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Longer-Term Durability of Using Default Options in the Electronic Health Record to Increase Generic Prescribing Rates

  • David Olshan
  • Charles A. L. Rareshide
  • Mitesh S. Patel
Concise Research Reports

INTRODUCTION

Default options are the action that takes place if no alternative choice is selected. Default options are abundant within electronic health records (EHRs) and can be used to significantly influence behavior.1 For example, we found that changing generic medication prescription settings in the EHR from opt-in to opt-out increased generic prescription rates across our health system from 75 to 98% in the first 7 months after implementation.2 However, the longer-term impact of default options has not been well examined and evidence on the sustainability of other types of nudges for reducing inappropriate antibiotic prescribing has been mixed.3, 4 The objective of this study was to evaluate the 2.5-year durability of the increase in generic prescribing rates after changing EHR prescription default settings.

METHODS

Similar to prior work,2we compared monthly generic prescription rates from January 2014 to May 2017 for all outpatient clinics at Penn Medicine for oral medications...

KEY WORDS

default options generic medication physician behavior durability 

Notes

Authors’ Contribution

Drs. Olshan and Patel had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Compliance with Ethical Standards

Conflict of Interest

Dr. Patel is supported by career development awards from the Department of Veterans Affairs HSR&D and the Doris Duke Charitable Foundation. Dr. Patel is founder of Catalyst Health, a technology and behavior change consulting firm. Dr. Patel also has received research funding from Deloitte, which is not related to the work described in this manuscript. All remaining authors declare that they do not have a conflict of interest.

Role of the Funder/Supporter

The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References

  1. 1.
    Patel MS, Volpp KG, Asch DA. Nudge Units to Improve the Delivery of Health Care. N Engl J Med. 2018;378(3):214–216.CrossRefGoogle Scholar
  2. 2.
    Patel MS, Day SC, Halpern SD, et al. Generic Medication Prescription Rates After Health System-Wide Redesign of Default Options Within the Electronic Health Record. JAMA Intern Med. 2016;176(6):847–848.CrossRefGoogle Scholar
  3. 3.
    Gerber JS, Prasad PA, Fiks AG, et al. Durability of benefits of an outpatient antimicrobial stewardship intervention after discontinuation of audit and feedback. JAMA. 2014;312(23):2569–2570.CrossRefGoogle Scholar
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    Linder JA, Meeker D, Fox CR, et al. Effects of Behavioral Interventions on Inappropriate Antibiotic Prescribing in Primary Care 12 Months After Stopping Interventions. JAMA. 2017;318(14):1391–1392.CrossRefGoogle Scholar
  5. 5.
    Choudhry NK, Denberg TD, Qaseem A, Clinical Guidelines Committee of American College of P. Improving Adherence to Therapy and Clinical Outcomes While Containing Costs: Opportunities From the Greater Use of Generic Medications: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2016;164(1):41–49.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2018

Authors and Affiliations

  • David Olshan
    • 1
    • 2
  • Charles A. L. Rareshide
    • 1
  • Mitesh S. Patel
    • 1
    • 3
    • 4
    • 5
  1. 1.Penn Medicine Nudge UnitPhiladelphiaUSA
  2. 2.Massachusetts General HospitalBostonUSA
  3. 3.Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.The Wharton SchoolUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Crescenz Veterans Affairs Medical CenterUniversity of PennsylvaniaPhiladelphiaUSA

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