The Effect of Regimen Frequency Simplification on Provider Order Generation: A Quasi-Experimental Study in a Korean Hospital.

Jungwon Cho,Young Mi Jeong,Euni Lee,Eunsook Lee,Sangmi Shin

doi:10.3390/ijerph18084086

Abstract

The multiplicity of dosing frequencies that are attached to medication orders poses a challenge to patients regarding adhering to their medication regimens and healthcare professionals in maximizing the efficiencies of health care service delivery. A multidisciplinary team project was performed to simplify medication regimens to improve the computerized physician order entry (CPOE) system to reduce the dosing frequencies for patients who were discharged from the hospital. A 36-month pre-test–post-test study was performed, including 12-month pre-intervention, 12-month intervention, and 12-month post-intervention periods. Two-pronged strategies, including regimen standardization and prioritization, were devised to evaluate the dosing frequencies and prescribing efficiency. The results showed that the standardized menu reduced the dosing frequencies from 4.3 ± 2.2 per day in the pre-intervention period to 3.5 ± 1.8 per day in the post-intervention period (p < 0.001). In addition, the proportion of patients taking medications five or more times per day decreased from 40.8% to 20.7% (p < 0.001). After prioritizing the CPOE dosing regimen, the number of pull-down options that were available reflected an improvement in the prescribing efficiency. Our findings indicate that concerted efforts in improving even a simple change on the CPOE screen via standardization and prioritization simplified the dosing frequencies for patients and improved the physicians’ prescribing process.

Highlights

The complexity of medication regimens performed during the care transitions of patients from hospitals to home- or community-based care settings poses a challenge to drug administration [1,2]
We evaluated the impact of the homegrown health information system (HIS) changes on medication simplification to improve the computerized physician order entry (CPOE) system and to reduce the dosing frequencies for patients
Interventions on medication simplification by changing direct services delivered by healthcare professionals [25,26,27,28], we believe that the significance of our study was in its approach to provide a system change

Summary

Introduction

The complexity of medication regimens performed during the care transitions of patients from hospitals to home- or community-based care settings poses a challenge to drug administration [1,2]. This complexity can be defined as the number of medications and the number of doses (dosing frequencies) prescribed to a patient [1]. Mealtimes are important for medication guidance on special food–drug interactions, issuing routine patient instructions using mealtime-based drug labels has not been considered to be evidencebased practice [9]. Hour-based dosing regimens (e.g., every eight hours) are prescribed when maximal drug effect is anticipated by considering the pharmacokinetic profile of the medication. In a system operating with various medication regimens, patients can experience difficulties in correctly taking their medications and the hardships may be

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