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An Ontology-Based Approach to Improving Medication Appropriateness in Older Patients: Algorithm Development and
Elena Calvo-Cidoncha1, Julián Verdinelli2, Javier González-Bueno3
1Pharmacy Service, Hospital Clínic of Barcelona, Barcelona, Spain.
JMIR Medical Informatics
|July 21, 2023
Summary
This study introduces OntoPharma, an ontology-based clinical decision support system (CDSS) to enhance medication appropriateness in older adults with multiple conditions, reducing adverse drug events.
Area of Science:
- Medical Informatics
- Pharmacology
- Geriatrics
Background:
- Inappropriate medication use in older adults with multimorbidity increases adverse drug event (ADE) risk.
- Clinical decision support systems (CDSSs) aim to improve medication appropriateness.
- Ontology-based CDSSs offer an alternative to traditional relational databases for enhanced medication management.
Purpose of the Study:
- To model a chronic patient domain for improving medication appropriateness in older adults.
- To implement and evaluate OntoPharma, an ontology-based CDSS, in a hospital setting for this domain.
Main Methods:
- Defined domain scope focusing on medication regimen complexity, anticholinergic/sedative drug burden, and adverse event triggers.
- Utilized Protégé-OWL for ontology modeling and SPARQL for querying.
- Implemented OntoPharma in a hospital setting and analyzed generated alerts.
Main Results:
- Developed 6 new classes and 5 new properties for the chronic patient domain.
- Generated 364 alerts for 107 patients, with 154 (42.3%) accepted.
- Alerts triggered by Medication Regimen Complexity Index (≥40), Drug Burden Index (≥1), or abnormal lab values.
Conclusions:
- An ontology-based approach using OntoPharma effectively supports medication appropriateness in older adults with multimorbidity.
- The system is scalable, sustainable, and reusable, integrating clinical practice.
- OntoPharma addresses medication regimen complexity, drug burden, and adverse event triggers.
Keywords:
adverse eventalertanticholinergic drug burdenbiological ontologieschronic conditionchronic diseaseclinicaldecision supportdecision support systemsdomainelderlyinappropriate prescribingmedicationmedication regimen complexityontologiesontology-basedpharmaceuticpharmacologypharmacytrigger tool
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