Online Prescribing Research Articles

Can the use of telemedicine facilitate online prescribing for multiple sclerosis treatment?

Can the use of telemedicine facilitate online prescribing for multiple sclerosis treatment?

Description of the Use of Consumable Medical Materials at Rindu B Pharmacy Depot Warehouse H. Adam Malik Hospital Medan Based on 2019 Standard Operating Procedures

Introduction: Managing consumable medical materials involves coordinating activities to ensure they work well together, aiming for effective and efficient management. This ensures doctors always have an adequate supply of high-quality consumable medical materials to support quality services. Objective: This study aimed to describe the Utilization of Consumable Medical Materials at the Pharmacy Warehouse of Depo Rindu B H. Based on the 2019 Standard Operating Procedures (SOP), Adam Malik Hospital Medan. Methods: The study utilized direct observation and interviews conducted from May to July 2019. Results: Expenditures in January, February, and March 2019 were 25,726, 22,332, and 24,503 units respectively. Distribution is facilitated through online prescribing and delivery. Observations indicated the use of storage systems such as First In First Out (FIFO) and First Expired First Out (FEFO), organised by dosage form, alphabetical order, and category. Conclusion: Procurement at the Depo Rindu B pharmaceutical warehouse at H. Adam Malik Hospital Medan during the 2019 period was by the applicable 2019 SOP

Who Accesses Birth Control Online? An Analysis of Requests for Contraception Submitted to an Online Prescribing Platform in the United States.

Telehealth has the potential to increase contraceptive access. Little is known about the characteristics of people using online prescribing platforms or whether these services help fill access gaps. We analyzed requests for contraception submitted between July 2015 and September 2017 to an online prescribing platform that offers sexual and reproductive care in the United States. We analyzed the characteristics of people seeking contraceptives, prevalence of contraindications to hormonal contraception among contraceptive seekers, and extent to which online prescribing may close contraceptive access gaps. A total of 38,439 requests for prescription hormonal birth control were received during the study period, with requests increasing dramatically over this timeframe as the platform expanded operations to an increasing number of states. Methods were dispensed in response to 63% of requests. In this population seeking contraception, an estimated 1.2% had a contraindication to progestin-only pills, and an estimated 12.0% of patients who reported their blood pressurehad a contraindication to combined hormonal methods. Few requests came from patients younger than 18 (1.2%). In multivariable negative binomial models, urban counties had a larger concentration of requests, whereas counties with higher rates of uninsurance and poverty had lower rates of requests. Results suggest that the population seeking contraception from one online prescribing platform has similar levels of contraindications to hormonal contraceptives as found in prior research. Future research should seek to understand why utilization of this online prescribing platform was lower among young people, how to expand outreach to rural populations, and what underlies individuals' decisions about using these services.

316 Improving Electronic Prescribing of Mechanical VTE Prophylaxis in General Surgery Patients

Abstract Aim Mechanical VTE prophylaxis forms part of NICE guidance in general surgical patients. Locally, thromboembolic deterrent (TED) stockings are used but not available as a prescription item on the electronic system. They are often prescribed verbally or via noted plans but do not appear on the medication administration record. Importantly, multiple incidents of patient harm through pressure damage have been seen due to poorly checked TEDs. Our aim was to audit and improve safe mechanical VTE prophylaxis prescribing. Method At each cycle, we retrospectively collected data from two weeks of admissions. Data relating to VTE assessment completion, VTE score, TEDs in use, TEDs prescription and LMWH prescription was collected. Our initial intervention consisted of departmental education regarding a work around enabling TEDs to be prescribed as a freehand extra-formulary item. This was reaudited at 12 months. Results All patients in both cycles had VTE assessments completed. TED stocking use increased significantly from 5.1% to 26.4% and prescription of TEDs, when used, increased from 0% to 61.1%. However, documentation regarding daily checks was non-existent. Conclusions Our QIP showed a significant improvement in TEDs use and prescription. However, the intervention is difficult and time consuming. Subsequently from this project, a TEDs stocking item is in the final approval phase for integration into the online prescribing system and will come with associated safety checks built into the nursing medication administration system. Once this is live, we will complete a third cycle to assess uptake and again at 6 months to assess for lasting change.

