A Retrospective, Comparative Study, for the Assessment of a Novel System, an Algorithm for Medication Safety and Consultation for Chronic Polypharmacy Patients
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 91
- 试验地点
- 1
- 主要终点
- Primary Outcome Measure: Noninferiority of agreement for combined categories
研究概览
简要总结
The aim of this study is to determine if insights based on the analysis of historical data of multidrug patients' electronic health records, by a novel system and algorithm, is noninferior to a clinical pharmacist analysis and insights.
Multidrug patients, also known as polypharmacy patients often suffer from adverse drug reactions (ADRs). In routine practice the clinical pharmacist helps prevent ADRs by comprehensive medication review, identifying drug related risks and problems and providing recommendations. The analysis of multidrug patients is highly complex and time consuming due to the large amount of multifactorial data of chronic multidrug patients' medications, symptoms, comorbidities and age-related issues. The MDI system is a tool for analyzing and providing insights on polypharmacy data [including electronic health records (EHRs) and claims data] to help clinicians evaluate complex medical records and ensure optimal and personal treatment recommendations.
After initial training of the MDI system on historical real-life patient EHRs, the MDI system and the clinical pharmacist reviewed patient EHR data from another patient cohort according to five categories: 1) duplication of therapy, 2) age-related issues, 3) incorrect dose, 4) current side effects and 5) future side effects risks. The insights of this assessment were recorded on patient conclusion sheets and adjudicated by an external judging committee, comprised of two senior academic clinical pharmacists. The judging committee were blinded to the source of the conclusion sheets.
Diagnostic accuracy parameters: agreement, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the MDI system and the clinical pharmacist were assessed. The gold standard of the diagnostic accuracy analysis was the judging committee.
Assuming that the total agreement is 5% higher for the MDI System, with a non-inferiority margin of 5%, α level of 5%, statistical power of 90%, and an expected standard deviation of 15%, the minimum sample size is about 20 cases. The achieved recruitment level was more than twice as much in the actual clinical trial.
详细描述
This is an observational, retrospective study performed on deidentified electronic health records (EHRs). The study includes two stages: A pilot study for training and verification of a novel system; and a clinical validation study for evaluating the MDI system performance in comparison to the clinical pharmacist.
The main aim of the study is to determine the noninferiority of a novel system performance in comparison to the clinical pharmacist, for the creation of insights based on the analysis of multidrug patients' EHRs. The quality and accuracy of the analysis and insights is adjudicated by an external judging committee (the gold standard), comprised of two (2) senior academic clinical pharmacists (Pharm.D, Ph.D).
The clinical site's Information systems division scanned for EHRs of multidrug patients according to extraction criteria. The raw data of the patients' records were reviewed by the principal investigator (PI). Medical coding definitions of the extraction criteria were modified according to discrepancies found by the PI. The patients' deidentified EHRs were randomized to a training cohort for the training phase and to the clinical validation cohort.
Stage 1 of the trial was for training the MDI system on real-life patient EHRs. Deidentified EHRs of the training cohort were uploaded to the MDI System platform, which calculates each patient's risk for drug induced problems according to five categories: 1) duplication of therapy, 2) age-related issues, 3) incorrect dose, 4) current side effects and 5) future side effects risks. The MDI System output report is reviewed by the clinical team. The algorithms are modified based on the system-wide conclusions and the risk calculation model.
Stage 2 of the trial was for the clinical validation of the MDI system. The MDI system and clinical pharmacists independently evaluated the clinical cohort EHRs and reported insights on conclusion sheets according to the five categories: 1) duplication of therapy, 2) age-related issues, 3) incorrect dose, 4) current side effects and 5) future side effects risks. An external judging committee comprised of two (2) senior clinical pharmacy doctors, who were blinded to the source of the conclusion sheets, adjudicated the MDI system and clinical pharmacist insights.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 45 Years 至 100 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Men or women aged 45 and over (inclusive) at the time of admission to hospital. Hospitalized at Hadassah Hospital from 2010 to 2017 in one of the following departments: Internal Medicine, Cardiology, Orthopedics, Neurology, Rehabilitation.
- •Patients who have available hospitalization summary information available that contains the content required to complete the indicated fields (according to the fields listed in Appendix 1 - Patient Sheet).
- •The patient's chronic medications at admission to hospital are from the following pharmacological families / medications: angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), Beta Blockers, calcium channel blockers (CCB), Alpha blockers, Potassium-sparing diuretics, diuretics loop, diuretics thiazide, Anti platelets agents anticoagulants, Metformin Insulin, sulfonylurea (SU) / repaglinide glucagon like peptide 1 (GLP1) analogues, dipeptidyl peptidase IV (DPP-4) inhibitors, sodium-glucose transport protein 2 (SGLT2) inhibitor, statin Fibrates, benzodiazapines / Z-drugs, Mirtazapine, selective serotonin reuptake inhibitors (SSRIs) / norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCA), Antispasmodic / Anticholinergic, Antiepileplic agents) Gabapentin, Pregabalin, Primidone) , Opioids, proton-pump inhibitors (PPIs), histamine 2 (H2) blockers.
- •Take at least six (6) chronic medications from the above list at the time of admission to the hospital (the list may also include medications that have been discontinued on admission to the hospital).
排除标准
- •Oncology patients
- •Dialysis patients
- •Epileptic patients
- •Respiratory and anesthetized
- •Breastfeeding patients
- •Pregnant patients
- •Patients with hyperparathyroidism
结局指标
主要结局
Primary Outcome Measure: Noninferiority of agreement for combined categories
时间窗: 90 days
The overall mean percentage of agreement between the MDI system/clinical pharmacists and the judging committee (gold standard) for the combined categories
次要结局
- Secondary Outcome: Noninferiority of agreement for separate categories(90 days)
- Secondary Outcome: Noninferiority of PPV, NPV, sensitivity and specificity for the separate categories(90 days)
- Secondary Outcome: Noninferiority of PPV, NPV, sensitivity and specificity for the combined categories(90 days)