Verbatim from the Applicant?s Abstract The purpose of this study is to determine the impact of the use of personal digital assistants (PDAs) by prescribers on potential medication errors in primary care physicians office-based practices.
The specific aims of this study are to: 1) measure the occurrence of potential preventable medication related errors in physician office-based practices; 2) assess physicians? attitudes toward the PDAs to determine issues related to frequency of use, ease of application to clinical situations, and confidence in the information obtained from the handheld computer applications related to medications; 3) identify barriers perceived by M.D.s to PDA use in practice and successful strategies to overcome these barriers; 4) determine the extent to which the frequency of potential medication related errors may be reduced by physicians having improved access to pharmaceutical information needed at the point of care through the use of personal digital assistant devices (PDAs); and 5) determine the extent to which the frequency of potential medication related errors may be reduced by physicians using the PDA as a prescription printing device in office-based practice. The primary project is a prospective, randomized, controlled trial of 40 physicians in 40 primary care office-based practices to observe the impact of PDA use on potential prescriber medication errors. A baseline potential medication error rate per physician will be determined for all physicians. The physicians will then be randomized to two groups: an intervention group and a control group. The intervention involves training the physicians to use clinical information applications during the prescribing process through the PDA and entering and printing the prescriptions to a local printer via the PDA. The control group will conduct their traditional prescribing practices throughout the study. Prior to introducing the intervention, an analysis of the human factors and environmental drivers on site in the physicians? offices will be conducted to identify barriers to the technology, strategies to overcome these barriers, and optimal incorporation of the technology and its applications into the office environment. Instructional design methods will be used to prepare a practice-based curriculum using case-simulation to teach the physician prescribers in the intervention group how to engage in and systematically use this process. A baseline assessment of their anticipated frequency of use, ease of applications to clinical situations, and confidence in information obtained will be studied. After use, these measures will be repeated by use of survey instruments and in-depth interviews. The difference between the control and intervention group mean potential error rate per physician will be determined. Bivariate nonparametric statistics will be used to assess the change in perception of the physicians regarding PDA use as a result of the intervention. Expected outcomes are 1) to improve provider education to reduce errors, 2) translate proven effective IT strategies into widespread practice, and 3) build capacity to further reduce errors. This project will generate new knowledge that can be used by providers, patients, payers, and policymakers to determine the contribution of handheld PDAs to reduce medical errors and improve patient safety in the primary care physician office-based practice environment.
