Prescription Process Research Articles

CÓMO MEJORAR LA SELECCIÓN DE PROVEEDORES DE ELEMENTOS COMPLEJOS USANDO LA INGENIERÍA DE PRODUCTO: PERSPECTIVAS DE LA INDUSTRIA

The supplier selection process is a complex and difficult decision-making process for practitioners but also considered a core contributor to company performance. Game-theory can be applied to the supplier selection process for explanation, prediction, or prescription, which could provide superior bargaining power over suppliers by creating competition. Anyhow, the empirical evidences on the application of game theory to the supplier selection process has been mainly descriptive or prescriptive in nature (whats), lacking deeper knowledge regarding the design and application (hows and whys). Specifically, deeper knowledge regarding the importance of using product engineering methods and tools when applying game theory to supplier selection is needed (specially for complex and highly engineering goods). Therefore, this work has the objective to provide a unique description of two case studies that show how and why product engineering methods and tools can be applied to the supplier selection, as well as how they contributed to enhance performance in supplier selection processes inspired by selected game-theory concepts. Among others, Value-Analysis, Reverse Engineering, QFD or FMEA have been utilized in both cases. Key Words: supplier selection, negotiation, product engineering, value analysis, reverse engineering, QFD, FMEA, game theory

Трансформація політики, інструментів і технологій обліку та оподаткування в умовах цифрової економіки

The article substantiates the role of digital technologies in the transformation of accounting and taxation systems. The analysis of the process of automation of the sphere of accounting and tax administration is carried out. The possibilities and effects of implementation technologies such as artificial intelligence, machine learning, cloud technologies, Big Data for predictive and prescriptive analytics, process optimization, risk assessment, cost reduction, clustering and segmentation of taxpayers, and so on are characterized. Considering the significant innovative potential and high cryptocurrency activity in the world, an analysis of legitimacy of the cryptocurrency, differences in the approaches to accounting for transactions and taxation of results of cryptocurrency activities is carried out. The main problems are identified and recommendations are given for the regulation, accounting and taxation of cryptocurrency in Ukraine.

Wearable Sensors Quantify Mobility in People With Lower Limb Amputation During Daily Life.

It is necessary to effectively assess functional mobility for appropriate prosthetic prescription and post-amputation rehabilitation. As part of this process, patients' ability for variable cadence and community ambulation are assessed in-clinic, often through visual assessments and without objective standards. The purpose of this study was to explore the clinical viability of using wearable sensors to characterize the functional mobility of people with lower limb amputation. We collected inertial measurement unit (IMU) and global positioning system (GPS) data over two weeks, from 17 individuals with lower limb amputation and 14 healthy non-amputee controls. We calculated stride-by-stride cadence, walking speed and stride lengths, along with whether they occurred in or out of the home. Self-selected walking speed was also assessed in the lab. Compared to the lab, both groups walked slower and with a lower cadence during their daily lives. There were no differences in cadence variability between groups or between strides taken in and out of the home. Both groups walked faster and with greater stride lengths away from the homes. The results suggest that functional capacity measured in the lab was not necessarily reflected in routine walking during daily life. The walking measures derived in this approach can be used to aid in the prosthetic prescription process or in the assessment of different interventions.

Patient engagement with antibiotic messaging in secondary care: a qualitative feasibility study of the \u2018review and revise\u2019 experience

BackgroundWe aimed to investigate and optimise the acceptability and usefulness of a patient leaflet about antibiotic prescribing decisions made during hospitalisation, and to explore individual patient experiences and preferences regarding the process of antibiotic prescription ‘review and revise’ which is a key strategy to minimise antibiotic overuse in hospitals.MethodsIn this qualitative study, run within the feasibility study of a large, cluster-randomised stepped wedge trial of 36 hospital organisations, a series of semi-structured, think-aloud telephone interviews were conducted and data were analysed using thematic analysis. Fifteen adult patients who had experienced a recent acute medical hospital admission during which they had been prescribed antimicrobials and offered a patient leaflet about antibiotic prescribing were recruited to the study.ResultsParticipants reacted positively to the leaflet, reporting that it was both an accessible and important source of information which struck the appropriate balance between informing and reassuring. Participants all valued open communication with clinicians, and were keen to be involved in antibiotic prescribing decisions, with individuals reporting positive experiences regarding antibiotic prescription changes or stopping. Many participants had prior experience or knowledge of antibiotics and resistance, and generally welcomed efforts to reduce antibiotic usage. Overall, there was a feeling that healthcare professionals (HCPs) are trusted experts providing the most appropriate treatment for individual patient conditions.ConclusionsThis study offers novel insights into how patients within secondary care are likely to respond to messages advocating a reduction in the use of antibiotics through the ‘review and revise’ approach. Due to the level of trust that patients place in their care provider, encouraging HCPs within secondary care to engage patients with greater communication and information provision could provide great advantages in the drive to reduce antibiotic use. It may also be beneficial for HCPs to view patient experiences as cumulative events that have the potential to impact future behaviour around antibiotic use. Finally, pre-testing messages about antibiotic prescribing and resistance is vital to dispelling any misconceptions either around effectiveness of treatment for patients, or perceptions of how messages may be received.Trial registrationCurrent Controlled Trials ISRCTN12674243 (10 April 2017),

