Translating clinical notes into quantitative measures—a real-world observation on the response to cholinesterase inhibitors or selective serotonin reuptake inhibitors prescribed to outpatients with dementia using electronic medical records

Frontiers in Pharmacology

Pharmacology

Peter Zandi¹  Roy Adams¹  Constantine G. Lyketsos¹  Milap A. Nowrangi¹  Jill S. Chotiyanonta²  Xin Xu²  Kengo Onda²  Xin Li²  Kenichi Oishi³ 

[1] Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States;Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States;Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States;Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States;Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States;

关键词: dementia;    cognitive impairment (dementia);    psychiatric symptom;    electronic medical record;    clinical notes;    treatment response;    selective serotonin reuptake inhibitor;    cholinesterase inhibitor;   

DOI  :  10.3389/fphar.2023.1177026

 received in 2023-03-01, accepted in 2023-04-24,  发布年份 2023

来源: Frontiers

【 摘 要 】

Objective: Cholinesterase inhibitors (CEIs) are prescribed for dementia to maintain or improve memory. Selective serotonin reuptake inhibitors (SSRIs) are also prescribed to manage psychiatric symptoms seen in dementia. What proportion of outpatients actually responds to these drugs is still unclear. Our objective was to investigate the responder rates of these medications in an outpatient setting using the electronic medical record (EMR).Methods: We used the Johns Hopkins EMR system to identify patients with dementia who were prescribed a CEI or SSRI for the first time between 2010 and 2021. Treatment effects were assessed through routinely documented clinical notes and free-text entries in which healthcare providers record clinical findings and impressions of patients. Responses were scored using a three-point Likert scale named the NOte-based evaluation method for Treatment Efficacy (NOTE) in addition to the Clinician’s Interview-Based Impression of Change Plus caregiver input (CIBIC-plus), a seven-point Likert scale used in clinical trials. To validate NOTE, the relationships between NOTE and CIBIC-plus and between NOTE and change in MMSE (Mini-Mental State Examination) before and after medication were examined. Inter-rater reliability was evaluated using Krippendorff’s alpha. The responder rates were calculated.Results: NOTE showed excellent inter-rater reliability and correlated well with CIBIC-plus and changes in MMSEs. Out of 115 CEI cases, 27.0% reported improvement and 34.8% reported stable symptoms in cognition; out of 225 SSRI cases, 69.3% reported an improvement in neuropsychiatric symptoms.Conclusion: NOTE showed high validity in measuring the pharmacotherapy effects based on unstructured clinical entries. Although our real-world observation included various types of dementia, the results were remarkably similar to what was reported in controlled clinical trials of Alzheimer’s disease and its related neuropsychiatric symptoms.

【 授权许可】

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Copyright © 2023 Chotiyanonta, Onda, Nowrangi, Li, Xu, Adams, Lyketsos, Zandi and Oishi.