Browsing by Author "Medicine Faculty Volunteers, IU School of Medicine"

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    Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation
    (Oxford University Press, 2014-10) Russ, Alissa L.; Zillich, Alan J.; Melton, Brittany L.; Russell, Scott A.; Chen, Siying; Spina, Jeffrey R.; Weiner, Michael; Johnson, Elizabette G.; Daggy, Joanne K.; McAnas, M. Sue; Hawsey, Jason M.; Puleo, Anthony G.; Doebbeling, Bradley N.; Saleem, Jason J.; Medicine Faculty Volunteers, IU School of Medicine
    OBJECTIVE: To apply human factors engineering principles to improve alert interface design. We hypothesized that incorporating human factors principles into alerts would improve usability, reduce workload for prescribers, and reduce prescribing errors. MATERIALS AND METHODS: We performed a scenario-based simulation study using a counterbalanced, crossover design with 20 Veterans Affairs prescribers to compare original versus redesigned alerts. We redesigned drug-allergy, drug-drug interaction, and drug-disease alerts based upon human factors principles. We assessed usability (learnability of redesign, efficiency, satisfaction, and usability errors), perceived workload, and prescribing errors. RESULTS: Although prescribers received no training on the design changes, prescribers were able to resolve redesigned alerts more efficiently (median (IQR): 56 (47) s) compared to the original alerts (85 (71) s; p=0.015). In addition, prescribers rated redesigned alerts significantly higher than original alerts across several dimensions of satisfaction. Redesigned alerts led to a modest but significant reduction in workload (p=0.042) and significantly reduced the number of prescribing errors per prescriber (median (range): 2 (1-5) compared to original alerts: 4 (1-7); p=0.024). DISCUSSION: Aspects of the redesigned alerts that likely contributed to better prescribing include design modifications that reduced usability-related errors, providing clinical data closer to the point of decision, and displaying alert text in a tabular format. Displaying alert text in a tabular format may help prescribers extract information quickly and thereby increase responsiveness to alerts. CONCLUSIONS: This simulation study provides evidence that applying human factors design principles to medication alerts can improve usability and prescribing outcomes.
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    Meeting the Needs of Underserved Patients in Western Kenya by Creating the Next Generation of Global Health Pharmacists
    (American Journal of Pharmaceutical Education, 2016-03-25) Miller, Monica L.; Karwa, Rakhi; Schellhase, Ellen M.; Pastakia, Sonak D.; Crowe, Susie; Manji, Imran; Jakait, Beatrice; Maina, Mercy; Medicine Faculty Volunteers, IU School of Medicine
    Objective. To describe a novel training model used to create a sustainable public health-focused pharmacy residency based in Kenya and to describe the outcomes of this training program on underserved populations. Design. The postgraduate year 2 residency was designed to expose trainees to the unique public health facets of inpatient, outpatient, and community-based care delivery in low and middle-income countries. Public health areas of focus included supply chain management, reproductive health, pediatrics, HIV, chronic disease management, and teaching. Assessment. The outcomes of the residency were assessed based on the number of new clinical programs developed by residents, articles and abstracts written by residents, and resident participation in grant writing. To date, six residents from the United States and eight Kenyan residents have completed the residency. Eleven sustainable patient care services have been implemented as a result of the residency program. Conclusion. This pharmacy residency training model developed accomplished pharmacists in public health pharmacy, with each residency class expanding funding and clinical programming, contributing to curriculum development, and creating jobs.
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    A Randomized, Controlled Pragmatic Trial of TelephonicMedication Therapy Management to ReduceHospitalization inHomeHealth Patients
    (Wiley Online Library, 2014-10) Zillich, Alan J.; Snyder, Margie E.; Frail, Caitlin K.; Lewis, Julie L.; Deshotels, Donny; Dunham, Patrick; Jaynes, Heather A.; Sutherland, Jason M.; Medicine Faculty Volunteers, IU School of Medicine
    OBJECTIVE: To evaluate the effectiveness of a telephonic medication therapy management (MTM) service on reducing hospitalizations among home health patients. SETTING: Forty randomly selected, geographically diverse home health care centers in the United States. DESIGN: Two-stage, randomized, controlled trial with 60-day follow-up. All Medicare- insured home health care patients were eligible to participate. Twenty-eight consecutive patients within each care center were recruited and randomized to usual care or MTM intervention. The MTM intervention consisted of the following: (1) initial phone call by a pharmacy technician to verify active medications; (2) pharmacist-provided medication regimen review by telephone; and (3) follow-up pharmacist phone calls at day seven and as needed for 30 days. The primary outcome was 60-day all-cause hospitalization. DATA COLLECTION: Data were collected from in-home nursing assessments using the OASIS-C. Multivariate logistic regression modeled the effect of the MTM intervention on the probability of hospitalization while adjusting for patients' baseline risk of hospitalization, number of medications taken daily, and other OASIS-C data elements. PRINCIPAL FINDINGS: A total of 895 patients (intervention n = 415, control n = 480) were block-randomized to the intervention or usual care. There was no significant difference in the 60-day probability of hospitalization between the MTM intervention and control groups (Adjusted OR: 1.26, 95 percent CI: 0.89-1.77, p = .19). For patients within the lowest baseline risk quartile (n = 232), the intervention group was three times more likely to remain out of the hospital at 60 days (Adjusted OR: 3.79, 95 percent CI: 1.35-10.57, p = .01) compared to the usual care group. CONCLUSIONS: This MTM intervention may not be effective for all home health patients; however, for those patients with the lowest-risk profile, the MTM intervention prevented patients from being hospitalized at 60 days.