Short-term PsychoEducation for Carers To Reduce Over Medication of people with intellectual disabilities (SPECTROM): study protocol

IntroductionPsychotropic medications that are primarily licenced for the treatment of psychiatric disorders are used widely (32%–85%) among people with intellectual disabilities (ID) often for the management of problem (challenging) behaviour...

The Implementation Process of Nurse Prescribing in Poland-A Descriptive Study.

The study aimed to investigate the situation of nurse prescribing, introduced in Poland in 2016, by analyzing the opinions of nurses, expected to be influential on nurses’ actual practices, in response to legislative change to enable nurses to prescribe and comparing this with actual nurse prescribing behaviours during the early years of the legislation. The paper fills a knowledge gap and provides baseline data analysis for subsequent research. Nurses’ opinions were collected during the period they were preparing themselves for prescribing. That data was compared with data on the character and extent of nurses’ actual prescribing practices over the first two years of implementation. The study showed the number of nurse prescriptions increased. Comparing the first and second years of nurse prescribing, the number of nurse independent prescriptions more than doubled. Over the same period, the number of nurse supplementary prescriptions increased almost six-fold. The implementation of nurse prescribing has increased the scope of nursing care, especially in the treatment of the infections, pain and chronic conditions in the elderly.

Pharmacist interventions for persons with intellectual disabilities: A scoping review.

Persons with intellectual disabilities (ID) often have complex health needs due to the development of multiple comorbidities. Given the higher associated use of problematic medications, such as antipsychotics, and polypharmacy, persons with ID may be particularly vulnerable to adverse side effects. With their medication expertise, pharmacists have the potential to address medication related challenges experienced by this population. Explore what is known about the care pharmacists provide to persons with ID. Following Arksey and O'Malley's 5-stage framework for scoping reviews, searches of the PubMed (MEDLINE), Ovid EMBASE, Ovid International Pharmaceutical Abstracts, Scopus and APA PsycINFO databases were conducted in January 2019 with no limits on publication date. Studies of participants diagnosed with ID or healthcare providers/caregivers of persons with ID that referenced a pharmacist care intervention were included. Studies with non-human populations and editorials, commentaries, letters to the editor or discussion papers were excluded. Twenty-six studies were included in the review. Seventy-six pharmacist care interventions were identified in cognitive pharmacy services (n=46); educational and advisory services (n=20); and medication prescription processing (n=10). Fifty-one outcomes were referenced including drug-related interventions (n=14), drug related problems (n=9), cost/time-effectiveness (n=7), secondary symptoms (n=6), other outcomes (n=5), general medication usage (n=4), caregiver and healthcare team satisfaction levels (n=3), and educational/knowledge (n=3). Pharmacists perform a variety of health care services to persons with ID but the impact of these interventions cannot be accurately measured due to a lack of: 1) universal definitions for ID; 2) reporting of multifactorial conditions contributing to a spectrum of ID severity; and 3) standardized reporting of ID-specific outcomes. Addressing these gaps is necessary for the development of a comprehensive evidence base regarding pharmacist involvement for medication challenges in persons with ID.

Improved antibiotic prescribing using indication-based clinical decision support in the emergency department.

