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.
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Acknowledgments
We gratefully acknowledge the assistance of Ken Whittemore, RPh, MBA and Ajit Dhalve, PharmD, MBA, of SureScripts in facilitating access to the software vendors and physician practices. This research was funded by a cooperative agreement entitled “Maximizing effectiveness of e-prescribing between physicians and community pharmacies” from AHRQ (U18 HS016394-01) to SureScripts. Mr. Whittemore and Dr. Dhalve did not participate in the collection, analysis, or interpretation of these data.
Conflict of Interest
A grant entitled “Maximizing effectiveness of e-prescribing between physicians and community pharmacies” funded by Agency for Healthcare Research and Quality Collaborative Agreement U18 HS016394-01 supported this research. Dr. Lapane [although not affiliated with SureScripts in any way (financial or otherwise)] was the principal investigator on the AHRQ-funded project. As a result, Brown University received a subcontract from SureScripts to conduct the evaluation of the AHRQ-funded project, funding for a graduate student to complete the final report to AHRQ, and funds to pay for the costs associated with performing a patient survey which were not allowable expenses on the AHRQ grant. None of the authors have any financial relationships with any of the vendors participating in this study. The authors have no other conflicts to declare.
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Lapane, K.L., Waring, M.E., Schneider, K.L. et al. A Mixed Method Study of the Merits of E-Prescribing Drug Alerts in Primary Care. J GEN INTERN MED 23, 442–446 (2008). https://doi.org/10.1007/s11606-008-0505-4
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DOI: https://doi.org/10.1007/s11606-008-0505-4