Abstract
BackgroundElectronic prescribing devices with clinical decision support systems (CDSSs) hold the potential to significantly improve pharmacological treatment management.ObjectiveThe aim of our study was to develop a novel Web- and mobile phone–based application to provide a dynamic CDSS by monitoring and analyzing practitioners’ antipsychotic prescription habits and simultaneously linking these data to inpatients’ symptom changes.MethodsWe recruited 353 psychiatric inpatients whose symptom levels and prescribed medications were inputted into the MEmind application. We standardized all medications in the MEmind database using the Anatomical Therapeutic Chemical (ATC) classification system and the defined daily dose (DDD). For each patient, MEmind calculated an average for the daily dose prescribed for antipsychotics (using the N05A ATC code), prescribed daily dose (PDD), and the PDD to DDD ratio.ResultsMEmind results found that antipsychotics were used by 61.5% (217/353) of inpatients, with the largest proportion being patients with schizophrenia spectrum disorders (33.4%, 118/353). Of the 217 patients, 137 (63.2%, 137/217) were administered pharmacological monotherapy and 80 (36.8%, 80/217) were administered polytherapy. Antipsychotics were used mostly in schizophrenia spectrum and related psychotic disorders, but they were also prescribed in other nonpsychotic diagnoses. Notably, we observed polypharmacy going against current antipsychotics guidelines.ConclusionsMEmind data indicated that antipsychotic polypharmacy and off-label use in inpatient units is commonly practiced. MEmind holds the potential to create a dynamic CDSS that provides real-time tracking of prescription practices and symptom change. Such feedback can help practitioners determine a maximally therapeutic drug treatment while avoiding unproductive overprescription and off-label use.
Highlights
From Electronic Health Records to mobile health (mHealth) ApplicationsOver the last decade, management of patients in hospitalization units has been supported by the emergence of electronic health records (EHRs) [1]
MEmind data indicated that antipsychotic polypharmacy and off-label use in inpatient units is commonly practiced
The appearance of these devices in medical practice has heralded the mobile health era, which in turn falls under the umbrella of electronic health, where mobile devices are used to advance public health [7]
Summary
Management of patients in hospitalization units has been supported by the emergence of electronic health records (EHRs) [1]. This software facilitates portability and processing of pertinent health and pharmacological treatment information [2]. The emergence of electronic prescribing or e-prescribing devices with clinical decision support systems (CDSSs) has significantly reduced diagnosis and prescription error rates [3]. Electronic prescribing devices with clinical decision support systems (CDSSs) hold the potential to significantly improve pharmacological treatment management
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