TH7.12 Improving electronic prescribing of mechanical VTE prophylaxis in general surgery patients

Abstract Aims Mechanical VTE prophylaxis forms part of NICE guidance in general surgical patients. Locally, thromboembolic deterrent (TED) stockings are used but not available as a prescription item on the electronic system. They are often prescribed verbally or via noted plans but do not appear on the medication administration record. Importantly, multiple incidents of patient harm through pressure damage have been seen due to poorly checked TEDs. Our aim was to audit and improve safe mechanical VTE prophylaxis prescribing. Methods At each cycle, we retrospectively collected data from two weeks of admissions. Data relating to VTE assessment completion, VTE score, TEDs in use, TEDs prescription and LMWH prescription was collected. Our initial intervention consisted of departmental education regarding a work around enabling TEDs to be prescribed as a freehand extra-formulary item. This was reaudited at 12 months. Results All patients in both cycles had VTE assessments completed. TED stocking use increased significantly from 5.1% to 26.4% and prescription of TEDs, when used, increased from 0% to 61.1%. However, documentation regarding daily checks was non-existent. Conclusions Our QIP showed a significant improvement in TEDs use and prescription. However, the intervention is difficult and time consuming. Subsequently from this project, a TEDs stocking item is in the final approval phase for integration into the online prescribing system and will come with associated safety checks built into the nursing medication administration system. Once this is live, we will complete a third cycle to assess uptake and again at 6 months to assess for lasting change.

Surgical Residency Programs Should Leverage Recent Advances in National Policy, Real-World Data, and Public Opinion to Improve Post-Surgery Opioid Prescribing.

Surgical Residency Programs Should Leverage Recent Advances in National Policy, Real-World Data, and Public Opinion to Improve Post-Surgery Opioid Prescribing.

Government decision on tougher online pharmacy regulation expected 'shortly'

The government is considering proposals from the Care Quality Commission (CQC) to close regulatory gaps in online prescribing, following a legislative review, the Department of Health and Social Care (DHSC) has said. In April 2021, the CQC said it submitted proposals to the DHSC for legislative changes that would address “safety gaps” in online prescribing, […]

Direct-to-Consumer Online Prescribing: Opportunities and Risks for Clinical Nurse Specialist Practice.

Direct-to-Consumer Online Prescribing: Opportunities and Risks for Clinical Nurse Specialist Practice.

Direct to Consumer Online Prescribing - Opportunities & Risks for Clinical Nurse Specialist Practice.

Direct to Consumer Online Prescribing - Opportunities & Risks for Clinical Nurse Specialist Practice.

CQC proposes law change to close online prescribing loopholes linked to patient deaths

The Care Quality Commission (CQC) has submitted proposals to the government for legislative changes that would close regulatory gaps in online prescribing, which have been ascribed to patient deaths. The CQC said the changes to primary and secondary legislation would improve its ability to regulate independent primary care providers that are currently “putting people’s lives […]

Shedding Light on Telemedicine & Online Prescribing: The Need to Balance Access to Health Care and Quality of Care.

The issue of online prescribing through the use of telemedicine raises ethical concerns. In particular, several studies suggest a correlation between telemedicine and overprescribing. Meanwhile, new developments in the law also have the potential to significantly impact online prescribing using telemedicine. In the absence of concrete federal guidance and a continued delay in issuing required federal regulations, states have developed their own laws, which vary considerably, regarding the ability of physicians to engage in online prescribing through telemedicine. As legal developments open doors for physicians to prescribe through telemedicine, current evidence of overprescribing, although limited, suggests the need to carefully balance access to health care and quality of care in this context, especially when crafting innovative legislative responses.This article attempts to explore this dynamic issue by closely evaluating the research on overprescribing involving telemedicine and the ethical issues surrounding online prescribing. It will continue by analyzing the current legal landscape for online prescribing for telemedicine at both the federal and state levels. Next, this article will examine ethics opinions offered by medical groups that touch this issue. Finally, this article will suggest several recommendations for law and policy moving forward by shedding light on the ethical issues surrounding telemedicine and online prescribing and how to strike a balance between access and quality of care.

