Artikel
Computerised physician order entry to promote seamless care: a pilot investigation
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Autoren
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S. Jank
- University Hospital Heidelberg, Dept. of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, Heidelberg
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M. G. Pruszydlo
- University Hospital Heidelberg, Dept. of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, Heidelberg
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S. U. Walk
- University Hospital Heidelberg, Dept. of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, Heidelberg
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J. Kaltschmidt
- University Hospital Heidelberg, Dept. of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, Heidelberg
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T. Bertsche
- University Hospital Heidelberg, Dept. of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, Heidelberg
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C. Mahler
- University Hospital Heidelberg, Dept. of General Practice and Health Services Research, Heidelberg
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J. Szecsenyi
- University Hospital Heidelberg, Dept. of General Practice and Health Services Research, Heidelberg
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W. E. Haefeli
- University Hospital Heidelberg, Dept. of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, Heidelberg
| Veröffentlicht: | 12. November 2007 |
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Gliederung
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Context: During hospital stay, a high proportion of a patient’s medication is usually changed, as documented in the discharge letter. Furthermore, whenever available, German clinicians are obliged to name a low-priced alternative in the discharge letter (§115c SGB V). Unlike clinicians, GPs (general practitioners) are legally obligated to preferably prescribe certain brands (§130a SGB V, discount contract) not necessarily matching those low-priced alternatives. Continuity of care is impaired by these circumstances.
Aim of the study: We aimed to assess the impact of a shared computerised physician order entry (CPOE) system on drug changes during hospital stay and the extent to which discount contracts are implemented by GPs.
Patients and methods: Within a seamless care project including the University Hospital Heidelberg and 73 GPs and their patients (HeiCare), a shared CPOE-system (AiDKlinik) was established allowing quality checks (e.g. drug interactions) and electronic transfer of medication data. A subset of 22 patients fulfilled the following criteria for inclusion into analysis: enrolment in HeiCare (n=534), one or more hospital stays since enrolment (n=108), and transfer and documentation of both drug history and discharge medication via AiDKlinik (intervention group (IG): n=22). 30 medical inpatients whose medication data had not been transmitted with AiDKlinik served as control group (CG).
Results: On admission, patients of the CG and IG were treated with 6.7 respectively 7.9 drugs (p=0.18, U-test) and only 8% of the regulated drugs complied with the current discount contracts. The discharge letter demonstrated that the same brand/generic was retained for 50% (CG) and 77% (IG, χ2-test: p<0.001) of the medication on admission.
Conclusion: The results indicate that usage of a CPOE to transfer medication data can promote seamless care by improving the continuity of drug treatment at the interface between primary and tertiary care (reduction of unsubstantiated switches and avoidable cost).
