Appropriateness of ambulatory prescriptions in Taiwan: translating claims data into initiatives

Abstract

Appropriate prescribing is fundamental to successful pharmacotherapy. The status of current ambulatory medication practices in medicine and pharmacy would be better understood through an analysis of community pharmacy prescription claims. The aims of the study were to investigate patterns of the types of prescriptions claimed by community pharmacies, undetected prescription errors by community pharmacists, and associated factors of prescription errors. A population-based claims database of prescriptions dispensed by community pharmacies in Taiwan. Ambulatory prescriptions were randomly sampled and reassessed for prescribing appropriateness by medical center pharmacists using explicit criteria. Demographics of patients, physicians, care facilities, and prescription/dispensing details were assessed and used to identify associated factors for prescription errors using descriptive analyses as well as logistic regression. Erroneous prescriptions prescribed by physicians, and dispensed and claimed through community pharmacies. The study included analyses of 3065 prescriptions dispensed in community pharmacies resulting from 1003 patient visits, mostly to physician or dental clinics (99.5%). Prescribing characteristics, patterns, and examples of prescription errors are described. Prescription errors were identified in 18.3% (n = 560) of prescriptions and 34.9% (n = 350) of patient visits. Potential prescribing errors included errors of omission (25.5%), errors of commission (53.4%), and others (21.1%). The top three errors were incorrect dosage (27.5%), missing indication (23.6%), and insufficient or unavailable drug information (18.9%). Drugs most frequently associated with prescription errors included antihistamines, hormones, and gastrointestinal agents. Prescription were also higher in the central and eastern regions of Taiwan. Pediatricians accounted for a disproportionate number of prescription errors. Prescription errors are prevalent in ambulatory care in Taiwan, and differential practice standards exist between community and hospital services. This disparity needs to be reconciled by pertinent initiatives to enhance community-hospital and pharmacist-general practitioner communication and interprofessional educational efforts to improve medication use and safety.