Practices and preferences for detecting chronic medication toxicity: a pilot cross-sectional survey of health care providers focusing on decision support systems.

Abstract

Adverse drug reactions (ADRs) are a critical concern: they are costly, both in dollars and in diminishing patients' quality of life. ADRs that occur due to prolonged exposure to a pharmaceutical agent (adverse drug reactions of long latency, ADRLLs) may be easier to prevent than acute ADRs, as ADRLLs inherently require continued medication exposures. This pilot study used glucocorticoid-induced osteoporosis (GIO) as an example ADRLL. The aims were to survey health care providers' current practices in avoiding ADRLLs and the perceived utility of decisional support systems (DSS) to aid them in preventing GIO. We administered an anonymous, cross-sectional survey to health care providers (fellows, doctor assistants, nurse practitioners and attending doctors) focusing on their methods to monitor for and prevent ADRLLs. The questionnaire also gauged usage of electronic medical records (EMRs) and each provider's perceived utility of specific DSS-based approaches to monitoring for GIO. Data were interpreted using descriptive statistics and histograms. A majority of the 33 responding providers (84.8%) reported that their primary ADRLL avoidance technique is simply remembering that a patient is on chronic glucocorticoids. The most favourably perceived DSS options included tracking medications on a flow sheet (84.8%) and digital tracking of cumulative glucocorticoid exposure with real-time prompts (83.9%). Surveyed providers reported that additional DSS implementation may help in the avoidance of ADRLLs such as GIO. Providers ranked both digital and non-digital DSS favourably, but a computerized approach is appealing in that it may be integrated into extant EMR systems.