Impact of generic substitution decision support on electronic prescribing behavior.

Stenner SP, Chen Q, Johnson KB
J Am Med Inform Assoc. 2010 17 (6): 681-8

PMID: 20962131 · PMCID: PMC3000753 · DOI:10.1136/jamia.2009.002568

OBJECTIVE - To evaluate the impact of generic substitution decision support on electronic (e-) prescribing of generic medications.

DESIGN - The authors analyzed retrospective outpatient e-prescribing data from an academic medical center and affiliated network for July 1, 2005-September 30, 2008 using an interrupted time-series design to assess the rate of generic prescribing before and after implementing generic substitution decision support. To assess background secular trends, e-prescribing was compared with a concurrent random sample of hand-generated prescriptions.

MEASUREMENTS - Proportion of generic medications prescribed before and after the intervention, evaluated over time, and compared with a sample of prescriptions generated without e-prescribing.

RESULTS - The proportion of generic medication prescriptions increased from 32.1% to 54.2% after the intervention (22.1% increase, 95% CI 21.9% to 22.3%), with no diminution in magnitude of improvement post-intervention. In the concurrent control group, increases in proportion of generic prescriptions (29.3% to 31.4% to 37.4% in the pre-intervention, post-intervention, and end-of-study periods, respectively) were not commensurate with the intervention. There was a larger change in generic prescribing rates among authorized prescribers (24.6%) than nurses (18.5%; adjusted OR 1.38, 95% CI 1.17 to 1.63). Two years after the intervention, the proportion of generic prescribing remained significantly higher for e-prescriptions (58.1%; 95% CI 57.5% to 58.7%) than for hand-generated prescriptions ordered at the same time (37.4%; 95% CI 34.9% to 39.9%) (p<0.0001). Generic prescribing increased significantly in every specialty.

CONCLUSION - Implementation of generic substitution decision support was associated with dramatic and sustained improvements in the rate of outpatient generic e-prescribing across all specialties.

MeSH Terms (13)

Decision Support Systems, Clinical Drugs, Generic Drug Substitution Electronic Prescribing Humans Medical Order Entry Systems Practice Patterns, Nurses' Practice Patterns, Physicians' Regression Analysis Reminder Systems Retrospective Studies Tennessee User-Computer Interface

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