Development,validation and evaluation of the Goal-directed Medication review Electronic Decision Support System (G-MEDSS)© |
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| Institution: | 1. Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and Health, The University of Sydney, Kolling Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia;2. Geriatric Medicine Research, Faculty of Medicine, and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada;3. Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Science, University of South Australia, Adelaide, South Australia, Australia;1. University of Wisconsin School of Pharmacy, Social & Administrative Sciences Division, Madison, WI, USA;2. University of Wisconsin School of Nursing, Madison, WI, USA;1. North Dakota State University School of Pharmacy, 1401 Albrecht Boulevard, Fargo, ND, 58108, USA;2. Ohio Northern University Raabe College of Pharmacy, 525 S. Main St, Ada, OH, 45810, USA;3. Ferris State University College of Pharmacy, 220 Ferris Dr, Big Rapids, MI, 49307, USA;4. Cedarville University School of Pharmacy, 251 N. Main St, Cedarville, OH, 45314, USA;1. University of Wisconsin-Madison, School of Pharmacy, Social and Administrative Sciences Division, Madison, WI 53705, USA;2. University of Wisconsin- Madison, School of Medicine and Public Health, Department of Biostatistics & Medical Informatics, Madison, WI 53726, USA;1. Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA;2. Health Science Center Libraries, University of Florida, Gainesville, FL, USA;3. Clinical Pharmacology and Pharmacy, IST, University of Southern Denmark, Odense, Denmark;4. Department of Clinical Pharmacology and Biochemistry, Odense University Hospital, Odense, Denmark;5. Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA |
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| Abstract: | Objectives1) To understand and investigate the experiences of accredited clinical pharmacists (ACP) using computerised clinical decision support systems (CCDSS) during medication reviews for older people, including those living with dementia; 2) To design, develop, validate, and evaluate a CCDSS that incorporates pharmacological and other deprescribing tools to aid person-centred management of high-risk medications in older adults living with and without dementia.MethodsThis study consisted of three phases and was designed on scenario-based methodology: a) the development phase, which included an exploratory survey and prototype building; b) the validation phase, which included qualitative data collection and usability testing with ACPs, general practitioners (GPs) and carers for people living with dementia; and c) the evaluation phase, using mixed-methods analyses.ResultsThe exploratory survey found that ACPs required a flexible, and reliable CCDSS to support them with clinical decisions regarding high-risk medication use in older adults. The Goal-directed Medication review Electronic Decision Support System (G-MEDSS)© was developed and validated using quantitative and qualitative feedback received from ACPs, GPs and carers for people with dementia. The mean (SD) System Usability Scale score was 69.0 (12.9), which indicated fair-good usability.Discussion and conclusionsInvolving end-users in the design process refined and improved the design of G-MEDSS, allowing for a person-centred and goal-directed delivery of pharmaceutical care. G-MEDSS allows healthcare practitioners conducting medication reviews for older adults living with and without dementia to tailor pharmaceutical care to meet their goals and preferences. Future studies may explore integration of G-MEDSS with prescribing or dispensing software. |
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| Keywords: | Polypharmacy Drug burden index Clinical decision support Usability Deprescribing |
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