BackgroundEvaluate an indication‐based clinical decision support tool to improve antibiotic prescribing in the emergency department.MethodsEncounters where an antibiotic was prescribed between January 2015 and October 2017 were analyzed before and after the introduction of a clinical decision support tool to improve clinicians’ selection of a guideline‐approved antibiotic based on clinical indication. Evaluation was conducted on a pre‐defined subset of conditions that included skin and soft tissue infections, respiratory infections, and urinary infections. The primary outcome was ordering of a guideline‐approved antibiotic prescription at the drug and duration of therapy level. A mixed model following a binomial distribution with a logit link was used to model the difference in proportions of guideline‐approved prescriptions before and after the intervention.ResultsFor conditions evaluated, selection rate of a guideline‐approved antibiotic for a given indication improved from 67.1% to 72.2% (P < 0.001). When duration of therapy is included as a criterion, selection of a guideline‐approved antibiotic was lower and improved from 24.7% to 31.4% (P < 0.001), highlighting that duration of therapy is often missing at the time of prescribing. The most substantial improvements were seen for pneumonia and pyelonephritis with an increase from 87.9% to 97.5% and 62.8% to 82.6%, respectively. Other significant improvements were seen for abscess, cellulitis, and urinary tract infections.ConclusionAntibiotic prescribing can be improved both at the drug and duration of therapy level using a non‐interruptive and indication based‐clinical decision support approach. Future research and quality improvement efforts are needed to incorporate duration of therapy guidelines into the antibiotic prescribing process.

Detecting Potential Medication Selection Errors During Outpatient Pharmacy Processing of Electronic Prescriptions With the RxNorm Application Programming Interface: Retrospective Observational Cohort Study.

BackgroundMedication errors are pervasive. Electronic prescriptions (e-prescriptions) convey secure and computer-readable prescriptions from clinics to outpatient pharmacies for dispensing. Once received, pharmacy staff perform a transcription task to select the medications needed to process e-prescriptions within their dispensing software. Later, pharmacists manually double-check medications selected to fulfill e-prescriptions before dispensing to the patient. Although pharmacist double-checks are mostly effective for catching medication selection mistakes, the cognitive process of medication selection in the computer is still prone to error because of heavy workload, inattention, and fatigue. Leveraging health information technology to identify and recover from medication selection errors can improve patient safety.ObjectiveThis study aimed to determine the performance of an automated double-check of pharmacy prescription records to identify potential medication selection errors made in outpatient pharmacies with the RxNorm application programming interface (API).MethodsWe conducted a retrospective observational analysis of 537,710 pairs of e-prescription and dispensing records from a mail-order pharmacy for the period January 2017 to October 2018. National Drug Codes (NDCs) for each pair were obtained from the National Library of Medicine’s (NLM’s) RxNorm API. The API returned RxNorm concept unique identifier (RxCUI) semantic clinical drug (SCD) identifiers associated with every NDC. The SCD identifiers returned for the e-prescription NDC were matched against the corresponding SCD identifiers from the pharmacy dispensing record NDC. An error matrix was created based on the hand-labeling of mismatched SCD pairs. Performance metrics were calculated for the e-prescription-to-dispensing record matching algorithm for both total pairs and unique pairs of NDCs in these data.ResultsWe analyzed 527,881 e-prescription and pharmacy dispensing record pairs. Four clinically significant cases of mismatched RxCUI identifiers were detected (ie, three different ingredient selections and one different strength selection). A total of 546 less significant cases of mismatched RxCUIs were found. Nearly all of the NDC pairs had matching RxCUIs (28,787/28,817, 99.90%-525,270/527,009, 99.67%). The RxNorm API had a sensitivity of 1, a false-positive rate of 0.00104 to 0.00312, specificity of 0.99896 to 0.99688, precision of 0.00727 to 0.04255, and F1 score of 0.01444 to 0.08163. We found 872 pairs of records without an RxCUI.ConclusionsThe NLM’s RxNorm API can perform an independent and automatic double-check of correct medication selection to verify e-prescription processing at outpatient pharmacies. RxNorm has near-comprehensive coverage of prescribed medications and can be used to recover from medication selection errors. In the future, tools such as this may be able to perform automated verification of medication selection accurately enough to free pharmacists from having to perform manual double-checks of the medications selected within pharmacy dispensing software to fulfill e-prescriptions.

A Primary Care Provider's Guide to Wheelchair Prescription for Persons With Spinal Cord Injury.

