification_V8-02.pdf
  • Nazarenko G.I., Kleymenova E.B., Zhujkov M.Yu., et al. System of computer-interpretable clinical guidelines and treatment audit. Vrach I Informatsionnye technoligii. 2014; (2): 23-31. (In Russ.) [Назаренко Г.И., Клейменова Е.Б., Жуйков М.Ю. и др. Система автоматизации клинических руководств и лечения. Врач и информ. технологии. 2014; (2): 23-31]
  • American College of Chest Physicians Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016; 149 (2): 315-352.
  • Bokeria L.A., Zatevakhin I.I., Kirienko A.I., Andriyashkin V.V. Phlebology Association of Russia. Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications. Phlebology 2015; (4): 4-52 (In Russ.) [Бокерия Л.А. Затевахин И.И., Кириенко А.И., Андрияшкин В.В. Ассоциация флебологов России. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений. Флебология. 2015; (4): 4-52]
  • Министерство здравоохранения Российской Федерации. Государственный реестр лекарственных средств. URL: http://www.grls.rosminzdrav.ru/Default.aspx Дата доступа: 05.12.2017.
  • Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium. Circulation. 2011; 123 (23): 2736–47.

Views

Abstract - 18

PDF (Russian) - 0

PDF (Russian) - 0

PlumX

Dimensions



Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies