A new study links e-prescribing with fewer adverse drug events
Primary care physicians often complain that the benefits of using electronic health record (EHR) systems are outweighed by the costs of implementing the technology and meeting government meaningful use (MU) standards. But a new study suggests that in at least one area—reducing adverse drug events—EHRs are having an impact.
The study examines whether physicians who meet the MU2 threshold for electronic prescribing—using the technology for at least 50% of the prescriptions they write—have lower rates of adverse drug events (ADEs) among their patients with diabetes. The results were published online May 6 by the Journal of the American Medical Informatics Association.
The authors looked at prescriptions from 129,000 providers written for Medicare beneficiaries with any type of diabetes and at least 90-days supplies of anti-diabetic medications, using claims from Medicare Parts A, B and D beneficiaries. ADEs are a particular concern among Medicare beneficiaries, the authors say, due to the greater prevalence of chronic disease—especially diabetes—and polypharmacy among that population. Moreover, they say, anti-diabetic drugs are the most common cause of ADEs and among the top five reasons for inpatient and treat-and-release emergency department (ED) visits for ADEs.
After dividing the providers into high e-prescribers (those who e-prescribed at least 50% of their prescriptions) and low e-prescribers, and controlling for provider and patient panel characteristics, the study found that “high e-prescribers were significantly less likely to have any patient hospitalized or have an ED visit for an ADE.” The high e-prescribers had a 7.9% chance of at least one ADE occurring among their patent panel (when weighted for panel size) compared with a 9.4% chance among the low prescribers. Similarly, the high prescribers had rate of 3.45 ADEs per 1000 patients, versus 3.99 per 1000 for the low prescribers.
The authors ascribe the lower incidence of ADEs among the high prescribers to the facts that “e-prescribing helps providers to send error-free and legible prescriptions to pharmacies,” and that “e-prescribing capability is accompanied by varying degrees of decision support and drug interaction alerts.” They note that a meta-analysis of studies published before 2006 showed that “even with many e-prescribers not having any decision support, e-preseciring was associated with fewer prescription errors, and fewer potential and actual ADEs.”
The authors add, however, that aspects such as comorbidity and patient income also have an impact on ADE rates, and thus “e-prescribing will not address all the factors leading to ADEs.”
By Jeffrey Bendix