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Published in: Journal of General Internal Medicine 4/2008

01-04-2008 | Original Article

A Mixed Method Study of the Merits of E-Prescribing Drug Alerts in Primary Care

Authors: Kate L. Lapane, PhD, Molly E. Waring, MA PhD candidate, Karen L. Schneider, PhD, Catherine Dubé, EdD, Brian J. Quilliam, PhD

Published in: Journal of General Internal Medicine | Issue 4/2008

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Abstract

Objectives

The objective of this paper was to describe primary care prescribers’ perspectives on electronic prescribing drug alerts at the point of prescribing.

Design

We used a mixed-method study which included clinician surveys (web-based and paper) and focus groups with prescribers and staff.

Participants

Prescribers (n = 157) working in one of 64 practices using 1 of 6 e-prescribing technologies in 6 US states completed the quantitative survey and 276 prescribers and staff participated in focus groups.

Measurements

The study measures self-reported frequency of overriding of drug alerts; open-ended responses to: “What do you think of the drug alerts your software generates for you?”

Results

More than 40% of prescribers indicated they override drug–drug interactions most of the time or always (range by e-prescribing system, 25% to 50%). Participants indicated that the software and the interaction alerts were beneficial to patient safety and valued seeing drug–drug interactions for medications prescribed by others. However, they noted that alerts are too sensitive and often unnecessary. Participant suggestions included: (1) run drug alerts on an active medication list and (2) allow prescribers to set the threshold for severity of alerts.

