Shivani K. Mhatre

Impact of Electronic Health Records on Nurses' Productivity

As the use of electronic health records increases, it becomes necessary to address their global impact on nurses’ productivity in hospitals. A retrospective cross-sectional study was conducted to explore the impact of electronic health records on nurses’ productivity and to examine whether the impacts are moderated through case-mix index or adjusted patient-days. Two sources of data were linked and analyzed for years 2007 and 2008: the American Hospital Association survey and the Centers for Medicare & Medicaid Services data. Almost two-thirds of the respondent hospitals in both years (63.9% in 2007 and 68.4% in 2008) had a high electronic health record index (≥5). Hospitals with higher penetration of electronic health records had more RNs employed (coefficient = 0.234, P = .002) compared with hospitals with low penetration of electronic health records, even when controlling for adjusted patient-day volumes. This difference decreased for hospitals with higher case-mix index values. The study findings fail to suggest any financial savings or superior productivity in nurses due to usage of electronic health records.

Development of a conceptual model of health-related quality of life among hepatitis C patients: A systematic review of qualitative studies.

The Food and Drug Administration guidelines emphasize that patient‐reported outcome (PRO) instruments used in clinical trials must be developed based on a conceptual model, yet existing PRO instruments currently used in clinical trials of hepatitis C virus (HCV) patients are not based on a predetermined model. The purpose of this study was to identify a comprehensive list of health‐related quality of life (HRQoL) themes that may be unique to HCV by reviewing qualitative research articles of HCV patients. The information collected from the review was used to develop a preliminary model of HRQoL in HCV patients.

Impact of Computerized Provider Order Entry on Pharmacist Productivity

Purpose To examine the impact of computerized provider order entry (CPOE) implementation on average time spent on medication order entry and the number of order actions processed. Methods An observational time and motion study was conducted from March 1 to March 17, 2011. Two similar community hospital pharmacies were compared: one without CPOE implementation and the other with CPOE implementation. Pharmacists in the central pharmacy department of both hospitals were observed in blocks of 1 hour, with 24 hours of observation in each facility. Time spent by pharmacists on distributive, administrative, clinical, and miscellaneous activities associated with order entry were recorded using time and motion instrument documentation. Information on medication order actions and order entry/verifications was obtained using the pharmacy network system. Results The mean ± SD time spent by pharmacists per hour in the CPOE pharmacy was significantly less than the non-CPOE pharmacy for distributive activities (43.37 ± 7.75 vs 48.07 ± 8.61) and significantly greater than the non-CPOE pharmacy for administrative (8.58 ± 5.59 vs 5.72 ± 6.99) and clinical (7.38 ± 4.27 vs 4.22 ± 3.26) activities. The CPOE pharmacy was associated with a significantly higher number of order actions per hour (191.00 ± 82.52 vs 111.63 ± 25.66) and significantly less time spent (in minutes per hour) on order entry and order verification combined (28.30 ± 9.25 vs 36.56 ± 9.14) than the non-CPOE pharmacy. Conclusion The implementation of CPOE facilitated pharmacists to allocate more time to clinical and administrative functions and increased the number of order actions processed per hour, thus enhancing workflow efficiency and productivity of the pharmacy department.

Influence of Benefits, Barriers and Cues to Action for Complementary and Alternative Medicine Use among University Students

The purpose of the study was to explore the influence of perceived benefits, barriers, and cues to action on Complementary and Alternative Medicine (CAM) use among university students. This was a prospective, cross sectional questionnaire-based study conducted at a large urban university in Houston, Texas. Of the 400 students surveyed, 143 (35.8%) were current CAM users (used CAM in the past 12 months). Biologically based medications such as herbs, vitamins, supplements and natural products were found to be most profoundly used among students (42%). Perceived benefits (OR 9.14, 95% CI 4.64-18), barriers to CAM use (OR 0.49, 95% CI 0.27-0.89) and cues to action (OR 5.21, 95% CI 1.02-26.51) were significant determinants of CAM use among students. Perceived ability of CAM to improve body defenses was found to be the major perceived benefit for CAM use while lack of sufficient scientific testing was found to be the major barrier. Recommendation by health care provider and CAM use by parents and grandparents significantly (p < 0.0001) influenced current CAM use among students. Thus, perceived benefits and cues to action for CAM use significantly promoted CAM usage while perceived barriers were found to hinder CAM use among students.

Impact and Determinants of Commercial Computerized Prescriber Order Entry on the Medication Administration Process

Purpose The purpose of this study was to evaluate the impact of commercial computerized prescriber order entry (CPOE) on efficiency outcomes in an 864-bed community hospital. Methods A retrospective study was developed to measure medication errors and medication order turnaround time in St. Lukes Episcopal Hospital located in the Texas Medical Center. The study data were collected by stratified random sampling through a review of medication orders submitted to the pharmacy using a paper-based order system and the CPOE system. Descriptive frequencies, chi-square test, Wilcoxon matched-pairs sign rank test, and logistic regression and multiple regression analyses were conducted to examine the relationship among variables. Results Of the 1,110 total orders reviewed (563 paper-based and 547 CPOE), a total of 135 medication errors were found, with 10.5% in paper-based versus 1.6% in CPOE. The most prevalent errors in paper-based orders were inappropriate abbreviations (24.4%), incorrect doses (15.6%), occurrences of allergy (13.3%), and wrong administration frequency (9.6%). In CPOE orders, the errors were occurrences of allergy (10.4%), incorrect doses (2.2%), and drug interaction (0.7%). CPOE resulted in a 50% reduction of medication order turnaround time (median = 24 minutes CPOE vs 48 minutes paper orders). A potential medication error, unidentified prescribers within medication orders, urgency of medication order, and implementation of CPOE were the significant (P < .05) determinants of medication order turnaround time. Conclusion The implementation of a commercial CPOE system reduced medication errors and improved medication order turnaround times.

