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Background The older patient population is significantly different from the younger adult population with regards to dose selection for a wide variety of drugs. Recent investigation of prescribing attitudes indicates that doctors feel there is insufficient distinction made between the two cohorts during their undergraduate education, and that doctors do not receive enough training in geriatric pharmacotherapy. Objectives The aim of this study was to determine if an online module, focused on geriatric pharmacotherapy, improves doctors’ prescribing knowledge, as well as prescribing confidence, as applied to older patients. Methods The impact of an online educational module (SCRIPT) on hospital doctors’ prescribing knowledge and confidence with regards to older patients was assessed by randomised controlled trial. Control and intervention groups completed assessments at baseline, 4 and 12 weeks. Primary outcome was difference in mean test scores. Student’s t tests were used to analyse the data. Qualitative data on participant’s confidence levels were also collected. Results Eighty participants completed the 12-week trial. The SCRIPT intervention resulted in a 22% difference in mean test scores between control and intervention groups at 4 weeks (23.12 marks versus 33.67 marks; p  < 0.0001; 95% CI 8.13–12.97). This significance was maintained at 12 weeks. Thirty-four percent of participants in the intervention group rated themselves as ‘confident’ with regards to prescribing for older patients post-intervention compared with 12% in the control group. Conclusion A short e-learning module focused on geriatric pharmacotherapy can significantly improve doctors’ prescribing knowledge and confidence with regards to older patients. Clinicaltrials.gov NCT02405975.

BackgroundOral anticoagulants reduce the risk of stroke in patients with atrial fibrillation. However, many patients with atrial fibrillation at elevated stroke risk are not treated with oral anticoagulants.ObjectiveTo test whether electronic notifications sent to primary care physicians increase the proportion of ambulatory patients prescribed oral anticoagulants.DesignRandomized controlled trial conducted from February to May 2017 within 18 practices in an academic primary care network.ParticipantsPrimary care physicians (n = 175) and their patients with atrial fibrillation, at elevated stroke risk, and not prescribed oral anticoagulants.InterventionPatients of each physician were randomized to the notification or usual care arm. Physicians received baseline email notifications and up to three reminders with patient information, educational material and primary care guidelines for anticoagulation management, and surveys in the notification arm.Main MeasuresThe primary outcome was the proportion of patients prescribed oral anticoagulants at 3 months in the notification (n = 972) vs. usual care (n = 1364) arms, compared using logistic regression with clustering by physician. Secondary measures included survey-based physician assessment of reasons why patients were not prescribed oral anticoagulants and how primary care physicians might be influenced by the notification.Key ResultsOver 3 months, a small proportion of patients were newly prescribed oral anticoagulants with no significant difference in the notification (3.9%, 95% CI 2.8–5.3%) and usual care (3.2%, 95% CI 2.4–4.2%) arms (p = 0.37). The most common, non-exclusive reasons why patients were not on oral anticoagulants included atrial fibrillation was transient (30%) or paroxysmal (12%), patient/family declined (22%), high bleeding risk (20%), fall risk (19%), and frailty (10%). For 95% of patients, physicians stated they would not change their management after reviewing the alert.ConclusionsElectronic physician notification did not increase anticoagulation in patients with atrial fibrillation at elevated stroke risk. Primary care physicians did not prescribe anticoagulants because they perceived the bleeding risk was too high or stroke risk was too low.Trial RegistrationClinicalTrials.gov identifier NCT02950285

