Electronic prescribing and medication adherence and compliance

Electronic Prescribing and Medication Adherence and Compliance:

Electronic Prescribing (e-prescribing) is the use of health information technology to transmit prescriptions. It is a common component of electronic medical records and has been recognized as an effective tool in reducing medication errors and improving the quality of patient care. As cited in other articles, the benefits of e-prescribing include the following:(1)

1.) Elimination of handwritten prescriptions, decreasing medication errors 2.) Reduces communication time between the health care provider and the pharmacy 3.) E-prescribing tools frequently offer real time access to drug formularies, current prescriptions, and allergy information for the patient 4.) Medication errors can be further decreased through the use of drop down menus 5.) Generic and preferred brand medications can be easily offered as alternatives, decreasing health care costs

While e-prescribing is projected to be an important tool in improving health care quality, its effect on medication adherence has only recently been studied. One of the potential benefits of e-prescribing is that it allows for the selection of medications that are best suited for the patient’s health condition, payment method and streamlines the prescription process, allowing for quicker delivery of the prescription to the pharmacy of choice. Because e-prescribing offers these components, it is reasonable to surmise that medication adherence and compliance may increase with e-prescriptions. The reviews below summarize some of the evidence to date regarding electronic prescribing and medication adherence and compliance.

∙ The rate of primary medication adherence (the rate of filling a new prescription) was analyzed using e-prescribing transactions, pharmacy claims, and provider characteristic files drawn form the eRx Collaborative database in Massachusetts.(2) A total of 195,930 e-prescriptions were written for 75,589 patients during the study period (1 year). The overall primary medication adherence rate was reported as 77.5%, amounting to 151,837 prescriptions filled. There was no control group in this study to compare primary medication adherence rates given that this was not the focus of the study.

∙ Another survey study conducted amongst private practices in New York examined primary medication compliance and the perceptions of the participating providers. The study reports that the primary noncompliance rate was 15%.(3)

∙ Two cohort studies were performed at an integrated health network in Pennsylvania to study primary medication adherence rates of hypertension and diabetes. Primary medication adherence for hypertension were reported as 83% while diabetic e-prescriptions reported an 85% rate of medication adherence.(4,5)

The results of the above studies are show that medication adherence continues to be a problem in electronic prescribing systems. Further investigation is needed to determine chronic medication adherence and compliance rates and other factors that may be affecting medication filling rates. In fact, results from European studies report much lower rates of noncompliance and nonadherence, ranging from 2-6%(6,7). This suggests that other factors such as socioeconomic concerns may be affecting medication fill rates despite the increased efficiency and quality of the electronic prescribing system.

References: 1. Balfour D.C, Evans S., Januska J., et al. Health Information Technology – Results from a Roundtable Discussion. Supplement to Journal of Managed Care Pharmacy. 2009. 15: S10-17. 2. Fischer M.A., Stedman M.R., Lii J., et al. Primary medication nonadherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010. 25(4): 284-90. 3. Hakim A. E-prescribing and primary noncompliance. Professional Case Management. 2010. 15(2) 62-67. 4. Shah N.R., Hirsch A.G., Zacker C. et al. Predictors of first fill adherence for patients with hypertension. Am J Hypertens. 2009. 22: 392-6. 5. Shah N.R., Hirsch A.G., Zacker C., et al. Factors associated with first fill adherence rates for diabetic medications. A cohort study. J Gen Intern Med. 2008: 24: 233-7. 6. Ekedahl A., Mansson N. Unclaimed prescriptions after automated prescription transmittals to pharmacies. Pharm World Sci. 2004. 26: 26-31. 7. Beardon P.H., McGilchrist M.M., McKendrick A.D., et al. Primary noncompliance with prescribed medication in primary care. British J Med. 1993: 207: 846-8.

Submitted by (Sujani Kakumanu)