Electronic Prescribing and Decision Support to Improve Rural Primary Care Quality

Project Final Report (PDF, 275.07 KB) Disclaimer

Project Details -
Completed

 

The purpose of this research was to examine whether, in rural ambulatory care settings, the use of an e-prescribing system with clinical decision support related to medication management increases patient prescription adherence, improves health outcomes in hypertensive patients, and improves the medication management process. The aims of the study were to:

  • Improve the rate of adherence to prescribed medications among patients with hypertension in rural communities. 
  • Improve adherence to prescribed medications among patients with hypertension through use of e-prescribing tools in rural care settings. 
  • Improve health outcomes for patients with hypertension in rural communities through the use of e-prescribing and associated clinical decision support tools.
  • Enhance patient and provider satisfaction with the e-prescribing tool.
  • Overcome barriers to successful adoption of e-prescribing. 
The project implemented e-prescribing extensively in nine rural ambulatory care clinic settings within the Avera Health System service area; particularly eastern South Dakota, southwest Minnesota, and northwest Iowa. The research focused on blood pressure management of hypertensive patients who were 18 years of age or older. The study model was a staged implementation, first gathering baseline measures, then tracking clinics using e-prescribing as a stand-alone tool, and moving to an integrated electronic medical record (EMR) with e-prescribing. Medical claims data and the e-prescribing patient-fill histories were used to examine whether patient prescription adherence improved. Improved outcomes were measured in blood pressure readings, and changes in treatment for patients with blood pressure higher than 140/90.  Additionally, provider interviews and patient surveys assessed the perception of e-prescribing.
Based on a  population analysis, the implementation of e-prescribing did not appear to have a significant effect on hypertension control. Compared to the baseline pre-implementation, provider perceptions were more positive for both the stand-alone electronic prescribing and the EMR implementations. There did appear to be an increase in patient adherence and an upward trend in the prescribing of generic anti-hypertensive medications.