Katherine S. Dodd

Medication Errors Among Adults and Children With Cancer in the Outpatient Setting

PURPOSE Outpatients with cancer receive complicated medication regimens in the clinic and home. Medication errors in this setting are not well described. We aimed to determine rates and types of medication errors and systems factors associated with error in outpatients with cancer. METHODS We retrospectively reviewed records from visits to three adult and one pediatric oncology clinic in the Southeast, Southwest, Northeast, and Northwest for medication errors using established methods. Two physicians independently judged whether an error occurred (kappa = 0.65), identified its severity (kappa = 0.76), and listed possible interventions. RESULTS Of 1,262 adult patient visits involving 10,995 medications, 7.1% (n = 90; 95% CI, 5.7% to 8.6%) were associated with a medication error. Of 117 pediatric visits involving 913 medications, 18.8% (n = 22; 95% CI, 12.5% to 26.9%) were associated with a medication error. Among all visits, 64 of the 112 errors had the potential to cause harm, and 15 errors resulted in injury. There was a range in the rates of chemotherapy errors (0.3 to 5.8 per 100 visits) and home medication errors (0 to 14.5 per 100 visits in children) at different sites. Errors most commonly occurred in administration (56%). Administration errors were often due to confusion over two sets of orders, one written at diagnosis and another adjusted dose on the day of administration. Physician reviewers selected improved communication most often to prevent error. CONCLUSION Medication error rates are high among adult and pediatric outpatients with cancer. Our findings suggest some practical targets for intervention, including improved communication about medication administration in the clinic and home.

A Systematic Review of Validated Methods for Identifying Cerebrovascular Accident or Transient Ischemic Attack Using Administrative Data

To perform a systematic review of the validity of algorithms for identifying cerebrovascular accidents (CVAs) or transient ischemic attacks (TIAs) using administrative and claims data.

A systematic review of validated methods for identifying heart failure using administrative data

To identify and describe the validity of algorithms used to detect heart failure (HF) using administrative and claims data sources.

Mini-Sentinel Systematic Evaluation of Health Outcome of Interest Definitions for Studies Using Administrative and Claims Data: Heart Failure

To identify and describe the validity of algorithms used to detect heart failure (HF) using administrative and claims data sources.

Exclusion of older adults and women from recent trials of acute coronary syndromes.

OBJECTIVES: To determine whether the participation of older adults and women in published clinical trials has increased during recent years.

Patients’ Beliefs and Preferences Regarding Doctors’ Medication Recommendations

BackgroundAn estimated 20–50% of patients do not take medications as recommended. Accepting a doctor’s recommendation is the first step in medication adherence, yet little is known about patients’ beliefs and preferences about how medications are prescribed.ObjectiveTo explore patients’ beliefs and preferences about medication prescribing to understand factors that might affect medication adherence.MethodsFifty members from 2 health plans in Massachusetts participated in in-depth telephone interviews. Participants listened to an audio-vignette of a doctor prescribing a medication to a patient and were asked a series of questions related to the vignette. Responses were reviewed in an iterative process to identify themes related to participants’ beliefs and preferences about medication prescribing.ResultsParticipants’ beliefs and preferences about medication prescribing encompassed 3 major areas: patient–doctor relationships, outside influences, and professional expertise. Important findings included participants’ concerns about the pharmaceutical industry’s influence on doctors’ prescribing practices and beliefs that there is a clear “best” medication for most health problems.ConclusionsPatients’ beliefs and preferences about medication prescribing may affect medication adherence. Additional empiric studies that explore whether doctors’ relationships with pharmaceutical representatives impact medication adherence by affecting trust are indicated. In addition, it would be worthwhile to explore whether discussions between patients and doctors regarding equipoise (no clear scientific evidence for 1 treatment choice over another) affect medication adherence.

Cluster randomized trials to study the comparative effectiveness of therapeutics: stakeholders' concerns and recommendations.

To describe the concerns raised by health plan members, providers and purchasers related to studying the comparative effectiveness of therapeutics using cluster randomized trials (CRTs) within health plans. An additional goal was to develop recommendations for increasing acceptability.

A Qualitative Study of Consumers’ Views on Public Reporting of Health Care–Associated Infections

Recent interest in publicly reporting health care–associated infections (HAIs) makes it important to develop reports that consumers can understand and evaluate. In-depth qualitative interviews were conducted with 59 consumers. Interviews focused on responses to existing and prototypical reports and on recommendations for improvements. Many interviewees were unfamiliar with HAIs and were distressed to learn HAIs occur and can result in death. Public reporting was seen as unlikely to affect hospital choice; other factors were considered more influential. Interviewees recommended that reports be brief and include information on prevention as well as performance data. Additional recommendations on format and content were identified. For public reporting of HAIs to be successful, attention to report content and format are necessary. Consumer involvement can help to identify potential sources of confusion and methods of improving reporting.