Abstract
Clinical pathways are care plans which detail essential steps in the care of patients with a specific clinical problem, usually a chronic disease. A pathway includes recommendations of medications prescribed at different stages of the care plan. For patients with three or more chronic diseases (known as multimorbidities) the multiple pathways have to be applied together. One common problem for such patients is the adverse interaction between medications given for different diseases. This paper proposes a solution for avoiding medication conflicts for patients with multimorbidities through the use of formal methods. We introduce the notion of a pharmaceutical graph to capture the medications associated to different stages of a pathway. We then explore the use of an optimising SMT solver (Z3) to quickly find the set of medications with the minimal number and severity of conflicts which is assumed to be the safest. We evaluate the approach on a well known case of an elderly patient with five multimorbidities.
This work is partially supported by EPSRC grant EP/M014290/1.
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Abidi, S.R.: Ontology-based knowledge modeling to provide decision support for comorbid diseases. In: Riaño, D., ten Teije, A., Miksch, S., Peleg, M. (eds.) KR4HC 2010. LNCS, vol. 6512, pp. 27–39. Springer, Heidelberg (2011)
Abidi, S.R., Abidi, S.S.R.: Towards the merging of multiple clinical protocols and guidelines via ontology-driven modeling. In: Combi, C., Shahar, Y., Abu-Hanna, A. (eds.) AIME 2009. LNCS, vol. 5651, pp. 81–85. Springer, Heidelberg (2009)
Barnett, K., Mercer, S., Norbury, M., Watt, G., Wyke, S., Guthrie, B.: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380(9836), 37–43 (2012)
Bjørner, N., Phan, A.-D., Fleckenstein, L.: \(\nu \)Z - an optimizing SMT solver. In: Baier, C., Tinelli, C. (eds.) TACAS 2015. LNCS, vol. 9035, pp. 194–199. Springer, Heidelberg (2015)
Boyd, C.M., Darer, J., Boult, C., Fried, L.P., Boult, L., Wu, A.W.: Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 294(6), 716–724 (2005)
Campbell, H., Hotchkiss, R., Bradshaw, N., Porteous, M.: Integrated care pathways. BMJ 316(7125), 133–137 (1998)
Directorate-General for Health, Food Safety, European Commission: Conference “Which priorities for a European policy on multimorbidity?”, Final report, Brussels, 27 October 2015
Long term conditions compendium of information, 3rd edn., Department of Health (2012)
Hawley, S., Zikmund-Fisher, B., Ubel, P., Jancovic, A., Lucas, T., Fagerlin, A.: The impact of the format of graphical presentation on health-related knowledge and treatment choices. Patient Educ. Couns. 73(3), 448–455 (2008)
Hughes, L.D., McMurdo, M.E.T., Guthrie, B.: Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing 42(1), 62–69 (2013)
Jafarpour, B., Abidi, S.S.R.: Merging disease-specific clinical guidelines to handle comorbidities in a clinical decision support setting. In: Peek, N., Marín Morales, R., Peleg, M. (eds.) AIME 2013. LNCS, vol. 7885, pp. 28–32. Springer, Heidelberg (2013)
Kenning, C., Fisher, L., Bee, P., Bower, P., Coventry, P.: Primary care practitioner and patient understanding of the concepts of multimorbidity and self-management: a qualitative study. SAGE Open Med. 1, 1–11 (2013)
López-Vallverdú, J.A., Riaño, D., Collado, A.: Rule-based combination of comorbid treatments for chronic diseases applied to hypertension, diabetes mellitus and heart failure. In: Lenz, R., Miksch, S., Peleg, M., Reichert, M., Riaño, D., ten Teije, A. (eds.) ProHealth 2012 and KR4HC 2012. LNCS, vol. 7738, pp. 30–41. Springer, Heidelberg (2013)
de Moura, L., Bjørner, N.S.: Z3: an efficient SMT solver. In: Ramakrishnan, C.R., Rehof, J. (eds.) TACAS 2008. LNCS, vol. 4963, pp. 337–340. Springer, Heidelberg (2008)
Mutasingwa, D.R., Ge, H., Upshur, R.E.: How applicable are clinical practice guidelines to elderly patients with comorbidities? Can. Fam. Physician 57(7), e253–e262 (2011)
Negrini, S., Giovannoni, S., Minozzi, S., Barneschi, G., Bonaiuti, D., Bussotti, A., D’Arienzo, M., Lorenzo, N.D., Mannoni, A., Mattioli, S., Modena, V., Padua, L., Serafini, F., Violante, F.: Diagnostic therapeutic flow-charts for low back pain patients: the Italian clinical guidelines. Europa Medicophysica 42(2), 151–70 (2006)
Piovesan, L., Molino, G., Terenziani, P.: An ontological knowledge and multiple abstraction level decision support system in healthcare. Decis. Analytics 1(1), 8 (2014)
Salive, M.E.: Multimorbidity in older adults. Epidemiol. Rev. 35(1), 75–83 (2013)
Shaneyfelt, T., Mayo-Smith, M., Rothwangl, J.: Are guidelines following guidelines? the methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA 281(20), 1900–1905 (1999)
Wilk, S., Michalowski, M., Tan, X., Michalowski, W.: Using first-order logic to represent clinical practice guidelines and to mitigate adverse interactions. In: Miksch, S., Riano, D., Teije, A. (eds.) KR4HC 2014. LNCS, vol. 8903, pp. 45–61. Springer, Heidelberg (2014)
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Kovalov, A., Bowles, J.K.F. (2016). Avoiding Medication Conflicts for Patients with Multimorbidities. In: Ábrahám, E., Huisman, M. (eds) Integrated Formal Methods. IFM 2016. Lecture Notes in Computer Science(), vol 9681. Springer, Cham. https://doi.org/10.1007/978-3-319-33693-0_24
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