The wheelchair is an essential tool for individuals with spinal cord injury (SCI). When the capacity and fit of a wheelchair is matched to the needs and abilities of an individual with SCI, health, function, community participation, and quality of life are maximized. Throughout an individual's life, function and health status can decline (or improve), necessitating a new wheelchair and/or seating components (eg, cushions and backrests). Additionally, a patient's current wheelchair may be identified as a factor contributing to a health concern or functional deficit, again necessitating wheelchair adjustments. Primary care physicians often manage the complex and lifelong medical needs of individuals with SCI and play a key role in wheelchair evaluation and prescription. This article provides a broad overview of indicators that a new wheelchair is needed, describes the wheelchair prescription process, identifies important team members, reviews the major wheelchair components, and provides guidance to match components to patients' needs and abilities.

Use of Integrated Clinical Decision Support Tools to Manage Parenteral Nutrition Ordering: Experience From an Academic Medical Center

Parenteral nutrition (PN) is a complex therapy with numerous opportunities for error during the prescribing, preparation, and administration processes. Advances in technology, such as computerized provider order entry (CPOE), electronic health records (EHRs), and clinical decision support (CDS) have helped decrease the risks associated with PN therapy. These technologies can be utilized to guide prescribing, provide automated safety checks, and increase overall safety and accuracy in PN ordering, compounding, and administration. In recent years, increased awareness of the risks associated with PN therapy, in particular issues with ordering and transcription, have magnified the need for improved support of PN ordering within currently available systems. Additionally, drug shortages continue to impact key components of PN admixtures, further increasing the risks associated with this complex therapy. These concerns and risks present an opportunity for the development of new functionality, as well as improvements in and innovative utilization of available technology within systems supporting the PN use process. This discussion will highlight the risks associated with PN, examine the role of drug shortages on the safety of this therapy, describe the application of available technology to manage shortages, and report the experience of using commercially available CDS tools at one academic medical center. It will also include a discussion of the transition from paper orders to CPOE/EHR-based orders for PN and the transition from one commercially available electronic system to another at this particular institution.

Impact of Physician Referral to Health Coaching on Patient Engagement and Health Risks: An Observational Study of UPMC's Prescription for Wellness.

Evaluate impact of physician referral to health coaching on patient engagement and health risk reduction. Four-year retrospective, observational cohort study with propensity-matched pair comparisons. Integrated delivery and finance system in Pittsburgh, Pennsylvania. 10 457 adult insured members referred to health coaching by their physician; 37 864 other members identified for health coaching through insurer-initiated outreach. Practice-based, technology-supported workflow and process for physician prescribing of health coaching during regular office visit, with follow-up on patient's progress and implementation supports. Patient engagement based on completion of pre-enrollment assessment, formal enrollment in health coaching, completion of required sessions, health risk levels, and number of health risks pre- and post-health coaching referral. Difference-in-difference analysis to assess change in health risk levels and number of health risks pre- and post-health coaching and probability weighting to control for potential confounding between groups. Members referred by a physician were significantly more likely to enroll in a health coaching program (21.0% vs 6.0%, P < .001) and complete the program requirements (8.5% vs 2.7%, P < .001) than when referred by insurer-initiated outreach; significant within group improvement in health risk levels from baseline (P < .001) was observed for both the groups. Patients are significantly more likely to engage in health coaching when a referral is made by a physician; engagement in health coaching significantly improves health risk levels.

Inappropriate direct oral anticoagulant dosing in atrial fibrillation patients is associated with prescriptions for outpatients rather than inpatients: a single-center retrospective cohort study

