E-prescribing System Research Articles

A qualitative study of prescribing errors among multi-professional prescribers within an e-prescribing system

Background Computerised Physician Order Entry (CPOE) is considered to enhance the safety of prescribing. However, it can have unintended consequences and new forms of prescribing error have been reported. Objective The aim of this study was to explore the causes and contributing factors associated with prescribing errors reported by multidisciplinary prescribers working within a CPOE system. Main Outcome Measure Multidisciplinary prescribers experience of prescribing errors in an CPOE system. Method This qualitative study was conducted in a hospital with a well-established CPOE system. Semi-structured qualitative interviews were conducted with prescribers from the professions of pharmacy, nursing, and medicine. Interviews analysed using a mixed inductive and deductive approach to develop a framework for the causes of error. Results Twenty-three prescribers were interviewed. Six main themes influencing prescribing were found: the system, the prescriber, the patient, the team, the task of prescribing and the work environment. Prominent issues related to CPOE included, incorrect drug name picking, default auto-population of dosages, alert fatigue and remote prescribing. These interacted within a complex prescribing environment. No substantial differences in the experience of CPOE were found between the professions. Conclusion Medical and non-medical prescribers have similar experiences of prescribing errors when using CPOE, aligned with existing published literature about medical prescribing. Causes of electronic prescribing errors are multifactorial in nature and prescribers describe how factors interact to create the conditions errors. While interventions should focus on direct CPOE issues, such as training and design, socio-technical, and environmental aspects of practice remain important.

Primary Non-Adherence to Antihistamines-Conclusions From E-Prescription Pilot Data in Poland.

BackgroundIn allergic conditions such as allergic rhinitis and urticaria, orally administered H1-antihistamines belong to first-line therapy and therefore, are widely prescribed. Due to the frequent, and often chronic, course of allergic diseases, adherence is of great importance. In 2018 a novel, nationwide e-prescription system was piloted in Poland, which allowed to analyze primary non-adherence to orally administered H1 antihistamines.ObjectivesTo assess the primary non-adherence to orally administered H1-antihistamines in Poland, defined as not redeeming the drug issued on a particular e-prescription within its validity period.MethodsThe study was based on all e-prescriptions issued in Poland in 2018, issued for 119.880 drugs. The analysis included nine major orally administered H1 antihistamines available in Poland.ResultsOut of 2280 analyzed e-prescriptions on orally administered antihistamines, 1803 (79.1%) of them were redeemed. Therefore, the level of primary non-adherence reached 21%. Among women it reached 19.9%, but it was not significantly lower than among men (23.4%, p=0.064). The highest non-adherence (31.3%) was observed in the age group 19-39, whilst the highest adherence rate (84.6%) was observed in those 75 years or older. The most frequently prescribed second-generation antihistamine was bilastine—596 e-prescriptions with 23.7% primary non-adherence.ConclusionsMore than 1 out of 5 e-prescriptions on orally administered H1-antihistamines were not redeemed in Poland in 2018. Age, but not gender, significantly influenced the degree of primary non-adherence to these drugs. To authors knowledge, this is the first real-life study on primary non-adherence to H1-antihistamines in Poland and one of the very few on this subject worldwide.

