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• W199587144 abstract "The challenges facing primary medical care today are substantial given the necessity to keep in touch with ever-increasing information and practice demands. A major cost to both patients and government are medications as they are the major modality for the management of so many conditions. Medications often do not provide a benefit for several reasons: many patients are not prescribed the appropriate medicine or dosage; doctors may not properly monitor for efficacy or adverse events; patients may misunderstand instructions; and patients fail to adhere to long term medications. Computerised clinical Decision Support Systems (DSSs) have been suggested as a means to support primary care practitioners in their efforts to deliver optimal medication management.This thesis aimed to systematically review the benefits of computerised systems that support medication management through reminders or feedback to healthcare providers, and to evaluate the effectiveness of a computerised DSS to improve patient medication adherence.Two main studies were undertaken to address these aims.1. A systematic review was undertaken to summarise the effects reported in randomised controlled trials (RCTs) of computer generated medication reminders or feedback, directed to either patients or healthcare providers.Methods. Seventy-six RCTs were identified from extensive computerised and manual literature searches before 1st January 2002. From these, twenty-six papers representing 29 comparisons (two papers reported on multiple interventions) were selected that compared computer-supported medication management to a control group. The quality of published papers was systematically assessed and scored independently by two reviewers. Heterogeneity of studies prevented a meta-analysis, but rates of compliance with (potential) reminders for the control and intervention groups were extracted. The comparisons were grouped into five areas.Results: 1) Six out of 12 RCTs of reminders to providers in outpatient settings demonstrated positive effects. Relative rates (Intervention rates / control rates) ranged from 1.0 to 42.0. 2) Five of seven RCTs of provider feedback in outpatient settings were able to improve clinician behaviour. The changes were less than for reminders. Relative rates ranged from 1.0 to 2.5. 3) A single comparison of combined reminders and feedback in outpatient settings found no improvement. 4) Three out of five RCTs of reminders to providers in inpatient settings showed improvements with relative rates from 1.0 to 2.1. 5) Two out of four RCTs of patient directed reminders showed improvements in patient compliance.Conclusion: This systematic review found benefits to the use of such DSSs. Reminders are somewhat more effective than feedback in modifying physician behaviour related to medication management and patient directed reminders can improve medication adherence.2. An RCT of a DSS to improve patient medication adherence was undertaken.Methods: 179 adult patients taking three or more long-term medications in one academic general practice in Brisbane participated in an unblinded, factorial RCT of computer generated consumer product information, computer generated medication timetable, both, or usual care. Adherence to medication was measured using the relative prescription rate for six groups of medications extracted by the Health Insurance Commission. Patients' knowledge of, and satisfaction with, medications, and GPs' attitudes to the decision support system were also measured.Results: This study found no effect on medication adherence. Although GPs were supportive of the system, neither patients' self reported knowledge of medications, nor satisfaction with care, was increased by the intervention.Conclusions: Simply providing patients with computer generated medication timetables and consumer product information may not improve medication adherence in primary medical care. A larger sample size may have demonstrated an effect.While it is clear from the systematic review that computer generated medication reminders or feedback, directed to either patients or healthcare providers may provide some benefit, careful evaluation of the knowledge base of DSSs and pragmatics of implementing them in primary medical care is warranted." @default.
• W199587144 created "2016-06-24" @default.
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• W199587144 date "2004-09-14" @default.
• W199587144 modified "2023-09-24" @default.
• W199587144 title "Computerised decision support of medication management in primary medical care" @default.
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