Electronic Transmission Of Prescriptions Research Articles

Primary Nonadherence to Oral Anticoagulants in Patients with Atrial Fibrillation: Real-World Data from a Population-Based Cohort.

Primary nonadherence (not filling a first prescription) is an important yet unstudied aspect of adherence to oral anticoagulant (OAC) therapy. To estimate the rates of primary nonadherence to OACs and determine associated factors in real-world practice. This population-based retrospective cohort study set in the Valencia region of Spain (about 5 million inhabitants) included all patients with atrial fibrillation who were newly prescribed OACs during 2011-2014 (N = 18,715). Primary nonadherence was obtained by linking electronic prescription and dispensing data and assessed by type of OAC-vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs). Covariates were obtained from diverse databases, including electronic medical records. Multivariate logistic regression models were used to assess characteristics associated with primary nonadherence, adjusting for a propensity score to minimize confounding by indication. Primary nonadherence to OACs was 5.62% (VKA 4.29% vs. NOAC 10.81%; P < 0.001), with varying rates among specific drugs (acenocoumarol 4.2%, warfarin 10.9%, apixaban 5.0%, dabigatran 7.9%, and rivaroxaban 15.5%). After adjusting for potential confounders, the likelihood of not filling the first prescription was higher for NOAC patients than for VKA patients (OR = 2.76, 95% CI = 2.41-3.15). High coinsurance in the older groups (OR = 2.63, 95% CI = 1.47-4.69 for patients aged 66-75 years and OR = 3.02, 95% CI = 1.58-5.76 for patients aged > 75 years); being a non-Spanish European (OR = 1.49, 95% CI = 1.12-1.99); and having dementia (OR = 1.72, 95% CI = 1.37-2.16) were positively associated with primary nonadherence. Electronic transmission of prescriptions (OR = 0.85, 95% CI = 0.74-0.96); liver disease (OR = 0.73, 95% CI = 0.54-0.99); and polypharmacy (OR = 0.59, 95% CI = 0.50-0.70) were inversely associated with primary nonadherence. Overall, primary nonadherence to OACs was relatively low (5%). However, important differences were found between VKAs and NOACs. After adjustment, patients prescribed NOACs nearly tripled the likelihood of nonadherence compared with patients prescribed VKAs, which could negatively affect their effectiveness in clinical practice. Identified correlates were similar to those shown in the limited evidence for other medications. This work was partially supported by the 2013 Collaboration Agreement between the Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO) from the Valencia Ministry of Health and Boehringer Ingelheim, a nonconditioned program to conduct independent research in chronic health care, pharmacoepidemiology, and medical practice variation. Rodriguez-Bernal was funded by the Instituto de Salud Carlos III, Spanish Ministry of Health, and cofinanced by the European Regional Development Fund (grant number RD12/0001/0005). The views presented here are those of the authors and not necessarily those of the FISABIO Foundation, the Valencia Ministry of Health, or the study sponsors. The funding sources had no access to study data and did not participate in any way in the design or conduct of the study, data analysis, decisions regarding the dissemination of findings, the development of the manuscript, or its publication. Peiró has received fees for participation in scientific meetings and courses sponsored by Novartis and Ferrer International. In 2014, Sanfélix-Gimeno participated in an advisory meeting of Boehringer Ingelheim. García-Sempere is a former employee of Boehringer Ingelheim. Rodriguez-Bernal and Hurtado have no relationships relevant to the contents of this article to disclose. This work was previously submitted as an abstract (podium presentation) at the 31st International Society of Pharmacoepidemiology (ISPE) Annual Conference; August 22-26, 2015; Boston, Massachusetts.

English community pharmacists’ experiences of using electronic transmission of prescriptions: a qualitative study