PMU54 ANALYSIS OF E-PRESCRIPTION SYSTEM AND AWARENESS OF PHARMACISTS ON REIMBURSEMENT PROGRAM IN UKRAINE

According to statistic data the consumption of drugs per one citizen was $73, that indicates a low solvency in Ukraine (2017). It is needed the state reimbursement of drugs. Since April 1, 2017 the governmental program "Affordable medicines” has been implemented for patients with cardiovascular disease, diabetes and asthma. Since April 1, 2019 the National Health Service of Ukraine (NHSU) implemented e-prescription system for 23 INN essential drugs. Analysis of statistic data on e-prescriptions for April-December 2019; SurveyMonke app. on awarwness of pharmacists There are reimbursement list included 254 trade names of essential drugs: 78 are free, 176 drugs are with copayment. E-prescription system for 23 INNs was implemented in 7,840 pharmacies (36,5%) in Ukraine. We established that during March-December 2019 family doctors prescribed 10,870,000 e-prescriptions. There were for 1,770,000 patients, 80% for cardiovascular diseases, 17% for diabetes, 3% for asthma Structure of e-prescription was for urban 68.6% and 31.4% rural population. The average number of e-prescriptions per one patient was 5.22. Analysis of data by the SurveyMonke app showed that the pharmacists have awareness level: excellent 10.7%, good 59.8%, satisfactory 29.5%. Pharmacists evaluated that more patients 90.9% want to receive a free drugs, willingness to copayment was low. The implementation of e-prescription system in reimbursement program improved the accessability of esssentila medicines for cardiovascular disease, diabetes and asthma patients. There is only 36,5% pharmacies included in e-Health, it is necessary to increase the number of pharmacies included in the reimbursement program to ensure physical accessibility for the rural population. The level of awareness on the Affordable medicines program among pharmacists is insufficient. Then the special training and education of pharmacists on e-prescribing and reimbursement are necessary in Ukraine.

PCV19 GENERIC SUBSTITUTION AND ITS ECONOMIC CONSEQUENCES ASSESSED FOR THE FIRST TIME IN POLAND THANKS TO THE RECENTLY INTRODUCED E-PRESCRIPTION SYSTEM

According to the recent government document ‘National Drug Policy’, generic drugs’ use is encouraged in Poland. Market share of generics in the community pharmacy setting reached 66% of value in 2017. Mechanisms supporting generic drug use include reference pricing and generic substitution, which is further stimulated by mandatory information on generic drugs’ availability provided to patients in community pharmacies. However, lack of reliable data limited the evaluation of the effectiveness of these mechanisms so far. Recent introduction of e-prescription system in Poland allowed to collect suitable data. This study aimed to perform pilot analysis of the extent and economic consequences of generic substitution in Poland. In this retrospective analysis we used the data from the national e-prescription repository. Prescriptions issued between 01.01.2019-31.12.2019 for Quinapril (ATC C09AA06) were analyzed. By comparing prescribing and pharmacy claims data, prescriptions were categorized into ‘never filled in’, ‘filled in without substitution’, and ‘filled in with substitution’. Economic evaluation relied on official prices and co-payment levels of reimbursed Quinapril brands. Market prices of non-reimbursed brands were used. In the studied period, 79,804 packs of Quinapril have been prescribed on e-prescriptions, of which 12.7% have never been filled in, 77.2% were filled in without substitution, and 10.1% filled in with substitution. Substitution resulted in 8.2% and 7.3% savings for the patients and public payer, respectively. However, in as many as 35% of substitution cases, the dispensed drug was more costly than the one prescribed. There was a potential to increase global savings due to generic substitution over tenfold. Pilot analysis allowed due to newly available e-prescription data proved that generic substitution is only infrequently used in Poland. Thus, the full cost-reduction potential of this method is underutilized. Further studies are necessary to investigate best ways to effectively stimulate generic drug use in Poland.

Quality of antimicrobial prescribing improved by the introduction of ePrescribing at Auckland City Hospital.

Improving antimicrobial prescribing is a difficult process often requiring labour-intensive, multi-modal interventions. Many hospitals have introduced ePrescribing systems but the effect on antimicrobial prescribing, without treatment choice decision support systems, has not been well described. We sought to determine whether the introduction of ePrescribing improved prescribing quality. Patient records for inpatients on four rehabilitation wards, two using ePrescribing and two using the National Medication Chart, during February 2017, were retrospectively reviewed to identify all antimicrobial prescriptions, which were then reviewed for quality. Documentation of indication was significantly better on ePrescribing wards (45/46, 98%) compared to National Medication Chart wards (47/59, 80%). Adherence to guidelines (32/46, 70% vs 33/59, 56%), appropriateness of therapy (42/46, 91% vs 50/59, 85%) and documentation of duration, stop or review dates (35/46, 76% vs 38/59, 64%) did not significantly differ. ePrescribing can improve the quality of antimicrobial prescribing when Antimicrobial Stewardship principles are used in system customisation but cannot address all factors impacting on prescribing quality.

