Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence
| Autor: | Douglas S. Bell, Ning Li, Steven M. Asch, Cynthia A. Jackevicius, Joshua M Pevnick |
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| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
Decision support system Clinical Sciences education Decision Support Systems Context (language use) Health Informatics Formularies as Topic Clinical decision support system Drug Prescriptions Medication Adherence Clinical 03 medical and health sciences Electronic Prescribing 0302 clinical medicine Clinical Research Electronic prescribing medicine Humans 030212 general & internal medicine Medical prescription Formulary Medication adherence health care economics and organizations Copayment business.industry 030503 health policy & services Health Policy Clinical decision support Decision Support Systems Clinical 3. Good health Computer Science Applications Family medicine 0305 other medical science business Medical Informatics Information Systems Research Article |
| Zdroj: | BMC Medical Informatics and Decision Making BMC medical informatics and decision making, vol 14, iss 1 |
| ISSN: | 1472-6947 |
| Popis: | BackgroundMedication non-adherence is prevalent. We assessed the effect of electronic prescribing (e-prescribing) with formulary decision support on preferred formulary tier usage, copayment, and concomitant adherence.MethodsWe retrospectively analyzed 14,682 initial pharmaceutical claims for angiotensin receptor blocker and inhaled steroid medications among 14,410 patients of 2189 primary care physicians (PCPs) who were offered e-prescribing with formulary decision support, including 297 PCPs who adopted it. Formulary decision support was initially non-interruptive, such that formulary tier symbols were displayed adjacent to medication names. Subsequently, interruptive formulary decision support alerts also interrupted e-prescribing when preferred-tier alternatives were available. A difference in differences design was used to compare the pre-post differences in medication tier for each new prescription attributed to non-adopters, low user (30% usage rate). Second, we modeled the effect of formulary tier on prescription copayment. Last, we modeled the effect of copayment on adherence (proportion of days covered) to each new medication.ResultsCompared with non-adopters, high users of e-prescribing were more likely to prescribe preferred-tier medications (vs. non-preferred tier) when both non-interruptive and interruptive formulary decision support were in place (OR 1.9 [95% CI 1.0-3.4], p = 0.04), but no more likely to prescribe preferred-tier when only non-interruptive formulary decision support was in place (p = 0.90). Preferred-tier claims had only slightly lower mean monthly copayments than non-preferred tier claims (angiotensin receptor blocker: $10.60 versus $11.81, inhaled steroid: $14.86 versus $16.42, p |
| Databáze: | OpenAIRE |
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