Stream: implementers
Topic: Medication stopped by Patient
John Moehrke (Oct 25 2019 at 12:15):
Is there a valueSet of codes for the various reasons a patient might give for why they have stopped taking a medication? The valueSet in the various versions of the FHIR spec seem to be more "reasons the medication was not given to the patient", more from the hospital perspective. I am looking more from a patient reporting why they stopped taking.
Arianne van de Wetering (Oct 25 2019 at 13:41):
In the Dutch situation we have our own custom list for a change or stop taking medication (the list combines both change / stop reasons - which forced us to create an extension for this):
- contraindication
- drug interaction
- intolerance
- no effect, or effect too weak
- effect too strong
- routecode does not suffice
- indication no longer exists
- medication management change
- admission to establishment
- request by patient
- according to request by health professional
- reinstate the intention / medication management of previous prescriber
- planned procedure
- other
John Moehrke (Oct 25 2019 at 13:51):
yes, that is the kind of concepts I am looking for. But I want a valueSet or at-least a set of codes that I can put into my own valueset. What are the codes behind these concepts ?
Mark Kramer (Oct 25 2019 at 15:59):
John,
We developed this set in regards to reasons for a change in care plan (not just medication change, but any kind of treatment):
SCT#405613005 "Planned Procedure (situation)" // planned change
SCT#266721009 "Absent response to treatment (situation)"
SCT#281647001 "Adverse reaction (disorder)" // more general than SCT#62014003 Adverse reaction to drug
SCT#182890002 "Patient requests alternative treatment (finding)"
SCT#160932005 "Financial problem (finding)" // more general than SCT#454061000124102 "Unable to afford medication (finding)"
SCT#105480006 "Refusal of treatment by patient (situation)" // patient choice or decision
SCT#184081006 "Patient has moved away (finding)"
SCT#309846006 "Treatment not available (situation)"
SCT#182992009 "Treatment completed (situation)"
John Moehrke (Oct 25 2019 at 16:02):
is that in a defined valueset published somewhere?
Mark Kramer (Oct 25 2019 at 16:03):
No, we didn't find one, and had to create it. Our VS has not been published.
John Moehrke (Oct 25 2019 at 16:04):
okay. thanks for sharing. would be a good #patient empowerment enabler.
John Moehrke (Oct 25 2019 at 16:05):
I got nothing better. just wanted to prevent creating something where it might already exist
Arianne van de Wetering (Oct 25 2019 at 16:28):
yes, that is the kind of concepts I am looking for. But I want a valueSet or at-least a set of codes that I can put into my own valueset. What are the codes behind these concepts ?
Our valueset only has a couple of SNOMED CT links, most codes are still local... Working on it.
https://simplifier.net/NictizSTU3-Zib2017/2.16.840.1.113883.2.4.3.11.60.20.77.11.37--20181218104254
The work being done, also resulted in SNOMED CT in namespace of The Netherlands:
438833006 Administration of drug or medicament contraindicated (situation)
79899007 Drug interaction (finding)
473010000 Hypersensitivity condition (disorder)
58848006 Lack of drug action (finding)
112251000146103 Too strong drug action (finding)
704417003 At risk of medication side effect (finding)
112191000146101 Insufficient route of administration (finding)
183966005 Drug treatment not indicated (situation)
305335007 Admission to establishment (procedure)
184003006 Patient requested treatment (situation)
112211000146102 Patient accepted drug therapy (situation)
112261000146100 Treatment previous prescriber continued (situation)
405613005 Planned procedure (situation)
John Moehrke (Oct 25 2019 at 16:59):
thanks. These still look far more like things that a clinician would determine. What are your local codes? They might be more patient centric?
Arianne van de Wetering (Oct 26 2019 at 13:56):
thanks. These still look far more like things that a clinician would determine. What are your local codes? They might be more patient centric?
Nope, same concepts as above
Peter Jordan (Oct 26 2019 at 23:58):
In the prescribing-->dispensing-->administration workflow, a patient does not necessary have to make a request to stop taking a medication, and the Dutch Value Set doesn't appear to cover that use case or, in fact, where the patient simply never takes the medication at all. These use cases are more common than many designers of provider-centric EHRs might imagine. Those living into their 80s, and beyond, with multiple conditions are often 'awash' with medications and their usage often varies greatly with instructions (backed by family experience and recent articles in the NZ Doctor).
Last updated: Apr 12 2022 at 19:14 UTC