BackgroundInappropriate dosing of direct oral anticoagulants (DOACs) has been associated with clinical safety and efficacy; however, little is known about clinical data associated with an inappropriate DOAC dosing in Japan. In addition, there is no report in which the appropriateness of DOAC dosing between prescription for inpatients and for outpatients was examined. In this study, we aimed to investigate the prevalence and factors associated in the inappropriate dosing of DOACs in patients with atrial fibrillation (AF).MethodsThe retrospective cohort study was conducted at a single Japanese university hospital. Both inpatients and outpatients, who were diagnosed with AF and for whom treatment with either dabigatran, rivaroxaban, apixaban, or edoxaban was initiated between April 1, 2014 and March 31, 2018, were enrolled in the study. Appropriateness of DOAC dosing was assessed according to the manufacturer’s labeling recommendations (dose reduction criteria) of each DOAC. Inappropriate reduced dose, namely, underdosing, was defined as prescription of a reduced dose of DOAC despite the patient not meeting the dose reduction criteria. Inappropriate standard dose, namely, overdosing, was defined as prescription of a standard dose of DOAC despite the patient meeting the dose reduction criteria. Inappropriate DOAC dosing was defined as a deviation of the recommended dose (both underdosing and overdosing).ResultsA total of 316 patients (dabigatran, 28; rivaroxaban, 107; apixaban, 116; and edoxaban, 65) were included, with a median (interquartile range) age of 75 (66–81) years and 62.3% male. DOACs were prescribed at an appropriate standard dose in 39.2% of patients, an appropriate reduced dose in 36.7%, an inappropriate standard dose in 2.5%, and an inappropriate reduced dose in 19.3%. Multivariate analysis revealed that the inappropriate dosing of DOACs was significantly associated with prescriptions for outpatients (vs. inpatients; odds ratio [OR] 2.87, 95% confidence interval [CI] 1.53–5.62, p < 0.001) and those with higher HAS-BLED scores (OR 1.87, 95% CI 1.42–2.51, p < 0.001).ConclusionsOur results demonstrated that the inappropriate dosing of DOACs occurred in approximately 20% of AF patients, and was more frequent in outpatients (vs. inpatients) and in those with a higher risk of bleeding. It is recommended that pharmacists play a greater role in assisting in the prescription process to help physicians make better decisions.

A qualitative study on factors influencing the implementation of a Clostridium difficile risk prediction tool in the Scottish secondary care setting

Introduction: Clostridium difficile is the leading cause of hospital-acquired diarrhoea, driven mainly by the consumption of 4C antibiotics (co-amoxiclav, clindamycin, cephalosporins and ciprofloxacin). In order to support secondary care clinicians in prescribing antibiotics, an algorithm helping to identify patients at high risk of contracting Clostridium difficile infections (CDI) has been created. The aim of this study was to identify factors that are influencing the implementation of a risk predictive tool in secondary care, focusing on podiatrist as potential users. Methods: Four podiatrists from NHS Fife were interviewed to gather their perception of CDI, the antibiotic prescription process, and the usefulness of a CDI tool in supporting their antibiotic prescribing decisions. The interviews were thematically analysed in NVivo using the consolidated framework for implementation research. Result: A facilitator emerged during the interviews suggested that, although podiatrists tend to not prescribe 4C antibiotics, they comprehend the risks involved with CDI. Therefore, for patient’s safety netting purposes, the use of the CDI tool during consultations was considered useful. However, a barrier emerged suggested that, although implementing the tool into their electronic system was deemed favourable, this isn't feasible, due to patient data in secondary care being allocated in different systems. Therefore, standalone app or website platforms were perceived as more appropriate to develop the CDI tool. Conclusion: In general it was understood that podiatrists are supportive in having a CDI tool, however, due to the impossibility of implementation of the tool into their system, a website or app will be developed.

Prevention strategies to identify LASA errors: building and sustaining a culture of patient safety

BackgroundPotential look-alike, sound-alike (LASA) errors in outpatient and inpatient prescriptions have been widely described worldwide. However, most strategies of reducing drug name confusion have been only focused on the processes of prescribing and dispensing, often following local rules.Main textAn illustrative recent example about this topic is given: the antidepressant Brintellix® (vortioxetine) (Takeda Pharmaceuticals USA, Inc.) and the antiplatelet medication Brilinta® (ticagrelor) (AstraZeneca LP). Revision of the initiatives that are currently applied to prevent potential LASA errors in different countries around the world and debate about the emerging strategies that could be implemented in short and mid-term. At present, a common policy worldwide on the authorization of unique names for innovative medicines does not exist. The implication of authorities in topdown strategies and the importance of developing an international health policy on the authorization of unique names for innovative medicines are highlighted in the following piece of opinion.ConclusionsBuilding and sustaining a culture of patient safety should be considered as a global top-down strategy which involved all the elements in the system (regulatory bodies, manufacturers and suppliers). The precedent established by the FDA in prevention strategies to identify and avoid LASA errors has been extremely important and should lead to international discussion. Coordinated international efforts are urgently needed in this area for the sake of patients’ safety.