Online Prescribing of Controlled Substances for Mental Health Issues: a View of the Current Landscape

Controlled substances, such as benzodiazepines, narcotic pain medications, and stimulants, can be helpful in the treatment of a wide variety of mental and physical conditions. In order to limit the improper use and abuse of these medications, the state and federal governments regulate how controlled substances are prescribed, distributed, and dispensed. Telemedicine physicians are often reluctant to utilize controlled substances out of fear and uncertainty of the rules. This represents a barrier to the expansion of telemedicine practice and development of new systems within accountable care organizations, resulting in patients being deprived of opportunities to obtain appropriate treatments. This article briefly defines and reviews online prescribing, controlled substances (history, current practices), telehealth (general, videoconferencing), and legal/regulatory practices (state, federal). Cases are provided to informally stratify the prescribing landscape and risk into categories of low, medium, and high risk of prescribing and to illustrate cases in which prescribing would probably require a policy change. The policy landscape pertaining to the prescription of controlled substances via telemedicine is complex and confusing to many. This primer for clinicians, administrators, and health care administrators provides information and an approach to evaluate issues and make decisions. It is intended to encourage further discussion and advocacy for policies that facilitate, rather than inadvertently impede, appropriate prescription of controlled substances via telemedicine. Clinicians, professional organizations, and telehealth organizations need to collaborate with others to adjust policies to improve access. More research on clinical care (best practices, barriers/obstacles) related to online prescribing is needed and how online prescribing is working and/or not working (e.g., barriers are arising).

Prescribing competency assessment for Canadian medical students: a pilot evaluation

The knowledge and ability to prescribe safely and effectively is a core competency for every graduating medical student. Our previous research suggested concerns about medical student prescribing abilities, and interest in a standardized assessment process. A multi-year cross-sectional study evaluating the feasibility, acceptability, and discriminative ability of an online prescribing competency assessment for final year Canadian medical students was conducted. Students at nine sites of four Ontario medical schools were invited to participate in an online one-hour exam of eight domains related to prescribing safely. Student feedback on perceived fairness, clarity, and ease of use formed the primary outcome. Exam performance and parity between schools were the secondary outcome. A total of 714 students completed the assessment during spring final review courses between 2016 and 2018. Student feedback was more favourable than not for appropriateness of content (53.5% agreement vs 18.3% disagreement), clarity of questions (65.5% agreement vs 11.6% disagreement), question layout and presentation (70.8% agreement vs 12.2% disagreement), and ease of use of online interface (67.1% agreement vs 13.6% disagreement). Few (23.6% believed their course work had prepared them for the assessment. Mean total exam score was 70.0% overall (SD 10.4%), with 47.6% scoring at or above the pass threshold of 70%.Conclusion: Our prescribing competency assessment proved feasible, acceptable, and discriminative, and indicated a need for better medical school training to improve prescribing competency. Further evaluation in a larger sample of medical schools is warranted.

O20 Online prescribing for sexually transmitted infections – what’s on offer!

IntroductionIn 2016, The British Association of Sexual Health and HIV (BASHH) expressed concern over the use of medications purchased online to treat Sexually Transmitted Infections (STIs) ‘without full examination and...