Optimising electronic prescribing in hospitals: a scoping review protocol

IntroductionElectronic prescribing (ePrescribing) systems can improve the quality of prescribing decisions and substantially reduce the risk of serious medication errors in hospitals. However, realising these benefits depends on ensuring that...

A Lightweight and Secured Certificate-Based Proxy Signcryption (CB-PS) Scheme for E-Prescription Systems

Electronic prescription (E-prescription) is an emerging technology that allows health practitioners (doctors, physicians, pharmacists, or nurses) to electronically transmit prescriptions to pharmacies. E-prescription systems allow doctors to avoid traditional medical practices in which prescriptions are sent manually in handwritten form. Additionally, in cases in which a patient may not be able to collect the medication in person due to physical disabilities, the medications can be delivered to the patient's home directly. Furthermore, payments can also be made online (e.g., using credit cards or bank transfers). However, these distinctive features require a series of guidelines for the successful deployment of the E-prescription system due to stringent legal requirements and privacy regulations. Two major security requirements i.e. confidentiality and authentication need to be addressed. In general, the solution to ensuring confidentiality and authentication lies in the combination of both the encryption and digital signature functions in a single logic step called signcryption. Therefore, in this article, we present a lightweight and provable secured certificate-based proxy signcryption (CB-PS) scheme for e-prescription systems. The formal security verification uses the Automated Validation of Internet Security Protocols and Applications (AVISPA) tool along with informal security analysis, which authenticates that the proposed CB-PS scheme can potentially be implemented in resource-constrained low-computing electronic devices in E-prescription systems.

Drug Error beyond the Hospital and Role of Pharmacists in drug Safety Process

Medication related error is one of the most common error prevailing in this time. Medication error can be defined as a ‘failure in the treatment process that leads to or has potential to lead to harm to the patient. Medication error can occur from the process of ordering to the administration to the patient. Among the healthcare professionals; a pharmacist can be responsible in identification of contributing factors and reducing its occurrence. Great efforts are needed in this area, due to diversity in the types of errors, the relationship between the provider and the patient, information transfer, optimization of e-prescribing systems, the lack of adequate training in analyzing the collected data and poor practical strategies for maintaining accurate drug lists in electronic medical records. Recently healthcare professionals have started becoming aware about the risks of patients’ medication exposure. After all, still the area of medication safety beyond the hospital setting needs community pharmacy intervention to avoid malpractice claims and misled decisions in solving medication safety-related problems in the outpatient setting. Approaches like medication reviews and reconciliation, monitoring drug therapy, reporting error will help in identify and prompt the detection of errors, open productive discussions, quality control checks, and effective system-based decisions like performing risk assessment subsequently reduces the harm and risks before patient is exposed to any form of drug error.

Unexpected Increase in Benzodiazepine Prescriptions Related to the Introduction of an Electronic Prescribing Tool: Evidence from Multicenter Hospital Data.