Nursing Home Clinicians' Decision to Prescribe Antibiotics for a Suspected Urinary Tract Infection: Findings From a Discrete Choice Experiment

ObjectiveTo determine which nursing home (NH) resident characteristics were most important to clinicians' decision to prescribe antibiotics for a suspected urinary tract infection (UTI), including both evidence-based and non-evidence-based characteristics. DesignWeb-based discrete choice experiment with 19 clinical scenarios. For each scenario, clinicians were asked whether they would prescribe an antibiotic for a suspected UTI. SettingOnline survey. ParticipantsConvenience sample of 876 NH physicians and advanced practice providers who practiced primary care for NH residents in the United States. MethodsEach scenario varied information about 10 resident characteristics regarding urinalysis results, resident temperature, lower urinary tract symptoms, physical examination, antibiotic request, mental status, UTI risk, functional status, goals of care, and resident type. We derived importance scores for the characteristics and odds ratios (ORs) for specific information related to each characteristic from a multinomial logistic regression. ResultsApproximately half of the participants were male (56%) with a mean age of 49 years. Resident characteristics differed in their importance (ie, part-worth utility) when deciding whether to prescribe for a suspected UTI: urinalysis results (32%), body temperature (17%), lower urinary tract symptoms (17%), physical examination (15%), antibiotic request (7%), mental status (4%), UTI risk (4%), functional status (3%), goals of care (2%), and resident type (1%). Information about “positive leukocyte esterase, positive nitrates” was associated with highest odds of prescribing [OR 19.6, 95% confidence interval (CI) 16.9, 22.7], followed by “positive leukocyte esterase, negative nitrates” (OR 6.7, 95% CI 5.8, 7.6), and “painful or difficult urination” (OR 4.8, 95% CI 4.2, 5.5). Conclusions and ImplicationsAlthough guidelines focus on lower urinary tract symptoms, body temperature, and physical examination for diagnosing a UTI requiring antibiotics, these characteristics were considered less important than urinalysis results, which have inconsistent clinical utility in NH residents. Point-of-care clinical decision support offers an evidence-based prescribing process.

Drug prescription goals in primary care: a cross-sectional study

BackgroundCare goals are often implicit, although their identification is a key element of any prescription process. This study aimed to describe the clinical goals of drug prescriptions in general practice, their determinants and the agreement between physicians and patients.MethodsThis was a cross-sectional study conducted by 11 resident trainees acting as observers in 23 general practices. The residents recorded the indication and main physician’s goal for all drugs prescribed during five consultation days in each practice in December 2015, and the main patient’s goal for a sub-sample of consultations. We used an eight-category generic classification of prescription goals, including three specific (mortality, morbidity and cure), three non-specific (symptoms, quality of life, functioning) and two non-specified (other goal, no goal) categories. Analyses were based on a multivariable, multilevel model and on the kappa statistic applied to the sub-sample of consultations.ResultsThe sample encompassed 2141 consultations and 5036 drugs. The main physicians’ goal of drug prescriptions was to relieve symptoms (43.3%). The other goals were to decrease the risk of morbidity (22.4%), to cure disease (11.7%), to improve quality of life (10.6%), to decrease the risk of mortality (8.5%) and to improve functioning (1.8%). The choice of a specific goal was more frequent in patients with the following characteristics: over 50 (OR [1.09;1.15]), of male gender (OR [1.09;1.39]), with full financial coverage for a long-term condition (OR [1.47;1.97]), known by the physician (OR [1.19;2.23]), or with a somatic health problem (OR [2.56;4.17]). Cohen’s kappa for drug prescription goals between the patients and the physicians was 0.26 (0.23–0.30).ConclusionsPhysicians’ goals are poorly shared with patients. It remains to be assessed whether it is possible to collect and discuss information on prescription goals on a daily basis.

An intervention of occupational therapy in parasports using the matching person and technology model: A case study.