BackgroundThe Electronic Prescription Service Release 2 (EPS2) in England has been designed to provide electronic transmission of digitally-signed prescriptions between primary care providers, with the intent on removing the large amounts of paper currently exchanged. As part of a wider evaluation of the EPS service, we wished to explore pharmacists’ experience with the new system and their perceptions of its benefits and any associated problems.MethodsWe conducted semi-structured telephone interviews with community pharmacists using EPS2. We used a purposive sampling technique to obtain views from pharmacists working in pharmacies with a range of sizes and locations and to include both independent pharmacies and multiples. Interviews were transcribed verbatim and coded using grounded theory to identify the main factors that have influenced deployment and implementation in the eyes of respondents. QSR Nvivo was used as to aid in this process.ResultsIt became apparent from the analysis that respondents perceived a wide range of advantages of EPS including improved safety, stock control, time management and improved relationships between pharmacy and General Practice staff. Respondents did not perceive a large difference in terms of work processes or development of their professional role. A large number of problems had been experienced in relation to both the technology itself and the way it was used by General Practices. It became apparent that work-around procedures had been developed for dealing with these issues but that not all these problems were perceived as having been addressed sufficiently at source. This sometimes had implications for the extent of EPS2 use and also limited some of the potential advantages of the EPS2 system, such as reduced effort in the management of prescription reimbursement. Respondents made suggestions for future improvements to EPS2. While interview data demonstrated that there were some feedback procedures in place, these were not regarded as being sufficient by the majority of respondents.ConclusionsWhilst pharmacists perceived a wide range of benefits of EPS, a large number of problems had been experienced. Despite these difficulties, no pharmacists expressed an overall negative view.

The Progression of Electronic Health Records and Implications for Psychiatry

The Progression of Electronic Health Records and Implications for Psychiatry

Pharmacy services and patient choice: insights into differences between patient groups

Abstract Objective To use data from the UK electronic transmission of prescriptions (ETP) pilot to examine how and why choice and use of pharmacy services differ between patients, and how introduction of new services might impact on patient choice. Method Patients were invited to participate in the ETP pilot in three consortia across the UK. A postal questionnaire was distributed to 276 participating patients, and 211 (76%) were returned. Questionnaires were also completed by 64 patients who had actively chosen not to take part in the ETP pilot. Semi-structured telephone interviews were conducted with 26 questionnaire respondents who had opted to use a mail order pharmacy participating in ETP. Key findings 54% of patients participating in ETP could have their prescription collected by pharmacy staff, but only half of these (52%) had made use of the service. Patients found it convenient to collect the prescription themselves (35%) and/or preferred to collect it themselves (34%). These patients were however still happy to use the new service offered by ETP. Reasons for using the same pharmacy centred on practical aspects, such as proximity to the GP practice (65%) and short waiting times (27%). Patients also positively rated their experiences of obtaining their prescription from their GP practice (80%) and the medication from their pharmacy (82%). Patients who were offered both ETP and mail order pharmacy but chose not to participate (n = 31) were more opposed to the mail order aspect than to ETP (70% vs 14% respectively). Patients not participating who were offered ETP without mail order pharmacy (n = 33) most frequently stated that they found the current system to be convenient (23%). Interviewees using the mail order pharmacy found not having to visit either the GP practice or pharmacy to be convenient and a repeat prescription reminder service to be advantageous. Conclusion The introduction of ETP and mail order to pharmacy services does have some impact on patient choice. Different aspects of pharmacy services appeal to different groups of patients. Convenience was paramount to the majority of patients in this study, but its definition differed between patients. The data will support the pharmacy profession in developments that enhance patient choice and optimise service use.

The (Slowly) Vanishing Prescription Pad

The prescription pad, as familiar a medical emblem as the stethoscope or the white coat, is on its way to becoming a historical curiosity. Electronic prescribing — narrowly speaking, the electronic transmission of prescriptions from physician to pharmacy, but generally considered to encompass a broader range of information exchange and connections — is spreading rapidly, propelled by improved technology, expectations of improved care and decreased costs, strong pushes from a variety of advocates (the pharmacy industry, some medical societies, insurers, and the companies that manage pharmacy benefits), and the threat of mandates. As of March 2008, about 7% of the . . .

Design and implementation of a point-of-care computerized system for drug therapy in Stockholm metropolitan health region—Bridging the gap between knowledge and practice

Introduction Stockholm County Council is the largest health care provider in Sweden with an annual budget of US$ 5 billion and catering the needs of a metropolitan population of 2 million people. About 10% of health care costs are used on drugs. In 1996 Stockholm County Council decided to address the main problems associated with the process and the quality of drug prescribing. Methods A multiyear strategy was designed, including the establishment of a strong evidence-based organisation, Drug and Therapeutics Committees and editorial resources to adapt information to the IT-media and the development of the IT-architecture. The development and implementation of computerized tools such as a physician drug order entry system including decision support, a drug information website and electronic transmission of prescriptions were started in 1996. Results The implementation was slow at the point-of-care units. It took about 6 years before the implementation process gained speed. In September 2005 almost 1000 doctors could use the decision support system for prescribing drugs and more than 70% of all prescriptions were transmitted electronically in our region. Conclusions The work with the strategy has shown that improvements in drug use can be accomplished by providing access to simple, rapid and safe electronic tools, but the information provided has to be associated with well-recognized regional and national expert organisations.