Electronic Prescribing tools (e-prescribing) have shown several benefits in terms of prescribing process adequacy and health care quality in hospital settings. We hypothesize however, that an undesired effect of digitalisation, due to the easier and faster prescribing process allowing patients to skip face-to-face conversations with patients and nurses, is that it could facilitate the prescription of medications at high risk of overuse or abuse, such as benzodiazepines (BZDs). We conducted a panel data study to investigate, the impact of the introduction of an e-prescribing system on new BZD prescriptions in hospitalised patients in a network of five teaching hospitals. During the observation period 1 July 2014–30 April 2019, 43,320 admissions were analysed. A fixed-effects model was adopted to estimate the effect of e-prescribing on new BZD prescriptions. E-prescribing implementation was associated with a significant increase of new BZD prescriptions: absolute +1.5%, and relative +43% (p < 0.001). The effect was similar in males and females (respectively, absolute +2.3%, relative +65% (p < 0.001); absolute +1.8%, relative +58% (p = 0.01)) and in patients ≥70 years old (absolute +1.6%, relative +59% (p < 0.001)). After controlling for time-varying explanatory variables, the implementation of the e-prescribing tool showed similar significant effects. E-prescribing implementation was associated with a significant increase of new in-hospital BZD prescriptions. For classes of drugs at risk of overuse or abuse, e-prescribing should be used cautiously, to minimize the risk of over-prescriptions. Further research in other settings and countries is needed to analyse causal interactions between e-prescribing and BZD prescriptions in the hospital setting, and to promote the ultimate goal of high-value care.

962P - Real world experience of nivolumab therapy in metastatic renal cancer patients: A 3 year multi-centre review

BackgroundIn the UK renal cancer has an incidence of around 12600 cases per year. Nivolumab is an anti-PD1 checkpoint inhibitor, which was approved in the UK for second or subsequent line treatment of advanced renal cancer in 2016. The aim of this study was to evaluate a regional experience of nivolumab use in this setting. MethodsA retrospective analysis was undertaken of patients who commenced nivolumab as monotherapy for advanced renal cancer at three Cancer Centres in South Central England between February 2016 and April 2019. Information was collated from electronic patient records and e-prescribing systems. Information was gathered on patient demographics, Heng (IMDC) prognostic scores, previous treatments, treatment toxicity, use of steroids and radiotherapy during treatment, physician assessment of response and survival data. Results109 eligible patients were identified. The average age was 59 with 72.5% of patients male. 67.9% (74/109) of patients had prior nephrectomy and 50.5% (55/109) had metastatic disease at diagnosis. 82.6% (90/109) had pure clear cell histology. 63.3% (69/109) received nivolumab as second-line treatment, 27.5% (30/109) as third-line treatment and 9.2% (10/109) as fourth-line and beyond. At the start of treatment 19.41% (19/103) had a ‘favourable’ risk Heng score, 61.2% (64/103) had an ‘intermediate’ risk and 18.3% (19/103) had a ‘poor’ risk. The number of Nivolumab cycles received ranged from 1-69, with a mean of 11 and median of 5. 45.9% of patients experienced toxicity of any grade, with 16.5% experiencing grade 3/4 toxicity. 24.8% (28/109) received radiotherapy and 40.4% (44/109) received steroids during nivolumab treatment. At response assessment 31.5% showed a response to nivolumab, 9.3% had stable disease and 59.3% had disease progression. From the start of nivolumab treatment median progression-free survival was 5.4 months, and the 12-month overall survival rate was 56.88%. 22.6% (24/109) are still receiving nivolumab. ConclusionsThis review has given us important real-world data on the safety and efficacy of nivolumab which reflects the findings of the pivotal phase 3 trials that led to it’s use. Further analysis will allow us to see the effect of different factors on these outcomes. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Digitising an Australian university hospital: qualitative analysis of staff-reported impacts.

