Medication HIstory

Presently, when a medication is discontinued, it is really just made inactive. The information about when a patient started the medication, and the dosage, and the purpose (episode) and the aim and advice, remains available. The user needs only to click the "inactive" checkbox atop the list to see these inactive medications.

When a medication gets altered, it can be clinically helpful that the previous information stays available.

Use case 1 = banish (no clinical relevance)

  • wrong entry
    • never communicated to (or acted upon) by patient.

This is covered by the existing action to "Delete" a medication

Use case 2 = therapy, advice unaltered

  • inputting or altering the values
    • "approved of" (input of which may have been "missed")
    • aim
    • duration
    • episode attachment

This is already achieved by the current Edit function

Use case 3 = therapy or advice altered

  • Substance
  • Preparation (form)
  • Strength
  • Schedule (dosage)
  • inputting or altering the advice

Alterations in advice are suggested to be important to keep easily available.

The current Edit dialog allows all of the above to be inserted or changed but under 0.8x these clinically-important prior values can be overwritten and short of examining audit tables become unavailable for clinical review.

If some clinicians would not want such historical preservation enforced in their praxis medication table, we could make it an option in the praxis preferences as a default:

Preserve medication change history [   ]

and this could even populate the value of a checkbox inside the dialog if this extent of granularity was desired:

[   ] preserve change history

and this should enable and cause, in the same step as the deprecated record gets copied into the audit table, a clone to be copied into the live medication table, except it would created with its status "inactive" and would also acquire from the edit entries:

  1. Discontinued = match the Start date for the new Preparation / Strength / Schedule
  2. Reason = whatever was the reason to change the therapeutics
    • unable to swallow pills (explains a change to liquid)
    • still symptomatic / not at target (to explain a dose increase)

This would mean that … Reason needs to be enabled during a medication change, even when there is not a total discontinuation. I have an idea about this... see bottom section

Use case 4 = replace one drug with another

When a drug is ineffective or intolerable and would result in a total change of medication (not just a reduction in the current medication), the user could be spared having to do it in two steps. They would not need to discontinue a drug in one step and then "add another" in a different step... they just input the NEW medication into the Substance field and the Reason (which applies to why the drug that is being edited had to be changed) goes into the deprecated-but-available-as-inactive drug

And now the maybe-final aspect is how to distinguish what is only intended as a change in the record accuracy, from a change to the therapeutics or advice, since (for example) it may later be realized that a start date which was left blank (because it was not known) is now able to be filled in or corrected and the same is true for discontinued.

Implementation

Suggest relocate "Start" away from "Discontinued" (I know you hate to do it) to the top of the window

Suggest under Brand to relocate Episode Schedule Advice

This would then leave Discontinued Reason Duration Aim

Suggest that if any fields above "Reason" gets touched, "Reason" should be enabled

************************************************************************************************** tweak request:

"Started" and "Discontinued" could instead be wanted as future instruction as to when to start or discontinue, the label might more helpfully be

Start(ed) Discontinue(d)

**************************************************************************************************
Topic revision: 21 Nov 2010, JamesBusser
 
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