Is There A Doctor in the House? Using Failure-to-warn Liability to Enhance the Safety of Online Prescribing

The ability to obtain prescription medications over the Internet without a proper prescription has inflamed regulators nationwide. Federal and state officials alike have proposed a host of new laws and regulations that attempt to limit this burgeoning phenomenon. Yet premature regulation of Internet prescribing could prevent consumers from realizing the tremendous benefits it might one day provide to the American health care delivery system. In this Note, Chester Chuang argues that subjecting Internet prescribing to a traditional failure-to-warn liability framework, rather than to additional regulations, adequately will ensure patient safety while allowing for the necessary innovations that will legitimize the distribution of prescription medications over the Internet. He suggests that pharmaceutical manufacturers can satisfy their duty to warn by contractually obligating websites that dispense prescription medications to implement comprehensive patient information systems. Chuang concludes that the proper application of this framework to these patient information systems will make certain that pharmaceutical manufacturers strike the proper balance between patients' health and safety concerns and the possibilities of Internet prescribing.

Centers for Medicare and Medicaid Services Hosts National Conference to Promote On-Line Prescribing

Centers for Medicare and Medicaid Services Hosts National Conference to Promote On-Line Prescribing

Competitive balance implications for hospitals of innovations in networked electronic health records

PurposeThe purpose of this paper is to examine the implications of electronic health records (EHRs) for competitive balance among hospitals in the USA.Design/methodology/approachTo analyze the competitive balance implications of EHR networks on hospitals, the authors reviewed empirical, theoretical and practical literatures bearing on the problem.FindingsUS hospitals are increasingly facing decisions regarding whether, when and how to participate in networks of EHRs. EHRs can replace paper‐based medical records, improve the quality of patient care and decrease medical errors. EHRs also support product innovations such as e‐visits and online prescribing. Such a significant innovation will alter the competitive standing of many hospitals, some favorably and others unfavorably. Hospitals with dynamic capabilities, absorptive capacity and organizational designs that facilitate innovation will fair best.Practical implicationsHospitals can also utilize several strategies to increase their odds of improving their competitive positions as the industry adopts EHR networks. Examples include strategies involving new products, early entry into an EHR network, promotion of organizational learning, and management of social impacts of workflow changes.Originality/valueThe findings show which hospitals are most likely to embrace EHR networks, and how hospitals can best manage the adoption of EHR networks.

Conversion from intravenous to oral medications: assessment of a computerized intervention for hospitalized patients.

Many hospitalized patients continue to receive intravenous medications longer than necessary. Earlier conversion from the intravenous to the oral route could increase patient safety and comfort, reduce costs, and facilitate earlier discharge from the hospital without compromising clinical care. We examined the effect of a computer-based intervention to prompt physicians to switch appropriate patients from intravenous to oral medications. This study was performed at Brigham and Women's Hospital, an academic tertiary care hospital at which all medications are ordered online. We targeted 5 medications with equal oral and intravenous bioavailability: fluconazole, levofloxacin, metronidazole, ranitidine, and amiodarone. We used the hospital's computerized order entry system to prompt physicians to convert appropriate intravenous medications to the oral route. We measured the total use of the targeted medications via each route in the 4 months before and after the implementation of the intervention. We also measured the rate at which physicians responded to the intervention when prompted. The average intravenous defined daily dose declined by 11.1% (P =.002) from the preintervention to the postintervention period, while the average oral defined daily dose increased by 3.7% (P =.002). Length of stay, case-mix index, and total drug use at the hospital increased during the study period. The average total monthly use of the intravenous preparation of all of the targeted medications declined in the 4 months after the intervention began, compared with the 4 months before. In 35.6% of 1045 orders for which a prompt was generated, the physician either made a conversion from the intravenous to the oral version or canceled the order altogether. Computer-generated reminders can produce a substantial reduction in excessive use of targeted intravenous medications. As online prescribing becomes more common, this approach can be used to reduce excess use of intravenous medications, with potential benefits in patient comfort, safety, and cost.

Online prescribing guidelines adopted by AMA

Online prescribing guidelines adopted by AMA

Online prescribing - the need for greater regulation

Unless controls are introduced, online prescribing will continue to be big business