Considerable investments are being made in commercial electronic prescribing systems (e-prescribing) in many countries. Few studies have measured or evaluated their effectiveness at reducing prescribing error rates, and interactions between system design and errors are not well understood, despite increasing concerns regarding new errors associated with system use. This study evaluated the effectiveness of two commercial e-prescribing systems in reducing prescribing error rates and their propensities for introducing new types of error. We conducted a before and after study involving medication chart audit of 3,291 admissions (1,923 at baseline and 1,368 post e-prescribing system) at two Australian teaching hospitals. In Hospital A, the Cerner Millennium e-prescribing system was implemented on one ward, and three wards, which did not receive the e-prescribing system, acted as controls. In Hospital B, the iSoft MedChart system was implemented on two wards and we compared before and after error rates. Procedural (e.g., unclear and incomplete prescribing orders) and clinical (e.g., wrong dose, wrong drug) errors were identified. Prescribing error rates per admission and per 100 patient days; rates of serious errors (5-point severity scale, those ≥3 were categorised as serious) by hospital and study period; and rates and categories of postintervention \"system-related\" errors (where system functionality or design contributed to the error) were calculated. Use of an e-prescribing system was associated with a statistically significant reduction in error rates in all three intervention wards (respectively reductions of 66.1% [95% CI 53.9%-78.3%]; 57.5% [33.8%-81.2%]; and 60.5% [48.5%-72.4%]). The use of the system resulted in a decline in errors at Hospital A from 6.25 per admission (95% CI 5.23-7.28) to 2.12 (95% CI 1.71-2.54; p<0.0001) and at Hospital B from 3.62 (95% CI 3.30-3.93) to 1.46 (95% CI 1.20-1.73; p<0.0001). This decrease was driven by a large reduction in unclear, illegal, and incomplete orders. The Hospital A control wards experienced no significant change (respectively -12.8% [95% CI -41.1% to 15.5%]; -11.3% [-40.1% to 17.5%]; -20.1% [-52.2% to 12.4%]). There was limited change in clinical error rates, but serious errors decreased by 44% (0.25 per admission to 0.14; p = 0.0002) across the intervention wards compared to the control wards (17% reduction; 0.30-0.25; p = 0.40). Both hospitals experienced system-related errors (0.73 and 0.51 per admission), which accounted for 35% of postsystem errors in the intervention wards; each system was associated with different types of system-related errors. Implementation of these commercial e-prescribing systems resulted in statistically significant reductions in prescribing error rates. Reductions in clinical errors were limited in the absence of substantial decision support, but a statistically significant decline in serious errors was observed. System-related errors require close attention as they are frequent, but are potentially remediable by system redesign and user training. Limitations included a lack of control wards at Hospital B and an inability to randomize wards to the intervention.

ABSTRACT BACKGROUND Non-adherence to essential medications represents an important public health problem. Little is known about the frequency with which patients fail to fill prescriptions when new medications are started (“primary non-adherence”) or predictors of failure to fill. OBJECTIVE Evaluate primary non-adherence in community-based practices and identify predictors of non-adherence. PARTICIPANTS 75,589 patients treated by 1,217 prescribers in the first year of a community-based e-prescribing initiative. DESIGN We compiled all e-prescriptions written over a 12-month period and used filled claims to identify filled prescriptions. We calculated primary adherence and non-adherence rates for all e-prescriptions and for new medication starts and compared the rates across patient and medication characteristics. Using multivariable regressions analyses, we examined which characteristics were associated with non-adherence. MAIN MEASURES Primary medication non-adherence. KEY RESULTS Of 195,930 e-prescriptions, 151,837 (78%) were filled. Of 82,245 e-prescriptions for new medications, 58,984 (72%) were filled. Primary adherence rates were higher for prescriptions written by primary care specialists, especially pediatricians (84%). Patients aged 18 and younger filled prescriptions at the highest rate (87%). In multivariate analyses, medication class was the strongest predictor of adherence, and non-adherence was common for newly prescribed medications treating chronic conditions such as hypertension (28.4%), hyperlipidemia (28.2%), and diabetes (31.4%). CONCLUSIONS Many e-prescriptions were not filled. Previous studies of medication non-adherence failed to capture these prescriptions. Efforts to increase primary adherence could dramatically improve the effectiveness of medication therapy. Interventions that target specific medication classes may be most effective.

Introduction Electronic prescribing (e-prescribing) systems can bring many advantages and challenges. This system has been launched in Iran for more than two years. This study aimed to investigate the challenges and advantages of the e-prescribing system from the point of view of physicians. Methods In this survey study and thematic analysis, which was conducted in 2023, a researcher-made questionnaire was created based on the literature review and opinions of the research team members and provided to the physician. Quantitative data were analyzed using SPSS software, and qualitative data were analyzed using ATLAS.ti software. Rank and point biserial, Kendall’s tau b, and Phi were used to investigate the correlation between variables. Results Eighty-four physicians participated in this study, and 71.4% preferred to use paper-based prescribing. According to the results, 53.6%, 38.1%, and 8.3% of physicians had low, medium, and high overall satisfaction with this system, respectively. There was a statistically significant correlation between the sex and overall satisfaction with the e-prescribing system ( p -value = 0.009) and the computer skill level and the prescribing methods ( P -value = 0.042). Physicians face many challenges with this system, which can be divided into five main categories: technical, patient-related, healthcare providers-related, human resources, and architectural and design issues. Also, the main advantages of the e-prescribing system were process improvement, economic efficiency, and enhanced prescribing accuracy. Conclusion The custodian and service provider organizations should upgrade the necessary information technology infrastructures, including hardware, software, and network infrastructures. Furthermore, it would be beneficial to incorporate the perspectives of end users in the system design process.

