A Mixed Method Study of the Merits of E-Prescribing Drug Alerts in Primary Care
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The objective of this paper was to describe primary care prescribers’ perspectives on electronic prescribing drug alerts at the point of prescribing.
We used a mixed-method study which included clinician surveys (web-based and paper) and focus groups with prescribers and staff.
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.
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?”
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.
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.
- Gandhi, TK, Weingart, SN, Borus, J (2003) Adverse drug events in ambulatory care. N Engl J Med 348: pp. 1556-64 CrossRef
- Gurwitz, JH, Field, TS, Harrold, LR (2003) Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 289: pp. 1107-16 CrossRef
- Field, TS, Gilman, BH, Subramanian, S, Fuller, JC, Bates, DW, Gurwitz, JH (2005) The costs associated with adverse drug events among older adults in the ambulatory setting. Med Care 43: pp. 1171-6 CrossRef
- Corley, ST (2003) Electronic prescribing: A review of costs and benefits. Top Health Inform Manage 24: pp. 29-38
- Sijs, H, Aarts, J, Vulto, A, Berg, M (2006) Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc 13: pp. 138-47 CrossRef
- Shah, NR, Seger, AC, Seger, DL (2006) Improving acceptance of computerized prescribing alerts in ambulatory care. J Am Med Inform Assoc 13: pp. 5-11 CrossRef
- Avery, AJ, Savelyich, BS, Sheikh, A, Morris, CJ, Bowler, I, Teasdale, S (2007) Improving general practice computer systems for patient safety: qualitative study of key stakeholders. Qual Saf Health Care 16: pp. 28-33 CrossRef
- Tamblyn, R, Huang, A, Perreault, R (2003) The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ 169: pp. 549-56
- Agresti, A (2002) Categorical data analysis: 2nd edition. Wiley-Interscience, New York
- Bell, DS, Cretin, S, Marken, RS, Landman, AB (2004) A conceptual framework for evaluating outpatient electronic prescribing systems based on their functional capabilities. J Am Med Inform Assoc 11: pp. 60-70 CrossRef
- Spina, JR, Glassman, PA, Belperio, P, Cader, R, Asch, S (2005) . Clinical relevance of automated drug alerts from the perspective of medical providers. Am J Med Qual 20: pp. 7-14 CrossRef
- 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).
- Smith, DH, Perrin, N, Feldstein, A (2006) The impact of prescribing safety alerts for elderly persons in an electronic medical record: an interrupted time series evaluation. Arch Intern Med 166: pp. 1098-104 CrossRef
- Weingart, SN, Toth, M, Sands, DZ, Aronson, MD, Davis, RB, Phillips, RS (2003) Physicians’ decisions to override computerized drug alerts in primary care. Arch Intern Med 163: pp. 2625-31 CrossRef
- Foxhall, K (2007) E-prescribing goes to Washington. With the federal government behind it, fselectronic prescribing is gaining speed, weight, and more standards. Healthc Inform 24: pp. 14-5
- Tamblyn, R, Huang, A, Kawasumi, Y (2006) The development and evaluation of an integrated electronic prescribing and drug management system for primary care. J Am Med Inform Assoc 13: pp. 148-59 CrossRef
- Bell, DS, Friedman, MA (2005) E-prescribing and the Medicare Modernization Act of 2003. Health Aff. (Millwood) 24: pp. 1159-69 CrossRef
- A Mixed Method Study of the Merits of E-Prescribing Drug Alerts in Primary Care
Journal of General Internal Medicine
Volume 23, Issue 4 , pp 442-446
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- electronic prescribing
- drug alerts
- primary care
- medication use
- Industry Sectors
- Author Affiliations
- 1. Department of Community Health, Brown Medical School, Providence, RI, USA
- 2. Institute for Community Health Promotion, Brown Medical School, Providence, RI, USA
- 3. College of Pharmacy, University of Rhode Island, Kingston, RI, USA