Impact of Electronic Health Record Alerts on Psychiatric Medication Monitoring in the Ambulatory Care Setting
by Mickey Hart, PharmD, BCACP, Evan Petrie, PharmD, Alexandra Sklansky, PharmD, BCPP, Lisa Rein, ScM, Thomas Heinrich, MD
"Introduction: Laboratory monitoring is an important component of the assessment of efficacy, safety, and adherence for many psychiatric medications. Despite the availability of evidence-based guidelines, compliance with recommended monitoring is generally low.
Methods: Targeted clinical decision support for laboratory monitoring recommendations for prescribers of antipsychotics, lithium, and valproic acid/divalproex were incorporated into the electronic health record (EHR). Inclusionary and exclusionary logic was determined based on evidence- based guidelines and clinician preferences.
This retrospective, pre-post quasi-experimental study evaluated the impact of the intervention on compliance with recommended monitoring. The primary study outcome was the difference in the rate of fully compliant medication monitoring pre- and post-intervention for antipsychotic, lithium, and valproic acid/divalproex medications. Secondary outcomes included the difference in mean percentage compliance with antipsychotic, lithium, and valproic acid/divalproex medication monitoring pre- and post-intervention.
Results: The rate of fully compliant antipsychotic, lithium, and valproic acid/divalproex medication monitoring improved from 45.0% in the pre- intervention period to 67.0% in the post-intervention period (p < 0.001). The mean percentage compliance with antipsychotic, lithium, and valproic acid/divalproex medication monitoring also improved, from 58.1% to 76.2% (SD 42.4 and 37.4 respectively; p < 0.001). This change was driven by improvements in metabolic monitoring for second-generation antipsychotics, whereas changes to lithium and valproic acid/divalproex monitoring were not significant.
Conclusions: Targeted clinical decision support for prescribers, in the form of EHR alerts, can be effective for improving compliance with recommended lab monitoring for psychiatric medications, particularly metabolic monitoring for second-generation antipsychotics, in the ambulatory setting."
Keywords: Decision Support Systems, Clinical, Retrospective Studies, Electronic Health Records, Laboratories, Drug Monitoring, Outcome Assessment, Health Care, Ambulatory Care Facilities, Logic, Family Characteristics
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2021 September/October Table of Contents
"Introduction: Laboratory monitoring is an important component of the assessment of efficacy, safety, and adherence for many psychiatric medications. Despite the availability of evidence-based guidelines, compliance with recommended monitoring is generally low.
Methods: Targeted clinical decision support for laboratory monitoring recommendations for prescribers of antipsychotics, lithium, and valproic acid/divalproex were incorporated into the electronic health record (EHR). Inclusionary and exclusionary logic was determined based on evidence- based guidelines and clinician preferences.
This retrospective, pre-post quasi-experimental study evaluated the impact of the intervention on compliance with recommended monitoring. The primary study outcome was the difference in the rate of fully compliant medication monitoring pre- and post-intervention for antipsychotic, lithium, and valproic acid/divalproex medications. Secondary outcomes included the difference in mean percentage compliance with antipsychotic, lithium, and valproic acid/divalproex medication monitoring pre- and post-intervention.
Results: The rate of fully compliant antipsychotic, lithium, and valproic acid/divalproex medication monitoring improved from 45.0% in the pre- intervention period to 67.0% in the post-intervention period (p < 0.001). The mean percentage compliance with antipsychotic, lithium, and valproic acid/divalproex medication monitoring also improved, from 58.1% to 76.2% (SD 42.4 and 37.4 respectively; p < 0.001). This change was driven by improvements in metabolic monitoring for second-generation antipsychotics, whereas changes to lithium and valproic acid/divalproex monitoring were not significant.
Conclusions: Targeted clinical decision support for prescribers, in the form of EHR alerts, can be effective for improving compliance with recommended lab monitoring for psychiatric medications, particularly metabolic monitoring for second-generation antipsychotics, in the ambulatory setting."
Keywords: Decision Support Systems, Clinical, Retrospective Studies, Electronic Health Records, Laboratories, Drug Monitoring, Outcome Assessment, Health Care, Ambulatory Care Facilities, Logic, Family Characteristics
Download PDF
2021 September/October Table of Contents