Objective This study aims to assist hospitals contemplating digital transformation by assessing the reported qualitative effects of rapidly implementing an integrated eHealth system in a large Australian hospital and determining whether existing literature offers a reliable framework to assess the effects of digitisation. Methods A qualitative, single-site case study was performed using semistructured interviews supplemented by focus groups, observations and documentation. In all, 92 individuals across medical, nursing, allied health, administrative and executive roles provided insights into the eHealth system, which consisted of an electronic medical record, computerised decision support, computerised physician order entry, ePrescribing systems and wireless device integration. These results were compared against a known framework of the effects of hospital digitisation. Results Diverse, mostly positive, effects were reported, largely consistent with existing literature. Several new effects not reported in literature were reported, namely: (1) improvements in accountability for care, individual career development and time management; (2) mixed findings for the availability of real-time data; and (3) positive findings for the secondary use of data. Conclusions The overall positive perceptions of the effects of digitisation should give confidence to health services contemplating rapid digital transformation. Although existing literature provides a reliable framework for impact assessment, new effects are still emerging, and research and practice need to shift towards understanding how clinicians and hospitals can maximise the benefits of digital transformation. What is known about the topic? Hospitals outside the US are increasingly becoming engaged in eHealth transformations. Yet, the reported effects of these technologies are diverse and mixed with qualitative effects rarely reported. What does this paper add? This study provides a qualitative assessment of the effects of an eHealth transformation at a large Australian tertiary hospital. The results provide renewed confidence in the literature because the findings are largely consistent with expectations from prior systematic reviews of impacts. The qualitative approach followed also resulted in the identification of new effects, which included improvements in accountability, time management and individual development, as well as mixed results for real-time data. In addition, substantial improvements in patient outcomes and clinician productivity were reported from the secondary use of data within the eHealth systems. What are the implications for practitioners? The overall positive findings in this large case study should give confidence to other health services contemplating rapid digital transformation. To achieve substantial benefits, hospitals need to understand how they can best leverage the data within these systems to improve the quality and efficiency of patient care. As such, both research and practice need to shift towards understanding how these systems can be used more effectively.

Embedding research recruitment in a community resource e-prescribing system: lessons from an implementation study on Chicago's South Side.

The study sought to implement and assess the CommunityRx e-prescribing system to recruit research participants from a predominantly non-Hispanic Black community on Chicago's South Side. CommunityRx integrates with electronic medical record systems to generate a personalized list of health-promoting community resources (HealtheRx). Between December 2015 and December 2016, HealtheRxs distributed at outpatient visits to adults with asthma or chronic obstructive pulmonary disease also incentivized participation in a pulmonary research registry. Usual practices for registry recruitment continued in parallel. Focus groups established acceptability and appropriateness among the target population. Pulmonary research registry recruitment information was included on 13437 HealtheRxs. Forty-one (90% non-Hispanic Black) patients responded with willingness to participate and 9 (8 non-Hispanic Black) returned a signed consent required to enroll. Usual recruitment practices enrolled 4 registrants (1 non-Hispanic Black). Automating research recruitment using a community e-prescribing system is feasible. Implementation of an electronic medical record-integrated, community resource referral tool promotes enrollment of eligible underrepresented research participants; however, enrollment was low.

Impact of the e-prescribing system on the incidence and nature of drug-related problems in children in a Saudi hospital.

To determine the impact of a computerised physician order entry (CPOE) system on the drug-related problems' (DRPs) incidence and characteristics in hospitalised children in a Saudi hospital, and to compare DRPs incidence pre-/post-CPOE implementation. An observational study. DRPs were identified by pharmacists, reviewing children's (0-14years) medical records on CPOE system, in paediatric wards and/or attending emergency department. DRPs preventability and severity were assessed. A total of 657 paediatric patients were included, with 235 (35.8%) experienced 328 DRPs, majority were preventable (99.7%, 327). Difference in DRP incidence pre- and post-CPOE implementation (44.8% versus 35.8%, P<0.01) was significant. The CPOE system has significantly reduced DRPs incidence in children in the study hospital.

Factors Affecting Rural Patients' Primary Compliance with e-Prescription: A Developing Country Perspective.

