Maine Benzodiazepine Study Group

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Maine Benzodiazepine Study Group

• Electronic Prescribing New Insights and
  Innovations for the Use of Benzodiazepines
• dff
• McGill University,
• Montreal, Quebec

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Outline

• Description of the MOXXI eRx System
• Dispensed Prescription Information from 2004
• Issues Identified Using eRx
• Potential Solutions
• Questions Comments

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The MOXXI eRx System

• Description

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MOXXI Electronic Prescribing and Drug Management
System
Doctors Office
eRx
MOXXI Server
Printer
Real-time adjudication
Pharmacy
Patient
Chart
eRx
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Log-In and Wireless Connection to the Server
Doctors Office
MOXXI Server
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Patient Selection
MOXXI Server
Acquisition of Demographic Information on
Patients Seen by the Physician in the Last 12
Months
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Start-up Problem List
Medical Services Claims (ICD-9
codes) Prescription Claims (Drugs with unique
disease indications)
MOXXI Server
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Electronic Drug Profile the Carrot
Medical services claims (hospitalization, ER
visits) Prescription claims
MOXXI Server
Pharmacy
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Dispensed Prescriptions from MOXXI Study
Physicians versus Other Physicians
Prescriptions from MOXXI physicians
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65
Prescriptions from other physicians
MOXXI-III 60,683 eligible patients insured by
the RAMQ drug insurance from January to December
2004
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Number of Prescribing Physicians perPatient
Risk of Inappropriate Prescribing
Risk of inappropriate prescriptions
MOXXI-III 60,683 eligible patients insured by
the RAMQ drug insurance, 2004
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Risk of Inappropriate Prescriptions by Number of
Dispensing Pharmacies
MOXXI-III 60,683 eligible patients insured by
the RAMQ drug insurance in 2004

(Tamblyn, CMAJ, 1993)
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Medication Dispensing
1.6 of these errors are potentially dangerous
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Medication Selection Drop Down Menus
1
2
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Safety Alerts
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Stop and Change Orders
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Information from MOXXI eRx

• January 1 December 31, 2004

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Population

• 37 primary care study physicians
• 161,814 patients visited the study physicians
• 4,217 prescribing physicians for these patients
• 60,683 of these patients had public drug
  insurance and received an Rx (37.5)
• 15,855 patients consented to participate (9.8)
• 7,411 of these consenting patients were given an
  eRx (46.7)

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Prescribing Benzodiazepines
Distinct Patients with Dispensed Rx (N60,683)
61.2
22.5
38.7
25.6
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Prescribing Benzodiazepines
Distinct Patients with eRx (N7,411)
9.0
58.9
41.1
13.3
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Prescribing All Medications
Distinct Patients with Dispensed Rx (N60,683)
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Prescribing All Medications
Distinct Patients with eRx (N7,411)
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Prescribing Benzodiazepines
Distinct Patients with Dispensed BZ Rx (N14,485)
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Prescribing Benzodiazepines
Distinct Patients with BZ eRx (N1,192)
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Type of Benzodiazepine for Patients with eRx
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Therapeutic Indications for BZ Rx
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Therapeutic Indications for BZ Rx
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Patient Confirmed Comorbidities
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Safety Alerts Related to BZ eRx
456 Alerts Involving a BZ in 350 Distinct
Sessions (13.4 of sessions)
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Safety Alerts Related to BZ eRx
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New Insights from eRx

• What are the problems?

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Outstanding Issues

• Alerts
• do not indicate appropriateness of duration
• lost in noise
• do not reflect risk level for patients
• If they are not prescribing benzodiazepines, what
  are they prescribing?
• Number of times indication is Not Recorded
• Proportion of patients without eRx Not my
  Patient!

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Building Functionalities into the eRx

• Some Solutions

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Inappropriate Prescribing of Psychotropic Drugs
Patients with at least one risk factor
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Specific Risk Factors
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Targeted Alerts in High Risk Patients

• psychotropic drugs prescribed for insomnia,
  anxiety or depression
• alternate treatment recommendations relative to
  the main reasons for prescription
• psychotropic drug problems that increase risk of
  fall-related injury
• excess dose
• cumulative toxicity from multiple drugs with
  sedating side-effects
• therapy duplication (e.g. multiple
  benzodiazepines)
• drug-age contraindications
• drug interactions where the concurrent use of the
  second drug would lead to a higher dose of the
  psychotropic drug

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Other Solutions

• Feedback for Physicians How many times do you
  create a problem for patients by not using eRx?
• Feedback of real-time safety and therapeutic
  effectiveness at point of prescribing
• Decisions Support for treatment of mental health
  problems in primary care

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The MOXXI Team

• Research Team
• McGill Faculty of Medicine
• Robyn Tamblyn PhD
• Allen Huang MD
• Gillian Bartlett PhD
• Robert Perreault MD
• Pierre Ernst MD
• Roland Grad MD
• Michal Abrahamowicz PhD
• Robert Platt PhD
• Yuko Kawasumi MSc
• James Brophy MD
• Martin Dawes MD
• Nancy Winslade PharmD
• McGill Faculty of Management
• Alain Pinsonneault PhD
• Laurel Taylor PhD
• University of Montreal Faculty of Pharmacy
• Claudine Laurier Pharm D

• Collaborators
• IRIS-Québec
• Collège des médecins du Québec
• Ordre des pharmaciens du Québec
• Régie de lassurance maladie du Québec
• Association québécoise des pharmaciens
  propriétaires
• Direction de la santé publique de Montréal-Centre
• McGill University Health Center
• Vigilance Santé
• HP, Bell Mobilité, SIP, DLD, Pharmaprix, ESI
  Canada, DMR Conseil
• MSSS
• MOXXI Médical Inc.
• lAgence de développement de réseau locaux de
  services de santé et de services sociaux

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Questions?

• www.moxxi.mcgill.ca