Browsing by Author "Hatfield, Mark D."
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Item Assessing the Impact of Multiple Levels of Influence on the Use of Hydrocodone Combination Products and Buprenorphine as Opioid Addiction/Dependence Treatment(2016-08) Hatfield, Mark D.; Fleming, Marc L.; Sansgiry, Sujit S.; Johnson, Michael L.; Essien, Ekere James; Todd, Knox H.Millions of Americans suffer from pain, which can be treated with a variety of therapies. Prescription opioid analgesics are among the most widely used treatments for pain. The appropriate use of prescription opioid analgesics can be effective as a part of a pain management strategy. However, a certain degree of risk of abuse, addiction, and dependence is inherently associated with prescription opioid analgesic use. This risk cannot be predicted nor eradicated. Interventions aimed at restricting the use of opioid analgesics have been implemented, the latest of which was rescheduling hydrocodone combination products (HCPs) from schedule III to schedule II (C-II). This federal intervention affected prescribing patterns across all states, though to varying degrees of which are yet to be determined. This study assessed the trends of HCP use over time, comparing the two neighboring states of Texas and Louisiana. These states have different prescribing policies for C-IIs, as well as other differing inherent characteristics influencing prescription opioid analgesic use. These differences were evident with the changes in prescribing trends for HCPs and other types of prescription opioid analgesics. Additionally, this study applied a social ecological model to assess the impact of multiple levels of influence on the treatment of opioid addiction/dependence using buprenorphine. The model showed utility in assessing the impact of the population-level influences at the national, state, and local levels. Interventions targeting a specific level of influence may improve patient care through its subsequent effectiveness.Item The Impact of Computerized Provider Order Entry (CPOE) on Medication Order Processing and Workflow Efficiency by Pharmacists: A Time and Motion Study(2012-12) Hatfield, Mark D.; Sansgiry, Sujit S.; Cox, Rodney; Essien, Ekere JamesIntroduction: Recently, there has been a tremendous increase in the preparation on the part of US hospitals to implement CPOE. Employer groups, the federal government, and others have been advocating its implementation since the early 2000s, yet the number of hospitals which have met meaningful use criteria for CPOE is still less than 15%. This number is projected to increase exponentially in a very short time, spurred by incentives from the Centers for Medicare and Medicaid (CMS). With such a large amount of hospitals preparing for CPOE implementation, there is still much to learn about the impact of these systems. The objective of this study is to quantify the change in pharmacist workflow after CPOE is implemented. Methods: An experimental, enhanced pretest-posttest, prospective, time and motion study was conducted in four inpatient pharmacies within the same hospital system. Order entry pharmacists were observed for two separate time periods. The intervention pharmacy was observed first as a non-CPOE pharmacy and then later, after CPOE had been implemented. There was a control pharmacy which was non-CPOE for both time periods. There were two treatment control pharmacies, both of which had CPOE for both time periods. A database instrument recorded 37 different pharmacist tasks, which were grouped into four activities: clinical, distributive, administrative, and miscellaneous. Comparisons of the amount of time spent by the order entry pharmacist in each of the four different activities were conducted. SAS® version 9.3 was used to analyze the data, with statistical significance set at 0.05. Results: A total of 114 hours at the non-CPOE site and 197 hours at the CPOE site met the inclusion criteria. Non-parametric linear regressions were modeled and the predicted values were analyzed. The predicted mean number of minutes for each recorded hour were, by activity (predicted mean ± SD for non-CPOE versus CPOE, p-value): clinical (5.10 ± 2.24 versus 3.83 ± 1.34, p<0.05); distributive (44.55 ± 1.07 versus 47.61 ± 1.43, p<0.05); administrative (7.25 ± 2.34 versus 6.67 ± 1.28, p<0.05); and miscellaneous (3.11 ± 0.77 versus 1.89 ± 0.68, p<0.05). Conclusions: Less time was spent in the clinical, administrative, and miscellaneous activities, while more time was spent in the distributive activity after CPOE implementation. These findings were statistically significant.