Conclusions

Primary care prescribers recognize the patient safety value of drug prescribing alerts embedded within electronic prescribing software. Improvements to increase specificity and reduce alert overload are needed.
Literature
1.
go back to reference Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556–64.PubMedCrossRef Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556–64.PubMedCrossRef
2.
go back to reference Gurwitz JH, Field TS, Harrold L, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289:1107–16.PubMedCrossRef Gurwitz JH, Field TS, Harrold L, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289:1107–16.PubMedCrossRef
3.
go back to reference Field TS, Gilman BH, Subramanian S, Fuller JC, Bates DW, Gurwitz JH. The costs associated with adverse drug events among older adults in the ambulatory setting. Med Care. 2005;43(12):1171–6.PubMedCrossRef Field TS, Gilman BH, Subramanian S, Fuller JC, Bates DW, Gurwitz JH. The costs associated with adverse drug events among older adults in the ambulatory setting. Med Care. 2005;43(12):1171–6.PubMedCrossRef
4.
go back to reference Corley ST. Electronic prescribing: A review of costs and benefits. Top Health Inform Manage. 2003;24(1):29–38. Corley ST. Electronic prescribing: A review of costs and benefits. Top Health Inform Manage. 2003;24(1):29–38.
5.
go back to reference van der Sijs H, Aarts J, Vulto A, Berg M. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc. 2006;13(2):138–47.PubMedCrossRef van der Sijs H, Aarts J, Vulto A, Berg M. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc. 2006;13(2):138–47.PubMedCrossRef
6.
go back to reference Shah N, Seger AC, Seger DL, et al. Improving acceptance of computerized prescribing alerts in ambulatory care. J Am Med Inform Assoc. 2006;13(1):5–11.PubMedCrossRef Shah N, Seger AC, Seger DL, et al. Improving acceptance of computerized prescribing alerts in ambulatory care. J Am Med Inform Assoc. 2006;13(1):5–11.PubMedCrossRef
7.
go back to reference Avery AJ, Savelyich BS, Sheikh A, Morris CJ, Bowler I, Teasdale S. Improving general practice computer systems for patient safety: qualitative study of key stakeholders. Qual Saf Health Care. 2007;16(1):28–33.PubMedCrossRef Avery AJ, Savelyich BS, Sheikh A, Morris CJ, Bowler I, Teasdale S. Improving general practice computer systems for patient safety: qualitative study of key stakeholders. Qual Saf Health Care. 2007;16(1):28–33.PubMedCrossRef
8.
go back to reference Tamblyn R, Huang A, Perreault R, et al. The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ. 2003;169(6):549–56.PubMed Tamblyn R, Huang A, Perreault R, et al. The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ. 2003;169(6):549–56.PubMed
9.
go back to reference Agresti A. Categorical data analysis: 2nd edition. New York: Wiley-Interscience; 2002. Agresti A. Categorical data analysis: 2nd edition. New York: Wiley-Interscience; 2002.
10.
go back to reference Bell DS, Cretin S, Marken RS, Landman AB. A conceptual framework for evaluating outpatient electronic prescribing systems based on their functional capabilities. J Am Med Inform Assoc. 2004;11:60–70.PubMedCrossRef Bell DS, Cretin S, Marken RS, Landman AB. A conceptual framework for evaluating outpatient electronic prescribing systems based on their functional capabilities. J Am Med Inform Assoc. 2004;11:60–70.PubMedCrossRef
11.
go back to reference Spina J, Glassman PA, Belperio P, Cader R, Asch S. Primary Care Investigative Group of the VA Los Angeles Healthcare System. Clinical relevance of automated drug alerts from the perspective of medical providers. Am J Med Qual. 2005;20(1):7–14.PubMedCrossRef Spina J, Glassman PA, Belperio P, Cader R, Asch S. Primary Care Investigative Group of the VA Los Angeles Healthcare System. Clinical relevance of automated drug alerts from the perspective of medical providers. Am J Med Qual. 2005;20(1):7–14.PubMedCrossRef
12.
go back to reference National Association of Boards of Pharmacy. Information packet: Omnibus Budget Reconciliation counseling and drug use review requirements. Park Ridge, IL, Publ. no. 101-508. 104 Stat 1388, 4401 (February, 1992). National Association of Boards of Pharmacy. Information packet: Omnibus Budget Reconciliation counseling and drug use review requirements. Park Ridge, IL, Publ. no. 101-508. 104 Stat 1388, 4401 (February, 1992).
13.
go back to reference Smith DH, Perrin N, Feldstein A, et al. The impact of prescribing safety alerts for elderly persons in an electronic medical record: an interrupted time series evaluation. Arch Intern Med. 2006;166(10):1098–104.PubMedCrossRef Smith DH, Perrin N, Feldstein A, et al. The impact of prescribing safety alerts for elderly persons in an electronic medical record: an interrupted time series evaluation. Arch Intern Med. 2006;166(10):1098–104.PubMedCrossRef
14.
go back to reference Weingart SN, Toth M, Sands DZ, Aronson MD, Davis RB, Phillips RS. Physicians’ decisions to override computerized drug alerts in primary care. Arch Intern Med. 2003;163(21):2625–31.PubMedCrossRef Weingart SN, Toth M, Sands DZ, Aronson MD, Davis RB, Phillips RS. Physicians’ decisions to override computerized drug alerts in primary care. Arch Intern Med. 2003;163(21):2625–31.PubMedCrossRef
15.
go back to reference Foxhall K. E-prescribing goes to Washington. With the federal government behind it, fselectronic prescribing is gaining speed, weight, and more standards. Healthc Inform. 2007;24(6):14–5.PubMed Foxhall K. E-prescribing goes to Washington. With the federal government behind it, fselectronic prescribing is gaining speed, weight, and more standards. Healthc Inform. 2007;24(6):14–5.PubMed
16.
go back to reference Tamblyn R, Huang A, Kawasumi Y, et al. The development and evaluation of an integrated electronic prescribing and drug management system for primary care. J Am Med Inform Assoc. 2006;13(2):148–59.PubMedCrossRef Tamblyn R, Huang A, Kawasumi Y, et al. The development and evaluation of an integrated electronic prescribing and drug management system for primary care. J Am Med Inform Assoc. 2006;13(2):148–59.PubMedCrossRef
17.
go back to reference Bell DS, Friedman MA. E-prescribing and the Medicare Modernization Act of 2003. Health Aff. (Millwood). 2005;24(5):1159–69.CrossRef Bell DS, Friedman MA. E-prescribing and the Medicare Modernization Act of 2003. Health Aff. (Millwood). 2005;24(5):1159–69.CrossRef
Metadata
Title
A Mixed Method Study of the Merits of E-Prescribing Drug Alerts in Primary Care
Authors
Kate L. Lapane, PhD
Molly E. Waring, MA PhD candidate
Karen L. Schneider, PhD
Catherine Dubé, EdD
Brian J. Quilliam, PhD
Publication date
01-04-2008
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 4/2008
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-008-0505-4

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