Medication safety remains a significant challenge in health care, particularly for patients managing complex treatment regimens. In Norway, the introduction of electronic prescribing (e-prescribing) for multidose drug dispensing (eMDD) aims to improve medication adherence and minimize errors by seamlessly integrating with the national e-prescription infrastructure. This study aimed to investigate the challenges faced by general practitioners (GPs) and pharmacists in using eMDD in Norway. Additionally, it sought to gather their recommendations for system improvements to guide future development and nationwide implementation. A parallel mixed methods design was used, integrating both quantitative and qualitative data. A structured online survey was distributed to 54 pharmacies and 190 GP surgeries across Norway. The survey included a combination of multiple-choice and open-ended questions. Qualitative responses were analyzed thematically using NVivo, while quantitative data were processed using the built-in analytical tools in Nettskjema. A total of 70 health care professionals participated in the study, revealing 7 key themes: training, system and technology, communication and interaction, division of responsibilities, medication safety, time and resource use, and implementation challenges. GPs reported inadequate training and an overwhelming volume of communication, while pharmacists identified issues with system integration and unclear role definitions. Both groups emphasized the need for improved system usability, stronger interprofessional collaboration, and a more defined governance structure. While the eMDD system has the potential to improve medication safety and optimize workflows, its success depends on addressing technical inefficiencies, improving user training, and clarifying role responsibilities. Actively involving end users in system development and policy planning is critical for achieving effective national implementation and ensuring integration with broader eHealth initiatives, such as the Patient's Medication List.

Medication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%-38%. However, studies assessing the effect of an internally developed electronic (E)-prescription system at discharge from an emergency department (ED) are comparatively minimal. Additionally, commercially available electronic solutions are cost-prohibitive in many resource-limited settings. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions. We conducted a pre- and post-intervention study comparing error rates in a randomly selected sample of discharge prescriptions (handwritten versus electronic) five months pre and four months post the introduction of the E-prescription. The internally developed, E-prescription system included a list of 166 commonly prescribed medications with the generic name, strength, dose, frequency and duration. We included a total of 2,883 prescriptions in this study: 1,475 in the pre-intervention phase were handwritten (HW) and 1,408 in the post-intervention phase were electronic. We calculated rates of 14 different errors and compared them between the pre- and post-intervention period. Overall, E-prescriptions included fewer prescription errors as compared to HW-prescriptions. Specifically, E-prescriptions reduced missing dose (11.3% to 4.3%, p <0.0001), missing frequency (3.5% to 2.2%, p=0.04), missing strength errors (32.4% to 10.2%, p <0.0001) and legibility (0.7% to 0.2%, p=0.005). E-prescriptions, however, were associated with a significant increase in duplication errors, specifically with home medication (1.7% to 3%, p=0.02). A basic, internally developed E-prescription system, featuring commonly used medications, effectively reduced medication errors in a low-resource setting where the costs of sophisticated commercial electronic solutions are prohibitive.

Background The aim of this systematic review was to synthesise peer-reviewed literature assessing the impact of electronic prescribing (eP) systems on the working practices of healthcare professionals (HCPs) in the inpatient setting and identify implications for practice and research. Methods We searched PubMed, Medline, Embase, Cochrane and the Cumulative Index to Nursing Allied Health Literature databases for studies published from inception to November 2018. We included controlled, uncontrolled, observational and descriptive studies that explored the effect of eP on HCPs’ working practices in an inpatient setting. Data on setting, eP system and impact on working practices were extracted. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Emergent themes were identified and subjected to narrative synthesis. The protocol was registered with PROSPERO (registration CRD42017075804). Results Searches identified 1301 titles and abstracts after duplicate removal. 171 papers underwent full-text review. A total of 25 studies met the inclusion criteria, from nine different countries. Nineteen were of commercial eP systems. There were a range of study designs; most ( n  = 14) adopted quantitative methods such as cross-sectional surveys, ten adopted qualitative approaches and a further one used mixed methods. Fourteen of the 25 studies were deemed to be of high quality. Four key themes were identified: communication, time taken to complete tasks, clinical workflow, and workarounds. Within each theme, study findings differed as to whether the effects of eP on HCPs’ working practices were positive or negative. Conclusion There is a lack of consensus within the literature on the impact of eP on HCPs’ working practices. Future research should explore the strategies resulting in a positive impact on HCPs’ working practices and learn from those that have not been successful.

