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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.

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.

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.

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.

Background This research aims to assess the level of awareness and readiness for the utilization of Electronic Prescription System (EPS) among medical professionals and patients, as well as to identify their opinions regarding the advantages and disadvantages of this system. Methods The study was conducted in Russia among 423 respondents, including medical professionals and patients, with an average age of 40 years. Results The awareness of EPS among medical professionals (20%) and patients (45.7%) is notably low. The majority of physicians possess only basic computer skills (62.5%). In contrast, pharmaceutical workers (60%) and medication consumers (45.7%) exhibit a confident level of computer proficiency. EPS is evaluated as more reliable (100% of physicians) and convenient (93.3% of pharmacists) compared to paper-based prescriptions. The results highlight the necessity of educating medical professionals and patients on the use of EPS. The study confirms the low awareness and readiness for the utilization of EPS among medical professionals and patients. However, the EPS is perceived as more reliable and convenient compared to paper prescriptions. Conclusions This research holds practical significance for the development of strategies for implementing EPS and enhancing the preparedness of medical professionals and patients for their use.

BackgroundWith hospital electronic prescribing and medicines administration (HEPMA) systems now in widespread use across hospital inpatient clinical services, work is underway to measure the benefits of HEPMA on healthcare systems and patient care. HEPMA functionality enables users to prescribe medicines by ‘bundle’ or ‘protocol’. Although it is assumed that this is a significant system benefit, there are few qualitative studies supporting this conclusion.AimTo explore the impact of an electronic anticipatory care medicines protocol on junior doctor perceptions of their confidence and competence to prescribe opioids and midazolam for patients at the end of life.MethodBetween May and August 2022, one-to-one semi-structured interviews were conducted at a 570-bed District General Hospital with junior doctors who had experience of prescribing on both HEPMA and paper-based systems. Audio recordings of the interviews were transcribed verbatim and underwent thematic analysis.ResultsTen junior doctors participated (median age 23 years). Analysis generated five main themes that described perceptions and attitudes towards confidence and competence. These were prescribing safety benefits; information technology infrastructure, interoperability and system design concerns; clinical knowledge and training needs; cultural and social factors and risks of automation in prescribing.ConclusionThis study suggests that junior doctors experienced an overall increase in their confidence and perceived competence to prescribe anticipatory medicines post-implementation of a HEPMA protocol. Further studies are required to detail the impact of HEPMA/CPOE protocols on clinical practice.

The medication in an electronic prescribing system (EPS) does not always match the patient’s actual medication. This prospective study analyzes the discrepancies (any inconsistency) between medication prescribed using an EPS and the medication revised by the clinical pharmacist upon admission to the observation area of the emergency department (ED). Adult patients with multimorbidity and/or polypharmacy were included. The pharmacist used multiple sources to obtain the revised medication list, including patient/carer interviews. A total of 1654 discrepancies were identified among 1131 patients. Of these patients, 64.5% had ≥1 discrepancy. The most common types of discrepancy were differences in posology (43.6%), commission (34.7%), and omission (20.9%). Analgesics (11.1%), psycholeptics (10.0%), and diuretics (8.9%) were the most affected. Furthermore, 52.5% of discrepancies affected medication that was high-alert for patients with chronic illnesses and 42.0% of medication involved withdrawal syndromes. Discrepancies increased with the number of drugs (ρ = 0.44, p < 0.01) and there was a difference between non-polypharmacy patients, polypharmacy ones and those with extreme polypharmacy (p < 0.01). Those aged over 75 years had a higher number of prescribed medications and discrepancies occurred more frequently compared with younger patients. The number of discrepancies was larger in women than in men. The EPS medication record requires verification from additional sources, including patient and/or carer interviews.

Electronic hospital pharmacy (EHP) systems are ubiquitous in today’s hospitals, with many also implementing electronic prescribing (EP) systems; both contain a potential wealth of medication-related data to support quality improvement. The reasons for reuse and users of this data are generally unknown. Our objectives were to survey secondary use of data (SUD) from EHP and EP systems in UK hospitals, to identify users of and factors influencing SUD.A national postal survey was sent out to all hospital chief pharmacists with pre-notifications and follow-up reminders. Descriptive statistical analysis was performed.Of 187 hospital organisations, 65 (35%) responded. All had EHP systems (for ≥20 years) and all reused data; 50 (77%) had EP systems (established 1–10 years) but only 40 (80%) reused data. Reported facilitators for SUD included medication safety, providing feedback, benchmarking, saving time and patient experience. The purposes of SUD included audits, quality improvement, risk management and general medication-related reporting. Earlier introduction of SUD could provide an opportunity to heighten local improvement initiatives.Data from EHP systems is reused for multiple purposes. Evaluating SUD and sharing experiences could provide richer insight into potential SUD and barriers/factors to consider when implementing or upgrading EP/EHP systems.

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.