Development and validation of a machine learning model to improve precision prediction for irrational prescriptions in orthopedic perioperative patients.

OBJECTIVE: Our objective was to develop a machine learning model capable of predicting irrational medical prescriptions precisely within orthopedic perioperative patients. METHODS: A dataset comprising 3047 instances of suspected irrational medication prescriptions was collected from a sample of 1318 orthopedic perioperative patients from April 2019 to March 2022. Four machine learning models were employed to forecast irrational prescriptions, following which, the performance of each model was meticulously assessed. Subsequently, a thorough variable importance analysis was conducted on the model that performed the best predictive capabilities. Thereafter, the efficacy of integrating this optimal model into the existing audit prescription process was rigorously evaluated. RESULTS: Of the models utilized in this study, the RF model yielded the highest AUC of 92%, whereas the NB model presented the lowest AUC of 68%. Also, the RF model boasted the most robust performance in terms of PPV, reaching 82.4%, and NPV, reaching 86.6%. The ANN and the XGBoost model were neck and neck, with the ANN slightly edging out with a higher PPV of 95.9%, while the XGBoost model boasted an impressive NPV of 98.2%. The RF model singled out the following five factors as the most influential in predicting irrational prescriptions: the type of drug, the type of surgery, the number of comorbidities, the date of surgery after hospitalization, as well as the associated hospital and drug costs. CONCLUSION: The RF model showcased significantly high level of proficiency in predicting irrational prescriptions among orthopedic perioperative patients, outperforming other models by a considerable margin. It effectively enhanced the efficiency of pharmacist interventions, displaying outstanding performance in assisting pharmacists to intervene with irrational prescriptions.

CLINICAL AND BEHAVIORAL PRACTICES OF PRIMARY HEALTHCARE PHYSICIANS IN ANTIBIOTICS PRESCRIBING IN GREECE.

OBJECTIVE: Aim: To evaluate primary health physicians' clinical and behavioral practices towards antibiotics administration in a specific region in Greece. PATIENTS AND METHODS: Materials and methods: A cross sectional study was conducted using a questionnaire in all structures of primary health care (PHC) of the Peloponnese Region. The study was conducted in May-October 2020. RESULTS: Results: In total, 306 out of 404 primary healthcare physicians completed the questionnaire (response rate of 75.8%). Our results showed that most of physicians used to prescribing antibiotics empirically in common diseases, except for the prevention of secondary respiratory tract infection. Overall, 66.3% answered that they do not feel diagnostic uncertainty that would lead them to prescribe antibiotics. Approximately 40% of the physicians stated an increase on antibiotics use and patients demand for antibiotic prescribing, however 71.4% "rarely/never" affected by this requirement. 51.9% of the sample used to prescribed brand name antibiotics. Statistically significant differences were found between demographic and professional characteristics, and physicians' clinical and behavioral practices (p≤ 0.05). CONCLUSION: Conclusions: Our findings could provide decision makers with information on how to manage antibiotic prescribing in primary health care in the country, focusing mainly on the use of specific diagnostic tests as well as relevant guidelines and protocols for changing prescription behavior.

Irrational prescription and its costs in neonatal surfactant therapy: public and private hospitals of Iran in 2018.

BACKGROUND: Irrational prescription and its subsequent costs are a major challenge worldwide. Health systems must provide appropriate conditions for the implementation of national and international strategies to prevent irrational prescription. The aim of the present study was to determine the irrational surfactant prescription among neonates with respiratory distress and the resulting direct medical costs for private and public hospitals in Iran. METHODS: This was a cross-sectional descriptive study performed retrospectively using data belonged to 846 patients. Initially, the data were extracted from the patients' medical records and the information system of the Ministry of Health. The obtained data were then compared with the surfactant prescription guideline. Afterward, each neonatal surfactant prescription was evaluated based on the three filters listed in the guideline (including right drug, right dose, and right time). Finally, chi-square and ANOVA tests were used to investigate the inter-variable relationships. RESULTS: The results showed that 37.47% of the prescriptions were irrational and the average costs of each irrational prescription was calculated as 274.37 dollars. It was estimated that irrational prescriptions account for about 53% of the total surfactant prescription cost. Among the selected provinces, Tehran and Ahvaz had the worst and the best performance, respectively. As well, public hospitals outperformed private hospitals in terms of the in drug selection, but they underperformed them in terms of the right dose determination. CONCLUSION: The results of the present study are considered as a warning to insurance organizations, in order to reduce unnecessary costs caused by these irrational prescriptions by developing new service purchase protocols. Our suggestion is the use of educational interventions to reduce irrational prescriptions due to drug selection as well as using computer alert approaches to reduce irrational prescriptions caused by wrong dose administration.

