JAMIA: Medication management IT research falls short

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A review of published literature on randomized controlled trials (RCT) investigating the effectiveness of medication management IT revealed many gaps and inconsistencies.

K. Ann McKibbon, MS, PhD, of McMaster University in Hamilton, Ontario, and colleagues conducted a search of multiple electronic journal databases and relevant gray literature to identify 87 RCTs for inclusion in their review, the results of which were published in the January 2012 edition of the Journal of the American Medical Informatics Association.

While the researchers determined that “many studies demonstrated benefits on process measures for medication management IT focused on improving medication management, little evidence of benefit is available for the effectiveness of the use of medication management IT on clinical outcomes.”

Although researchers found 37 reports that showed behavioral changes in healthcare providers, only five indicated improved patient outcomes and researchers “also found some studies showing unintended negative consequences including increased error rates (existing and new errors caused directly by the systems or indirectly by changes in workflow) and adverse drug events with computerized provider order entry.”

According to the review, most RCTs investigated the prescribing and monitoring phases of medication management, with a total of 74 focusing on prescribing, 38 on monitoring and 27 on both phases. Order communication, dispensing, administering, education and reconciliation each received attention in only one to two RCTs.

Researchers found that medication management IT literature has mostly focused on implementation and demonstration projects that “were not designed to evaluate and establish clinical benefit for patients in settings that used medication management IT systems compared with those who received usual care without medication management IT.”

McKibbon and company graded the overall quality of articles as “poor, with scores indicating that only half reported the use of methods generally accepted as minimizing bias,” and they also found “varying definitions and methods of measurement of outcomes and lack of consensus on reporting.”

To improve the quality of future medication management IT research, they suggested that “the consistent application of a set of agreed-upon standards for the assessment, evaluation and description of medication management IT could improve the quality and generalizability of future research.

“Multiple study methods need to be used to produce a comprehensive analysis of the benefits, harms and costs of medication management IT systems,” researchers concluded.