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Accuracy of a Prescription Claims Database
11 Nov2010
INTRODUCTION
Attention to patient safety in the hospital setting is increasing, largely because of the efforts of the US Institute for Healthcare Improvement’s 100,000 Lives campaign and the Safer Healthcare Now! initiative2 in Canada. Both of these programs include medication reconciliation as a priority topic, and many hospitals across North America have launched projects aimed at improving this process to meet accreditation standards. Medication reconciliation, defined as “a formal process of obtaining a complete and accurate list of each patient’s current home medications”, is now a requirement of the Canadian Council of Health Services Accreditation and a safety goal of the US Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations). However, in a recent Canadian study conducted in the emergency department of a large teaching hospital, medication reconciliation revealed a high rate of prescribing errors on admission, with serious health implications. The authors suggested that hospital access to prescription dispensation data from community pharmacies could help improve the accuracy of medication reconciliation.
The following targets are currently recommended for reducing blood pressure:
• in general, less than 140 mm Hg systolic and less than 90 mm Hg diastolic
• for patients with diabetes or chronic kidney disease, less than 130/80 mm Hg
Use Combinations of Medications and Lifestyle Modifications to Achieve Blood Pressure Targets
Most patients require 2 or more drugs to achieve recommended blood pressure targets. Individualization of antihypertensive therapy should always be considered (Table 1). In general, the average reduction in blood pressure with a single blood-pressure-lowering medication is 10/5 mm Hg. Combining medications is therefore to be expected in therapy for hypertension. Using lifestyle modifications can reduce the number and doses of medications required for blood pressure control and should be recommended for all hypertensive patients. The systolic blood pressure target is usually more difficult to achieve; however, the patient’s cardiovascular prognosis is at least as closely associated (if not more closely associated) with systolic blood pressure as with diastolic blood pressure.
- In: Main
- Tags: Education Program, Hypertension
OLD BUT STILL VERY IMPORTANT MESSAGES OF CHEP
Measure Blood Pressure in All Adults at All Appropriate Visits
For many Canadians with hypertension, the condition remains undetected; therefore, measure blood pressure in all adults at all appropriate visits.
- In: Main
- Tags: Education Program, Hypertension
NEW KEY MESSAGE OF THE 2006 RECOMMENDATIONS: IMPROVE PATIENT ADHERENCE TO ANTIHYPERTENSIVE THERAPIES
Adherence with antihypertensive management can be improved by implementing a multipronged approach incorporating the following strategies.
- In: Main
- Tags: Education Program, Hypertension
INTRODUCTION
Hypertension remains a significant health problem that is projected to become a greater global burden in the next 20 years. The estimated total number of adults with hypertension was 972 million in 2000: 333 million in economically developed countries and 639 million in less economically developed countries. The number of adults with hypertension is anticipated to increase by about 60% by 2025, to a total of 1.56 billion. Hence, hypertension is an important and growing public health challenge worldwide. Prevention, detection, treatment, and control of this condition should receive high priority. The Canadian Hypertension Education Program (CHEP) has a mandate to improve the management of hypertension, to develop tools to aid health care professionals, and to evaluate the impact of these activities. CHEP continues to provide the most current evidence-based recommendations to Canadian health care workers.
- In: Main
- Tags: Education Program, Hypertension
The ACCP recommends that physicians be given hospital-specific data demonstrating the potential benefits of prophylactic strategies and that they be involved in educational programs, to motivate them to use such strategies. Despite the employment of these recommendations in educational interventions at the authors’ institution, rates of prophylaxis remained poor. Previous studies have found that didactic education, printed continuing education materials, conferences, and mailings are all weak tools for implementing change when used alone. To be successful, educational strategies must incorporate methods that continuously reinforce change, such as automated reminder systems (e.g., preprinted order sheets), academic detailing, and concurrent and retrospective feedback. Furthermore, multiple interventions are more effective than any single approach.
VTE is potentially preventable in general medical patients, but until recently the frequency of this condition in patients admitted to general medicine wards had not been established, because of the different methods used to diagnose deep vein thrombosis and the heterogeneity of the patient population studied. In 3 recent randomized trials (MEDENOX, PREVENT, and ARTEMIS) LMWH was compared with placebo in the general medical population; these studies helped to establish that VTE prophylaxis with LMWH can significantly and safely reduce the incidence of VTE in general medical patients admitted to hospital. In several randomized clinical trials (most recently the PRINCE trial) directly comparing LDUH and LMWH, there have been no significant differences in rates of deep vein thrombosis or bleeding between these 2 agents.