Background: The electronic prescription system has emerged to reduce the ambiguity and misunderstanding associated with handwritten prescriptions. The opportunities and challenges of e-prescription system, its impact on reducing medication error, and improving patient's safety have been widely studied. However, not enough studies were conducted to explore and quantify the factors that affect rural patients' compliance with e-prescription, especially from the perspective of Asian developing countries where most of the world's population resides.Objective: The objective of this study is to explore and assess the factors that affect rural patients' primary compliance with e-prescription in Bangladesh.Methods: Data were collected from 95 randomly selected rural patients who received e-prescription through a field survey with a structured questionnaire from Bheramara subdistrict, Bangladesh, during June and July 2016. Logistic regression analysis was performed to test the research hypotheses.Results: The study found patients' gender as the most significantly influential factor (regression coefficient [Coef.] = 2.02, odds ratio [OR] = 7.51, p < 0.05) followed by visiting frequency (Coef. = 0.99, OR = 2.70, p < 0.05); education (Coef. = 0.92, OR = 2.51, p < 0.05); and distance to healthcare facility (Coef. = 0.82, OR = 2.26, p < 0.01). However, patients' age, monthly family expenditure, and use of cell phone were found insignificant. The model explains 59.40% deviance (R2 = 0.5940) in the response variable with its constructs. And the “Hosmer–Lemeshow” goodness-of-fit score (0.99) is also above the standard threshold (0.05), which indicates the data fit well with the model.Conclusions: The findings of this study are expected to be helpful for e-health service providers to gain a better understanding of the factors that influence their patients to comply with e-prescriptions.

Dietitians can improve accuracy of prescribing by interacting with electronic prescribing systems

BackgroundDietitians increasingly interact with electronic health records (EHRs) and use them to alert prescribers to medication inaccuracies.ObjectiveTo understand renal dietitians’ use of electronic prescribing systems and influence on medication accuracy...

CommunityRx, an E-Prescribing System Connecting People to Community Resources.

The author discusses the creation of CommunityRx, an e-prescribing system that helps to connect patients with community health resources, following the U.S. Centers for Medicare & Medicaid Services' request for health care innovations to advance health care's aim while stimulating the future workforce.

Physicians' Perceptions of Electronic Prescribing with Electronic Medical Records in Kuwaiti Primary Healthcare Centres.

This study aimed to evaluate physicians' perceptions of electronic prescribing in Kuwaiti primary healthcare centres. This cross-sectional study was conducted between June and August 2017 among 368 physicians from 25 primary healthcare centres in Kuwait. Data were collected from the participants using a self-reported questionnaire, including sociodemographic characteristics, previous experience with computers and awareness, knowledge and use of e-prescribing systems and their functional features. In addition, perceptions of the benefits and levels of satisfaction associated with e-prescribing were explored. A total of 306 physicians completed the survey (response rate: 83%). The majority had positive perceptions regarding the use of e-prescribing, particularly in terms of time-savings (86%), healthcare quality (84%), productivity (80%) and clinical workflow and efficiency (83%). However, many respondents indicated that e-prescribing systems required additional improvements in terms of functionality. Most physicians in primary healthcare centres in Kuwait recognised the importance of e-prescribing to improve the quality of patient care, streamline workflow, increase productivity and reduce medical errors. However, there is a need to improve the design and infrastructure of e-prescribing systems, which may aid in the adoption of such systems in Kuwait.

The Barriers in Implementing Electronic Prescribing in The Health Care: a Systematic Review

Medication error remain extremely common, and the health care system can do much more to prevent it. Electronic prescribing is increasingly being viewed by health care stakeholders as an important step toward improved medication safety, better management of medication costs, increased practice efficiency, and improved health care quality. However, the adoption of e-prescribing has been difficult to attain owing to numerous barriers throughout the industry. Even with all the benefits of e-prescribing, many providers and pharmacists remained hesitant about completely adopting an e-prescribing system. The main purpose of this study was to explore and to assess the barriers of electronic prescribing implementation. The methodology for this study followed the basic principles of a systematic review with PRISMA methode retrieved from online database PubMed using a keyword “barriers” OR “obstacles” AND “electronic prescribing” OR “electronic prescription” AND “implementation”. Finally 6 documents were selected by full text inclucion and assessed for eligibility. The result of the study are inefficiency, the low uptake of the physicians, the cost of implementing the electronic prescription, system errors and the privacy and legacy. The conclusion from the studies should that electronic prescribing implementation barriers those we divided into 2 groups : the user factors and the system factors of the electronic prescription. Vendors or the consultants to facilitate more adequately the adoption of e-prescribing by giving the physicians the free trial and provide evaluation and improvement according to the physicians' needs for the features in the e-prescription.

