Twelve-month prescribing of contraceptive pill, patch, and ring before and after a standardized electronic medical record order change

Abstract

ObjectiveTo evaluate the proportion of 12-month contraceptive pill, patch, and ring prescriptions before and after an institution-wide change of default electronic medical record facility orders to dispensing 12-month supply. Study designThis retrospective pre-post study compares outpatient contraception prescriptions from August 10, 2019 through April 9, 2020 obtained from our institutional electronic medical record prescription database. On December 10, 2019, we facilitated a change in the default orders for dispensing self-administered hormonal contraceptives from one-month to 12-months. We evaluated the primary outcome of 12-month supply prescriptions during the four months before and after the change. We also compared 12-month supply prescriptions for pills, patch, and ring by prescriber specialty and location. ResultsThe dataset included 4897 distinct evaluable prescriptions for the pill, patch, or ring, with an overall increase in 12-month prescriptions from 260/2437 (10.7%) to 669/2460 (27.2%) after the order change (p < 0.001). Twelve-month pill prescriptions increased from 238/2250 (10.6%) to 607/2250 (27.0%) (p < 0.001), patch prescriptions from 6/40 (15.0%) to 21/44 (47.7%) (p = 0.002), and ring prescriptions from 16/147 (10.9%) to 41/165 (24.8%) (p = 0.001). Twelve-month prescriptions increased after the order change among all provider types at the medical center campus (194/594 [32.7%] to 329/623 [52.8%], p < 0.001). At community clinics, non-obstetrics/gynecology providers increased 12-month prescriptions after the order change (58/1616 [3.6%] to 327/1612 [20.3%], p < 0.001), but obstetrics/gynecology providers did not (8/227 [3.5%] to 13/225 [5.8%], p = 0.27). ConclusionProviders more frequently prescribed a 12-month supply of contraceptive pills, patches, and rings after a change in the default dispensing quantity in electronic medical record orders. ImplicationsInstitution-wide changes to the electronic medical record default facility order settings can increase 12-month supply contraceptive prescriptions. As a 12-month prescription order represents only one step of many in obtaining a 12-month contraception supply, additional research is required to elucidate and remove other potential barriers.