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Elektronischer Medikationsprozess in der Hausarztpraxis - Herausforderungen und Perspektiven

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47. Kongress für Allgemeinmedizin und Familienmedizin (DEGAM)– 12.-14. September 2013, München
Einführungsvortrag zum Workshop "Elektronischer Medikationsprozess in der Hausarztpraxis - Herausforderungen und Perspektiven".
Details: http://www.degam2013.de/programme/default_session.asp?node=69&day=saturday&sessionID=65

Published in: Health & Medicine
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Elektronischer Medikationsprozess in der Hausarztpraxis - Herausforderungen und Perspektiven

  1. 1. Elektronischer Medikationsprozess in der Hausarztpraxis – Herausforderungen und Perspektiven - Einführung und wissenschaftliche Evidenz 47. Kongress für Allgemeinmedizin und Familienmedizin – 12.-14. September 2013, München Tobias Neisecke, Wissenschaftlicher Mitarbeiter – Institut für Allgemeinmedizin, Universitätsklinikum Jena Tobias.Neisecke@med.uni-jena.de – http://www.allgemeinmedizin.uni-jena.de
  2. 2. Prozessmodell Medikationsmanagement • Potentielle Fehlerquellen bei jedem Schritt • Viele beteiligte Personen Prescribe Transmit Dispense Administer Monitor Vereinfacht nach Bell, 2004
  3. 3. IT als Lösungsansatz? Befürworter: • Institue of Medicine (IOM) • Agency for Healthcare Research and Quality (AHRQ) • Europäische Commission • National Health Service (NHS)
  4. 4. Eingabemodule Elektron. Anordnungen Computerized Physician Order Entry (CPOE) Medikamente Diagnostik Laboruntersuchungen IT in der Hausarzpraxis Arztpraxisinformationssystem (APIS), Praxisverwaltungssystem (PVS) Electronic Health Record (EHR) Erfassung, Bereitstellung, Pflege und Archivierung von Patientendaten Entscheidungshilfen Clinical Decision Support Systems (CDSS) Medikamentencheck Leitlinien DMP Organisation und Administration Terminplanung Abrechnung QM Etc. Externe Systeme (Pharma-) Datenbanken Einweiserportale Telemedizin Institutionen (KV) Schnittstellen Eigene Darstellung
  5. 5. Arzneiverordnungssoftware CPOE„Eingabehilfe“ Arzneimittel Handelsname Wirkstoff Darreichungsform Dosierungsschema Einzeldosis Frequenz Anwendungszeitraum Bedarfsmedikation -> Strukturierte Verordnung -> Dokumentation (Wer-Was-Wann) CDSS„Entscheidungshilfe“ Wechselwirkungs-Check Medikamentenallergien-Check Dosis-Check Preisvergleich / Arzneimittel-RL Schwangerschaft/Stillzeit-Check Doppelverordnungscheck-Check Dosierungsanpassung (Alter, Gewicht, Geschlecht, Laborwerte) Diagnosen-Check [Drug-Gene Check] -> Entscheidungshilfe -> Warnhinweise Ziele: - Vermeidung Medikationsfehler - Erhöhung Arzneimitteltherapiesicherheit Eigene Darstellung, CDSS Features modifiziert nach Mollon, 2009
  6. 6. Stand der Wissenschaft •Sicherheit •Kosten / Nutzen •Nutzerzufriedenheit
  7. 7. Sicherheit • Reduktion Medikationsfehler (Wille, 2009; Kuo,2008; Kaushal, 2003; Bates, 1999; Kohn, 1999) • Erhöhte Patientensicherheit (Kuperman, 2007) • Verbesserung Medikationsmanagement (Bright, 2012; Durieux, 2008; Eslami, 2007; Kawamoto, 2005) Voraussetzung: • Training • Adäquate Nutzung • Qualitative Umsetzung
  8. 8. Kosten / Nutzen Gemischte Ergebnisse: • Reduzierte Kosten in 6 Studien (Hemens, 2011) • Erhöhte Kosten in einer Studie (Hemens, 2011) • Keine signifikante Änderung in 5 Studien (Hemens, 2011 ) • Reduzierte Kosten für Medikamente (Kuperman, 2007)
  9. 9. Kosten / Nutzen • Qualität der Literatur zur Wirtschaftlichkeit ist dünn (Bright, 2012; o´Reilly, 2012) • “Selbst wenn e-Health effektiv ist, bleibt es immer noch komplex, teuer in der Anschaffung, der Implementierung und dem Betrieb.” (o´Reilly, 2012)
  10. 10. Nutzerzufriedenheit • Mehrheit der Nutzer sind zufrieden (Bright, 2012; Hemens, 2011; Eslami, 2007) • Sehen verbessertes Medikationsmanagement und erhöhte Behandlungsqualität (Hemens, 2012; Eslami, 2007) • Möchten Technologie weiterhin nutzen(Hemens, 2012) Voraussetzung: • Training und Support • Einwandfreie Funktion • Benutzerfreundlichkeit
  11. 11. Prescribe Transmit Dispense Administer Monitor IT-gestütztes Medikationsmanagement Ist-Zustand in Deutschland mit regional verfügbaren Erweiterungen Tele- monitoring E-RezeptHausarzt IT Apotheken IT
  12. 12. Prescribe Transmit Dispense Administer Monitor IT-gestütztes Medikationsmanagement Perspektivische Maximalvariante Hausarzt IT Tele- monitoring Tele- monitoringE-Rezept Apotheken IT Elektronischer Austausch von Medikamenten-bezogenen Daten
  13. 13. Fazit Herausforderungen: • Implementierungsstrategien verbessern • Weitere Optimierung der Technik • Effizienz und Nutzerzufriedenheit steigern Perspektiven: • Vernetzung der Akteure intensivieren • Abdeckung des gesamten Medikationsprozesses
  14. 14. Vielen Dank für Ihre Aufmerksamkeit! 47. Kongress für Allgemeinmedizin und Familienmedizin – 12.-14. September 2013, München Tobias Neisecke, Wissenschaftlicher Mitarbeiter – Institut für Allgemeinmedizin, Universitätsklinikum Jena Tobias.Neisecke@med.uni-jena.de – http://www.allgemeinmedizin.uni-jena.de
  15. 15. Appendix
  16. 16. Framework nach Bell et al. Quelle ; © 2004, American Medical Informatics Association

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