The practice of occupational therapy in parasports aims to improve participation in sports as an occupation, reducing barriers stemming from the environmental factors. To analyze the process of choice, prescription and follow-up of assistive technology (AT) in competitive adolescent parasports using the theoretical model Matching Person and Technology. Case study with 3 adolescents from 12 to 18 years old in Bocce and Para-badminton modalities was performed. Characterization Questionnaire; Quebec User Evaluation of Satisfaction with assistive Technology (B-Quest); Assistive Technology Device - Predisposition Assessment (ATD PA-Br); Brazil Criteria and Intervention Report were used. Level of income was intermediate and low. The AT used were handcrafted by family and coaches. The Psychosocial factors detected were low privacy, autonomy, discomfort and device appearance. Pre-intervention there was dissatisfaction with AT related to the device and the context. Post-intervention, satisfaction scores increased. The model was a positive guide regarding the intervention of technology in the parasport, directing the participation of the specialist with the parathletes, their family and coaches, in the continuous monitoring of its use. This was key for the satisfaction in using the AT in sports, besides contributing to their occupational performance and maintaining people with disability in parasports, increasing the possibility of adolescents becoming professional para-athletes. Further studies in this area are suggested.

ПРОБЛЕМЫ И ПЕРСПЕКТИВЫ СИСТЕМЫ "ЭЛЕКТРОННЫЙ РЕЦЕПТ" В РОССИИ. СИСТЕМАТИЧЕСКИЙ ОБЗОР

Development and implementation of the electronic prescription system is one of the priority areas of eHealth which fulfils a number of functions from prescribing medicines to comprehensive analysis of information and support for medical and management decisions. The current Russian legal framework legitimizes a doctor's prescription in the form of an electronic document. However, there is no definition of the following concepts in the legal acts: “Electronic prescription” and “Electronic prescription system”. The subject of the study is information space in the field of electronic prescription. The purpose is to study the Russian and foreign experience in its implementation, problems and prospects for its introduction at the national and cross-border level on the basis of descriptive and analytical methods. Analysis of the situation in the developed countries shows that currently most of the countries have implemented the electronic prescription system which involves physicians, pharmacists, regulatory organizations, insurance companies, and patients. This system ensures rapid interaction between all parties, lower medical errors, monitoring of medicines’ use, information analysis, and enables the patient to see the prescribed and provided medicines. Large-scale European eHealth projects of the last decade have initiated the exchange of digital prescriptions at the cross-border level, when a patient can get medicines from a pharmacy in the country of temporal residence with a prescription issued in the country of permanent resistance. Information support for the processes of prescribing and dispensing medicines in different regions of the Russian Federation is uneven, from its almost complete absence to full-fledged information systems close to the best analogues in the developed countries by functionality. Specific features of implementing the electronic prescription system in Russia are related to the obligatory registration of information related to supply of medicines to benefit recipients, involvement into circulation of medicines of systems and subsystems of various organizations: registration, keeping the state register of medicines, monitoring of medicine movement, monitoring of procurement, prescription and write off in health care facilities, dispensing within the pharmacy network, circulation of medicines and medical devices of the Eurasian Economic Union countries. It is impossible to develop a full-fledged system of electronic prescription in the Russian Federation without consolidated efforts of all parties, legislative consolidation of basic concepts, a unified information space, and standard data management approaches. Keywords: eHealth; electronic prescription (e-prescription); electronic prescription system; system of electronic drug prescription; medical information system; information system of drug provision to benefit recipients; information support for prescription.

Utilization and Perception of Information and Communication Technologies Among Pharmacists and Development of Pharmacy Informatics in Bosnia and Herzegovina.

Background:Information and communication technologies (ICT) are widely used in a health care as a result of pharmaceutical informatics and technology developments. There is a huge potential for pharmaceutical practice of technologies utilization in a different practice settings especial community pharmacy and patient counseling.Objective:To evaluate Bosnia and Herzegovina (BH) pharmacists` knowledge and attitudes towards informational and communication technologies and extend of its utilization.Methods:Online survey conducted among pharmacists from different practice settings.Results:Pharmacists in BH are familiar and well known regarding importance of informational technologies. 93% are using special pharmaceutical information systems, and majority use technologies and software for prescription processing (47%), calculations (24%) communication (22%) and 9% for Internet search. 90% of pharmacists have profiles on social media mainly Facebook, followed by Instagram and LinekdIn mainly used for networking and communication with peers but less with patients. They have positive attitude regarding potential benefits of using social media for communication with patients and treatment outcomes improvement.Conclusion:Pharmacists in Bosnia and Herzegovina have satisfactory level of information and communication technologies understanding and knowledge. It is of high importance that education of future pharmacist in this field is in line with nature of pharmaceutical informatics in light of its clinical application rather than technical so future pharmacists can contribute to improvements in social media medicines-related information, learn from consumers’ online activities, and design new ways of delivering care to communities and individuals.