AHRQ: Med management literature is all over the map

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Medication management through health IT (MMIT), although well studied, is not uniform across phases of medication management, groups of people involved or types of MMIT, according to an April report from the Agency for Healthcare Research and Quality (AHRQ).

“MMIT holds the promise of improved processes [yet] clinical and economics studies and the understanding of sustainability issues are lacking,” the report continued.

Conducted by McMaster Evidence-based Practice Center for AHRQ, in Hamilton, Ontario, the research was intended to review the evidence on the impact of health IT on all phases of the medication management process (prescribing and ordering, order communication, dispensing, administration and monitoring as well as education and reconciliation) to identify the gaps in the literature and make recommendations for future research.

The researchers searched peer-reviewed electronic databases, "grey literature" (internet searching, reviewing relevant web sites, etc.) and performed hand-searches of databases including Embase and Medline. AHRQ, of Rockville, Md., also provided all references in its e-prescribing, barcoding and computerized provider order entry (CPOE) knowledge libraries.

After 40,582 articles were retrieved, duplicates were removed, resulting in 32,785 articles to be screened at the title and abstract phase. The final report included data from 428 articles. Study quality varied according to the phase of medication management. Clinical decision support systems and CPOE systems were studied more than any other application of MMIT, according to the researchers.

“Physicians were more often the subject of evaluation than other participants,” the authors stated. “Other healthcare professionals, patients and families are important, but not studied as thoroughly as physicians. These nonphysicians groups often value different aspects of MMIT, have diverse needs and use systems differently.”

Hospitals and ambulatory clinics were well-represented in the literature, with less emphasis placed on long-term care facilities, communities, homes and nonhospital pharmacies. Most studies evaluated changes in process and outcomes of use, usability, and knowledge, skills and attitudes. Most showed moderate to substantial improvement with implementation of MMIT, the report stated.

Economic studies and those with clinical outcomes were less frequently studied. Those articles that did address economics and clinical outcomes often showed equivocal findings on the effectiveness and cost-effectiveness of MMIT systems.

Qualitative studies provided evidence of strong perceptions, both positive and negative, of the effects of MMIT and unintended consequences, the authors noted. “We found little data on the effects of forms of medications, conformity, standards and open-source status. Much descriptive literature discusses implementation issues but little strong evidence exists.”

“The literature of MMIT presents challenges. It is diffused across multiple disciplines, and much of it is descriptive in nature. We also found that although studies with strong methods exist, they are not uniformly dispersed across phases of medication management, people, settings or health IT applications," the report concluded.

“The literature would be stronger if standardized definitions of issues like medication errors, adverse effects, MMIT applications and sustainability were implemented. The evidence of effectiveness can be made stronger with directed evaluation funding. With direction the evaluations could be encouragement for studies to be done appropriately and not just on small budgets or by the system developers.”