Background The use of Electronic Prescribing (ePrescribing) platforms in prescribing, dispensing and claiming medications has become a trend worldwide. The utilization of this technology contributes to safer, more efficient, and satisfactory patient care. However, the experience and perspective of family physicians regarding this platform were not sufficiently evaluated in Saudi Arabia. Thus, this study aims to explore the perspectives, usage patterns, and perceived impacts of an ePrescribing platform, named Wasfaty, which has been adopted in primary healthcare centers by family physicians in Hail region in Saudi Arabia. Methods A qualitative study was conducted using online semi-structured interviews which took place from March to September 2024. By using purposive sampling, we interviewed 12 out of 69 licensed family physicians working in different primary healthcare centers at Hail region. Five key themes (i.e., registration and adoption, quality of clinical documentation, patient safety, perspectives, and recommendation) and open questions were identified through a comprehensive literature search and consensus among researchers to assess the users’ experiences and perspectives toward and impacts of the use of the ePrescribing platform in the primary healthcare centers. Thematic analysis used descriptive and inductive approaches. Results The study revealed that the registration process of family physicians to the portal was straightforward. Although there were no orientation or regular training sessions after the registration, the usability and simplicity were positive. The physicians normally continued using the portal during the workday without automatic log-out during inactivity mode. The impacts of using the portal on the comprehensiveness, accuracy, and reliability of clinical documentation were optimistic. The portal supported the continuity of care for chronic disease conditions. It improved the dosage accuracy, reduced medication errors and eliminated drug-drug interactions when compared to traditional prescribing. Physicians preferred to be continuously updated about new information and features and suggested the incorporation of artificial intelligence into the portal. Conclusion The overall experience of family physicians was positive and their perspectives toward this digital transformation are optimistic. Findings of this study asserted the inclusion of physicians in the early phase of eHealth application development. Results may be limited by the purposive sampling method and restricted generalizability to other healthcare settings. Further research is needed to expand the adoption of ePrescribing services in all Saudi healthcare centers and to improve the user experience with the electronic prescribing service worldwide.

Background Electronic prescribing (e-prescribing) is an essential technology in the modern health system. This technology has made many changes in the prescription process, which have advantages and disadvantages and have created opportunities for transforming the health system. This study aimed to investigate the strengths, weaknesses, opportunities, and threats of the e-prescribing system implemented in Iran from the physician’s viewpoint. Methods This phenomenological qualitative study was conducted in 2022. The participants were 15 Iranian specialist physicians working at Urmia University of Medical Sciences, selected purposively and deliberately. Data was collected through in-depth semi-structured interviews using an interview guide comprising 16 questions. Interviews were conducted until data saturation was reached. The audio data was transcribed into text and analyzed using the thematic analysis. To ensure the validity and reliability of the findings, the criteria introduced by Lincoln and Guba were employed. Results The results of this study showed that the e-prescribing system executed in Iran has diverse and multidimensional strengths, weaknesses, opportunities, and threats. In the strengths section, the analysis of the interviews led to the extraction of semantic units in the categories of prescription process, prescriber, patient, technical, economic, communication, and insurance. Also, the weaknesses in the three categories of the prescriber, patient, and technical were debatable. The opportunities extracted from the narratives of the interviewees were placed in four categories including technical, national macro policies, Ministry of Health macro-policies, and socio-cultural issues. Finally, the discussed threats are classified into two technical and macro policies of the Ministry of Health categories. On the other hand, technical issues played an effective role in all aspects of the SWOT model. Conclusion The e-prescribing system in Iran has strengths, weaknesses, opportunities, and threats. An overarching factor across all aspects of the SWOT model was technical infrastructure. A robust technical infrastructure is considered a strength and an opportunity for the growth of the electronic prescribing system in Iran. Conversely, any shortcomings in these systems are viewed as weaknesses and pose a threat to the system’s sustainability.