Analysis of 402 pieces of irrational prescriptions for discharge / 中国基层医药

Objective To analyze the unreasonable prescription of the discharged drug and to propose the intervention measures to further improve the rationality of the prescription.Methods 18 506 pieces of hospital discharge prescriptions were collected,and the above prescriptions were commented by the prescription review working group.The classified items and their constituent ratios of irrational prescriptions for discharge were statistically analyzed.Results The irrational prescription of this study was 402 pieces,and the unreasonable prescription rate was 2.17%.Of which 321 pieces were not standardized prescriptions, accounting for 79.85%, 81 pieces for the inappropriate prescriptions, accounting for 20.15%.321 pieces of non-standard prescription, doctors do not regulate the signature and seal up 74 pieces, accounting for 23.05%,drug dosage, specification, number of errors69 pieces,21.50%,the third allergy test does not indicate53 pieces,accounting for 16.51%;81 pieces inappropriate medication prescription, usage of the drug, did not suitable for most,51 pieces,62.96%,followed by not suitable for combination 22 pieces, accounted for27.16%.Conclusion Through the prescription review, the discharge of drug irrational prescription analysis, and strengthen exchanges with clinical departments can promote the clinical rational drug use, improve the safety of clinical medication.

Analysis and improvement measures of irrational prescriptions in our hospital in 2016 / 中国生化药物杂志

Objective To analyze the irrational prescriptions, improvement measures and improvement effect in our hospital in 2016. Methods 7200 outpatient and emergency prescriptions of our hospital in 2016 were randomly selected to study. 3600 prescriptions from January 2016 to June were selected as pre intervention group, and 3600 prescriptions from July 2016 to December were selected as post intervention group,First of all, the prescription of the pre intervention group was reviewed, according to the results of the review and literature review to determine the intervention measures. The types of prescription drugs, average amount of prescription, rate of antibiotic use and unreasonable prescription rate of two groups were observed. Results Types of prescription drugs(2.27 kinds vs. 1.93 kinds), average amount of prescription(171.74 yuan vs. 152.86 yuan), rate of antibiotic use(34.39% vs. 25.47%) and unreasonable prescription rate (9.36% vs. 2.14%)of post intervention group were significantly lower than those of pre intervention group(P<0.05). Conclusion The prescription comment and targeted intervention can reduce the incidence of irrational drug use and promote rational drug use in clinic, which has important clinical value.

Pareto Chart Analysis of Unreasonable Factors of Prescription in Outpatient and Emergency Departments of Our Hospital during 2013-2015 / 中国药房

OBJECTIVE:To investigate the current situation of unreasonable prescriptions in outpatient and emergency depart-ments of our hospital,and to provide reference for rational drug use in the clinic. METHODS:The evaluation of outpatient and emergency prescriptions in our hospital during 2013-2015 were summarized and analyzed. Irrational prescriptions were divided into 3 categories,involving 19 items. The main,secondary and general factors of irrational prescriptions were analyzed by Pareto chart. RESULTS:Among 19 types of irrational prescriptions,main factors included unsuitable drug selection,inappropriate usage and dosage,inappropriate drug combination,prescribing not in accordance with the antibiotics management regulations,incomplete di-agnosis. No indications of medication,drug dosage beyond the regulations ofthree urgent seven slowwere treated as the second-ary factors. Other 12 items were general factors. CONCLUSIONS:According to the main and secondary irrational drug use types, clinical pharmacists should carry out effective intervention and pharmaceutical care to improve the level of rational drug use and en-sure the safety of clinical drug use.

Rational Prescription for a Dermatologist.

The ultimate goal in dermatological therapy is to use the safest and least number of drugs in order to obtain the best possible effect in the shortest period and at reasonable cost. Rational drug use (RDU) is conventionally defined as the use of an appropriate, efficacious, safe and cost-effective drug given for the right indications in the right dose and formulation, at right time intervals. WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly as prescribed by the doctor. The process of Rational prescription for a Dermatologist (RPD) involves a series of steps such as defining the patient's illness, specifying the treatment objectives, using the principle of P-treatment, starting the treatment, providing appropriate information and monitoring the treatment. Reasons for irrational prescription could be physician related, patient related, industry related, regulations related. Practicing medicine irrationally can lead to disastrous events like increased morbidity and mortality, drain of resources, drug resistance etc. Principles to enhance the RDU in our practice and minimize errors of prescription are discussed in detail in this article.