Integrated care and electronic transmission of prescriptions: experience of the evaluation of ETP pilots

The NHS Care Records Service will connect more than 30,000 GPs and 270 acute, community and mental health NHS trusts in a single, secure national system. This will support electronic transmission of prescriptions (ETP) to pharmacies linked to the NHS Care Records Service spine and also to the national Prescription Pricing Authority (PPA). This article reflects on the experience of evaluating three pilot implementations of ETP in England in 2002, and concludes that some evaluation findings may be relevant not only to ETP messaging but also to electronic health record (EHR) systems and hence to the broader implications of implementing the NHS Care Records Service.

Not what the doctor ordered [health care

The IT revolution at the NHS [National Health Service] has run into problems. The new IT plan for the NHS is not in good shape. The Department of Health&apos;s National Programme for IT (NPfIT) was the subject of not simply local, but international praise when it was first launched and, in British terms, it was portrayed as totemic in meeting Labour&apos;s pledge to restore the NHS to its former glory. NPfIT has four fundamental initial goals: electronic appointment booking, the electronic care records service, electronic transmission of prescriptions, and the installation of the IT infrastructure across. However, within this apparently straightforward &apos;to do list&apos;, many medical professionals say they remain confused because of a lack of consultation, standards and training.

Electronic transmission of prescriptions: towards realising the dream

The UK National Health Service (NHS) is about to commence upon major computerisation of its processes as part of a government plan of modernisation. One of these is the Electronic Transmission of Prescription (ETP). To achieve success it is important to know what benefits are expected from the new system and what barriers to adoption the systems will face. This paper reviews substantial ETP published material, and identifies 17 issues that need to be addressed. These issues are categorised under four major headings of stakeholders, cost, technology, and current process and practice, and are then further classified as positive or negative influences on the project's success. Many of these influences will be common to most of the computerisation projects to be undertaken by the NHS, and therefore this paper has wider applicability than ETP.

Security issues in the electronic transmission of prescriptions.

The UK government has stated within its plan of reform for the National Health Service that a secure system for the Electronic Transfer of Prescriptions will be available by 2004. The objectives of this paper are to highlight the significant barriers faced in securing an ETP system, to provide a critical analysis of the security mechanisms in the models currently being piloted and to suggest an alternative revised model which overcomes the identified deficiencies and security hurdles. To identify the significant security issues relevant to the adoption of ETP, the authors have combined their analysis of present prescription processing practice with their knowledge of computer security. The authors identify and describe how the issues of patient confidentiality, authorization, identity authentication, audit, scalability, availability and reliability are significant barriers to the adoption of ETP, particularly if they effect ease of use. The paper's contribution to the field of ETP is to suggest solutions to each of the identified security issues and to combine the solutions together in a revised and developed model.

Applying new thinking from the linked and emerging fields of digital identity and privacy to information governance in health informatics.

Recent work in the emerging field of network or digital identity suggests a new approach to the design of informatics systems, in which the individual becomes the guardian of their own personal data, and is assisted in controlling access to it by an infrastructure that is aware of roles, such as 'doctor', and relationships, such as 'doctor-patient'.For these purposes, an 'identity' is defined as the history of a relationship between two entities, and thus encompasses not only name and address but also data that would usually be regarded as part of an electronic patient or health record. This paper presents a description of how such a true person-centric architecture might work, and shows how it can be seen as an evolution of current plans in the NHS for a national patient data spine. One application, the electronic transmission of prescriptions, is described in detail. Other applications, both within and without the healthcare field, are described in outline. The implementation of such a person-centric system requires a modest degree of technical innovation, but significant change in organisational and business models. It is suggested that there is a need for one or more not-for-profit trusts, each with a remit to act as host for an individual's digital identity, and as the individual's true agent. Service providers - such as healthcare organisations - will pay the trust for provision of authentication, and for the storage and transmission of a patient's data; the trust in turn will pay implementation partners, such as smart card issuers and providers of communication channels, acting on behalf of the individual.

UK pilots on electronic transmission of prescriptions

UK pilots on electronic transmission of prescriptions