Influence of patient perceived relationship with pharmacist and physician and its association with beliefs in medicine

The purpose of this study was to evaluate the association between patients’ perceived relationship with their pharmacist and physicians and its association with their beliefs in medicine.

Effect of warning placement on the information processing of college students reading an OTC drug facts panel

ABSTRACT Objective: To compare three over-the-counter (OTC) Drug Facts panel versions for information processing optimization among college students. Participants: University of Houston students (N = 210) participated in a cross-sectional survey from January to May 2010. Methods: A current FDA label was compared to two experimental labels developed using the theory of CHREST to test information processing by re-positioning the warning information within the Drug Facts panel. Congruency was defined as placing like information together. Information processing was evaluated using the OTC medication Label Evaluation Process Model (LEPM): label comprehension, ease-of-use, attitude toward the product, product evaluation, and purchase intention. Results: Experimental label with chunked congruent information (uses-directions-other information-warnings) was rated significantly higher than the current FDA label and had the best average scores among the LEPM information processing variables. Conclusion: If replications uphold these findings, the FDA label design might be revised to improve information processing.

Abstract P6-10-01: Risk of chemotherapy-induced febrile neutropenia (FN) in patients (pts) with non-metastatic breast cancer (BC) and documented risk factors for FN

Background: Clinical practice guidelines recommend primary prophylactic colony-stimulating factor (CSF) for pts with cancer receiving myelosuppressive chemotherapy when their risk of FN is high (≥20%). Evaluating FN risk in pts who receive regimens that are not documented as high risk in guidelines can be challenging; these pts may be at a high risk of developing FN based on a combination of regimen and pt risk factors. This retrospective study estimated FN risk among subgroups of pts with non-metastatic BC receiving 1 of 3 commonly used, non-high risk chemotherapy regimens. Methods: Pt-level data from 2 US healthcare claims databases comprising medical and outpatient pharmacy claims from commercial and Medicare supplemental plans were pooled. Eligible pts were ≥18 years old and had initiated a course of TC, TCH, or non-dose-dense AC/AC-T for non-metastatic BC between July 1, 2003 and June 30, 2012. Occurrence of FN during any cycle of the first chemotherapy course was identified using diagnosis codes for neutropenia, fever, or infection. Risk factors, documented in guidelines and the published literature, were evaluated during the 12 months before chemotherapy initiation. The percentage of pts, FN risk, and relative risk (RR, compared to pts with no risk factors) for subgroups of pts with specific risk factors are presented. Results: 50,893 pts were included in the analysis. FN risks by chemotherapy regimen and subgroup are shown in the table. A high proportion of pts (74%-78%) had ≥1 risk factor for FN, and these pts had a higher FN risk than pts with no risk factors. 55.4%, 56.7%, and 42.2% of all pts who received TC, TCH, or AC/AC-T, respectively, received CSF prophylaxis in cycle 1. Conclusions: FN risk assessments are needed for pts who are receiving non-high risk regimens. Citation Format: Derek Weycker, Xiaoyan Li, Richard Barron, Hongsheng Wu, Phuong Khanh Morrow, Hairong Xu, Maureen Reiner, Jacob Garcia, Shivani Mhatre, Gary Lyman. Risk of chemotherapy-induced febrile neutropenia (FN) in patients (pts) with non-metastatic breast cancer (BC) and documented risk factors for FN [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-10-01.

Community Pharmacists' Impact on an Employer-Initiated Diabetes Disease Management Program

Background: Diabetes is the third most expensive physical health condition for US employers. Thus, there is a need for employers to engage in disease management programs for their diabetic employees in order to ensure long-term benefits. Objective: To evaluate the clinical outcomes of successful implementation of an employer-initiated pharmacist-based disease management program for diabetic patients. Methods: This was a longitudinal retrospective study analyzing clinical indicators in diabetic employees after a community pharmacist-based diabetes disease management (DDM) program in a rural setting. The program involved comprehensive drug therapy assessment and individualized disease management education. Outcomes measured in this study were fasting serum glucose (FSG) levels, glycated hemoglobin (A1C) levels, diastolic blood pressure (DBP), systolic blood pressure (SBP), body mass index (BMI), and complete lipid profiles including high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), and total cholesterol (TC) levels. Results: A total of 137 patients were enrolled in this program. Significant improvement in mean clinical outcome scores was achieved for FSG (p = 0.004), DBP (p = 0.018), and SBP (p = 0.044). At the end of the 1-year intervention, targeted FSG and A1C goals were attained by 39.1% (p = 0.029) and 39.4% of patients, respectively. Also, targeted DBP, SBP, BMI, LDL, HDL, TG, and TC levels were achieved by 54.8% (p < 0.001), 38.5%, 38.3%, 56.8%, 38.2%, 37.5%, and 52.4% of patients, respectively. Conclusions: This study establishes a need for implementation of long-term employer-initiated pharmacist-based DDM programs that improve clinical outcomes for employees. Further studies evaluating outcomes for a longer time period would provide more conclusive results.