Health information exchange in Finland: Usage of different access types and predictors of paper use

IntroductionTimely, complete and accurate patient data is needed in care decisions along the continuum of care. To access patient data from other organizations, there are three types of regional health information exchange systems (RHIS) in use In Finland. Some regions use multiple RHISs while others do not have a RHIS available. The recently introduced National Patient Data Repository (Kanta) is increasingly used for health information exchange (HIE). ObjectivesThe purpose of this study was to assess usage of paper, RHISs and Kanta by context in 2017; evolution of paper use over the years; and predictors of paper use in 2017 among Finnish physicians for HIE system development. MethodsData from national electronic health record (EHR) usage and user experience surveys were taken from 2010 (prior to ePrescription system implementation), 2014 (prior to implementation of Kanta) and 2017 (Kanta was in full use in the public sector and in large private organizations). The web-based surveys were targeted to all physicians engaged in clinical work in Finland. ResultsKanta was the most frequently used means of HIE in 2017. Paper use had reduced significantly from 2010 to 2014. The trend continued in 2017. Still, up to half of the physicians reported using paper daily or weekly in 2017. There were great variations in paper use by healthcare sector, available RHIS type and EHR system used. In multivariable analysis (with all other variables constant), predictors of more frequent use of paper than electronic means for HIE were: private sector or hospital, access to Master Patient Index RHIS (type 1), multiple RHIS (type 4) or no RHIS (type 5), two particular EHR systems, older age, less experience, operative, psychiatric or diagnostic specialties, and male gender. ConclusionsUsability of HIE systems including EHRs as access points to HIE need to be improved to facilitate usage of electronic HIE. Usage ensures more timely and complete patient data for safe, coordinated care. Specialty-specific needs and requirements call for more user participation in HIE design. Especially older professionals need training to better exploit HIS for HIE.

Factors influencing the use of the \u201cnot for generic substitution\u201d mention for prescriptions in primary care: a survey with general practitioners

BackgroundGeneric drug substitution is a public health policy challenge with high economic potential. Generic drugs are generally cheaper than brand-name drugs. Drugs are a significant part of the total health expenditure, especially in ambulatory care. We conducted a cross-sectional study with general practitioners in the Champagne-Ardenne region to determine physician-related factors and beliefs causing doctors to use the Not for Generic Substitution (NGS) mention.MethodsQuestionnaires were sent to General Practitioners (GPs) practicing in Champagne-Ardenne via 3 shipments, from January 2015 to May 2015. Prescriber characteristics and beliefs influencing the use of the NGS mention were assessed for frequent (≥ 5%) and less frequent (< 5%) users of the NGS mention.ResultsFactors associated with above average NGS mention use in bivariate analysis included patient comorbidity, polypharmacy, a concern that generic and brand-name drugs are not bioequivalent and belief in higher efficacy of the brand name drug. The use of an e-prescribing system (EPS) and medical practice in rural areas appeared to be associated with lower use of NGS mention in bivariate analysis but not in multivariable analysis. In multivariable analysis, patient request was associated with a higher use of the NGS mention (NGS ≥ 5%, adjusted Odds Ratio (aOR) = 2.52; 95% CI = [1.46–4.35]; p = 0.001), which was also linked to patient age over 65 (NGS ≥ 5%, aOR = 2.33; 95% CI = [1.03–5.30]; p = 0.04). The NGS mention was often used for drugs where substitution is debated in the literature (thyroid hormones, antiepileptic drugs).ConclusionThis work highlights the involvement of the doctor-patient pair for the use of the NGS mention. Patient request was the major reason for using the NGS mention, even though it was not always endorsed by prescribers. Further studies are needed to assess patient views on generic drugs and drug substitution, accounting for their health status and socio-economic condition, to help improve the relevance of the information available to them.