Application Evaluation of Prescription Comment Software in Our Hospital / 中国药房

OBJECTIVE:To evaluate the application of prescription comment software in our hospital. METHODS:552 pre-scriptions were evaluated by pharmacist A,B and software,and the Kappa values were calculated to evaluate the reliability of the software. The results of comment by pharmacist B and by software were combined (serial test and parallel test),and then com-pared with the results of comment by pharmacist A. The sensitivity,specificity and Youden's index were calculated to evaluate the reliability of the software. The comment results of 552 prescriptions by pharmacist A for twice were compared to calculate Kappa value,and it was used to evaluate the comment consistency of pharmacist A. RESULTS:The pharmacist A,B comment results and software comment results showed poor consistency,and Kappa value were 0.020 2 and 0.002 0,with significant difference (P<0.001);pharmacist A comment results had strongest consistency with pharmacist B comment results,and Kappa value was 0.843 0,with no significant difference(0.1

Propuesta metodológica para el funcionamiento de los Comités Farmacoterapéuticos en la Atención Primaria de Salud / Methodological proposal for the operation of Pharmacotherapy Committees in Primary Health Care

La OMS ha intensificado sus esfuerzos por promover y alcanzar un uso racional del medicamento para contribuir al bienestar del individuo y de la sociedad. El comité farmacoterapéutico es un foro para la mejora de la prestación de servicios de salud, es también un instrumento para fomentar un uso más eficaz y racional de los medicamentos. En Cuba se ha comprobado que existen problemas de uso irracional, lo que hace pensar que los comités farmacoterapéuticos no están funcionando según lo establecido. Objetivo: brindar una metodología a las instituciones de la Atención Primaria de Salud para el correcto funcionamiento del comité farmacoterapéutico. Método: se realizó una revisión exhaustiva de la literatura científica sobre los aspectos relacionados con cada apartado, se designó a un grupo multidisciplinario de profesionales expertos, procedentes de las áreas de Atención Primaria de Salud y Farmacoepidemiología con experiencia en el tema. El texto final estuvo sometido a comentarios y sugerencias, las recomendaciones fueron consensuadas por todo el grupo redactor. Resultados: se obtuvo un documento dirigido a los profesionales prescriptores y todos aquellos que realizan las tareas específicas de mejora de uso de medicamentos en las instituciones correspondientes a la Atención Primaria de Salud y a los gestores sanitarios que deben fomentarlas. La aplicación del mismo traerá como consecuencia beneficios médicos, económicos y sociales, una vez implantada la estrategia que estimulen e impulsen la actividad de dichos comité y así lograr un uso eficiente y racional de los medicamentos. Conclusiones: la metodología aportada por este documento hará que los CFT funcionen como foros de discusión para un uso adecuado, racional y seguro de los medicamentos...

The World Health Organization (WHO) has intensified its efforts to promote and achieve a rational use of medications to contribute to the individual and social welfare. The Pharmacotherapy Committee is a forum for improving health care services and is also considered an instrument to foster a more efficient and rational use of medication. In Cuba, it has been proven that there is an irrational use of medications, what makes us think that the Pharmacotherapy Committees are not functioning in accordance with the established. Objective: to provide a methodology to Primary Health Care institutions for the correct operation of the Pharmacotherapy Committee. Method: we conducted a detailed review of the scientific literature about the aspects related to each section and designed a multidisciplinary group of professional experts from Primary Health Care areas and Pharmacoepidemiology with experience on the topic. The final text was submitted to comments and suggestions and the recommendations were agreed by the consensus among the whole editor group. Results: we obtained a document which was directed to all professional prescribers and those that perform specific tasks for the improvement of the use of medications in Primary Health Care institutions as well as the sanitary managers that should encourage them. The application of this document will result in medical, economic and social benefits once the strategy has been implemented. These benefits should stimulate and promote the activities of such committees to achieve an efficient and rational use of medications. Conclusions: the methodology provided by this document will make the Pharmacotherapy Committees function as discussion forums for a safe, rational and adequate use of medications...