Journal of General Internal Medicine

, Volume 23, Issue 4, pp 442–446 | Cite as

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

  • Kate L. Lapane
  • Molly E. Waring
  • Karen L. Schneider
  • Catherine Dubé
  • Brian J. Quilliam
Original Article

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.

KEY WORDS

e-prescribing electronic prescribing drug alerts primary care medication use 

References

  1. 1.
    Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556–64.PubMedCrossRefGoogle Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    Corley ST. Electronic prescribing: A review of costs and benefits. Top Health Inform Manage. 2003;24(1):29–38.Google Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedGoogle Scholar
  9. 9.
    Agresti A. Categorical data analysis: 2nd edition. New York: Wiley-Interscience; 2002.Google Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    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).Google Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    Bell DS, Friedman MA. E-prescribing and the Medicare Modernization Act of 2003. Health Aff. (Millwood). 2005;24(5):1159–69.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Kate L. Lapane
    • 1
  • Molly E. Waring
    • 1
  • Karen L. Schneider
    • 1
  • Catherine Dubé
    • 1
    • 2
  • Brian J. Quilliam
    • 3
  1. 1.Department of Community HealthBrown Medical SchoolProvidenceUSA
  2. 2.Institute for Community Health PromotionBrown Medical SchoolProvidenceUSA
  3. 3.College of PharmacyUniversity of Rhode IslandKingstonUSA

Personalised recommendations