Physician practices, e-prescribing and accessing information to improve prescribing decisions.

Research brief Pub Date : 2011-05-01
Joy M Grossman, Ellyn R Boukus, Dori A Cross, Genna R Cohen
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Abstract

Hoping to reduce medication errors and contain health care costs, policy makers are promoting electronic prescribing through Medicare and Medicaid financial incentives. Many e-prescribing systems provide electronic access to important information--for example, medications prescribed by physicians in other practices, patient formularies and generic alternatives--when physicians are deciding what medications to prescribe. However, physician practices with e-prescribing face challenges using these features effectively, according to a new qualitative study by the Center for Studying Health System Change (HSC) funded by the Agency for Healthcare Research and Quality (AHRQ). While most of the 24 practices studied reported that physicians had access to patient formulary information, only slightly more than half reported physician access to patient medication histories, and many physicians did not routinely review these sources of information when making prescribing decisions. Study respondents highlighted two barriers to use: (1) tools to view and import the data into patient records were cumbersome to use in some systems; and (2) the data were not always perceived as useful enough to warrant the additional time to access and review them, particularly during time-pressed patient visits. To support generic prescribing, practices typically set their system defaults to permit pharmacist substitution of generics; many practices also used other tools to more proactively identify and select generic alternatives at the point of prescribing. Overall, physicians who more strongly perceived the need for third-party data, those in practices with greater access to complete and accurate data, and those with easier-to-use e-prescribing systems were more likely to use these features consistently.

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医生实践,电子处方和获取信息以改善处方决策。
为了减少用药错误和控制医疗成本,政策制定者正在通过医疗保险和医疗补助计划的财政激励措施推广电子处方。当医生决定开什么药时,许多电子处方系统提供对重要信息的电子访问——例如,医生在其他实践中开出的药物、患者处方和非专利替代方案。然而,根据卫生保健研究和质量机构(AHRQ)资助的卫生系统变革研究中心(HSC)的一项新的定性研究,医生在使用电子处方时面临着有效利用这些功能的挑战。虽然研究的24个实践中大多数报告说医生可以获得患者的处方信息,但只有略多于一半的报告说医生可以获得患者的用药历史,而且许多医生在制定处方决定时没有定期审查这些信息来源。受访者强调了使用的两个障碍:(1)在一些系统中,查看和导入数据到患者记录的工具使用起来很麻烦;(2)这些数据并不总是被认为足够有用,不足以保证额外的时间来访问和审查它们,特别是在时间紧迫的患者就诊期间。为了支持仿制药处方,实践通常设置其系统默认值以允许药剂师替代仿制药;许多实践还使用其他工具在开处方时更主动地识别和选择通用替代方案。总的来说,那些更强烈地意识到需要第三方数据的医生,那些在实践中更容易获得完整和准确数据的医生,以及那些更容易使用电子处方系统的医生更有可能始终如一地使用这些功能。
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