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A cross-country time and motion study to measure the impact of electronic medication management systems on the work of hospital pharmacists in Australia and England.
Int J Med Inform 2019; 129:253-259IJ

Abstract

BACKGROUND

Qualitative studies have provided important insights into how hospital pharmacists' work changes when electronic medication management (EMM) systems are introduced. Quantitative studies of work practice change are rare. Despite the use of EMM systems internationally, there are no cross-country comparative studies of their impact on health professionals' work. We aimed to quantify and compare the type and magnitude of changes in hospital pharmacists' work pre- and post-EMM implementation in two countries.

METHODS

Parallel, direct observational, time and motion studies of pharmacists in Australia and England pre- and post-EMM implementation. 20 pharmacists were observed: 9 in an Australian 440-bed hospital (155 h); and 11 pharmacists in a 500-bed English hospital (258 h). The Work Observation Method By Activity Timing (WOMBAT) software was used to collect observational data. Proportions of observed time in 11 tasks by study period (pre- versus post-EMM) and site, time spent with others or alone, and using different tools (e.g computers, paper) were calculated. Magnitude of changes between pre- and post-EMM by task and country were determined using z-tests for proportions adjusting for multiple testing.

RESULTS

At baseline, Australian and English pharmacists spent the greatest proportion of time in medication review. Post-EMM, time in medication review (Australia 21.6%-27.5%; England 27.1%-33.8%) and history-taking (Australia 7.6%-13.3%; England 19.5%-28.9%) significantly increased. Despite country differences in these tasks at baseline, the magnitude of changes did not significantly differ. English pharmacists increased time engaged in medication discussions with patients post-EMM (from 5.9% to 10.8%; p = 0.01). The Australian rate did not change (18.0%-27.2%; p = 0.09), but was higher at baseline. Post-EMM, Australian pharmacists spent 63.4% of time working alone, compared to 92.0% for English pharmacists.

CONCLUSIONS

EMM systems impacted the same core areas of work and had a similar magnitude of effect on pharmacists' work in both countries. Anticipated reductions in medication review and history taking were not observed.

Authors+Show Affiliations

Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia. Electronic address: johanna.westbrook@mq.edu.au.Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, United Kingdom.Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Norway.Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, The Old Medical School, Edinburgh, United Kingdom.Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, The Old Medical School, Edinburgh, United Kingdom.Department of Strategic Systems and Technology, Patients and Information, NHS England, London, United Kingdom.Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, The Old Medical School, Edinburgh, United Kingdom.Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, The Old Medical School, Edinburgh, United Kingdom.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31445264

Citation

Westbrook, Johanna I., et al. "A Cross-country Time and Motion Study to Measure the Impact of Electronic Medication Management Systems On the Work of Hospital Pharmacists in Australia and England." International Journal of Medical Informatics, vol. 129, 2019, pp. 253-259.
Westbrook JI, Li L, Shah S, et al. A cross-country time and motion study to measure the impact of electronic medication management systems on the work of hospital pharmacists in Australia and England. Int J Med Inform. 2019;129:253-259.
Westbrook, J. I., Li, L., Shah, S., Lehnbom, E. C., Prgomet, M., Schofield, B., ... Sheikh, A. (2019). A cross-country time and motion study to measure the impact of electronic medication management systems on the work of hospital pharmacists in Australia and England. International Journal of Medical Informatics, 129, pp. 253-259. doi:10.1016/j.ijmedinf.2019.06.011.
Westbrook JI, et al. A Cross-country Time and Motion Study to Measure the Impact of Electronic Medication Management Systems On the Work of Hospital Pharmacists in Australia and England. Int J Med Inform. 2019;129:253-259. PubMed PMID: 31445264.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A cross-country time and motion study to measure the impact of electronic medication management systems on the work of hospital pharmacists in Australia and England. AU - Westbrook,Johanna I, AU - Li,Ling, AU - Shah,Sonal, AU - Lehnbom,Elin C, AU - Prgomet,Mirela, AU - Schofield,Behnaz, AU - Cresswell,Kathrin, AU - Slee,Ann, AU - Coleman,Jamie J, AU - McCloughan,Lucy, AU - Sheikh,Aziz, Y1 - 2019/06/18/ PY - 2018/10/31/received PY - 2019/06/11/revised PY - 2019/06/16/accepted PY - 2019/8/25/pubmed PY - 2019/8/25/medline PY - 2019/8/25/entrez KW - Computerised provider order entry system KW - Electronic health records KW - Electronic prescribing KW - Observation KW - Time and motion SP - 253 EP - 259 JF - International journal of medical informatics JO - Int J Med Inform VL - 129 N2 - BACKGROUND: Qualitative studies have provided important insights into how hospital pharmacists' work changes when electronic medication management (EMM) systems are introduced. Quantitative studies of work practice change are rare. Despite the use of EMM systems internationally, there are no cross-country comparative studies of their impact on health professionals' work. We aimed to quantify and compare the type and magnitude of changes in hospital pharmacists' work pre- and post-EMM implementation in two countries. METHODS: Parallel, direct observational, time and motion studies of pharmacists in Australia and England pre- and post-EMM implementation. 20 pharmacists were observed: 9 in an Australian 440-bed hospital (155 h); and 11 pharmacists in a 500-bed English hospital (258 h). The Work Observation Method By Activity Timing (WOMBAT) software was used to collect observational data. Proportions of observed time in 11 tasks by study period (pre- versus post-EMM) and site, time spent with others or alone, and using different tools (e.g computers, paper) were calculated. Magnitude of changes between pre- and post-EMM by task and country were determined using z-tests for proportions adjusting for multiple testing. RESULTS: At baseline, Australian and English pharmacists spent the greatest proportion of time in medication review. Post-EMM, time in medication review (Australia 21.6%-27.5%; England 27.1%-33.8%) and history-taking (Australia 7.6%-13.3%; England 19.5%-28.9%) significantly increased. Despite country differences in these tasks at baseline, the magnitude of changes did not significantly differ. English pharmacists increased time engaged in medication discussions with patients post-EMM (from 5.9% to 10.8%; p = 0.01). The Australian rate did not change (18.0%-27.2%; p = 0.09), but was higher at baseline. Post-EMM, Australian pharmacists spent 63.4% of time working alone, compared to 92.0% for English pharmacists. CONCLUSIONS: EMM systems impacted the same core areas of work and had a similar magnitude of effect on pharmacists' work in both countries. Anticipated reductions in medication review and history taking were not observed. SN - 1872-8243 UR - https://www.unboundmedicine.com/medline/citation/31445264/A_cross-country_time_and_motion_study_to_measure_the_impact_of_electronic_medication_management_systems_on_the_work_of_hospital_pharmacists_in_Australia_and_England L2 - https://linkinghub.elsevier.com/retrieve/pii/S1386-5056(18)31238-3 DB - PRIME DP - Unbound Medicine ER -