Ross S et al. 2005 "Effects of electronic prescribing on formulary compliance and generic drug utilization in the ambulatory care setting: a retrospective analysis of administrative claims data."
Reference
Ross S, Papshev D, Murphy E, et al. Effects of electronic prescribing on formulary compliance and generic drug utilization in the ambulatory care setting: a retrospective analysis of administrative claims data. J Manag Care Pharm 2005;11(5):410.
Abstract
"OBJECTIVE: Electronic prescribing (e-prescribing) provides formulary information at the point of care. The objective of this study was to assess the effects of e-prescribing on formulary compliance and generic utilization. METHODS: This was a retrospective analysis of pharmacy claims data from a large national managed care organization. A sample of 95 providers using predominantly e-prescribing was randomly selected (e-prescriber group). A matched sample of 95 traditional prescribers was selected (traditional prescriber group), matched to the e-prescriber group by zip code and medical specialty. A total of 110,975 paid pharmacy claims, for the 12 months from August 1, 2001, through July 31, 2002, were analyzed to assess the effect of e-prescribing on formulary compliance and generic utilization. All paid pharmacy claims were examined for each group; for the e-prescriber group, this included all claims, not just those prescribed using an e-prescribing device. A written qualitative survey was distributed to physicians and office managers to assess e-prescribing usage, sources of formulary information, and effects of e-prescribing on office resources. RESULTS: Both predominantly e-prescribers and traditional prescribers demonstrated high levels of formulary compliance, 83.2% versus 82.8%, respectively (P=0.32). Formulary compliance for these groups did not differ from the overall prescriber population (82.0%). There was not a difference in generic drug utilization rates between e-prescribers and traditional prescribers (absolute rates 37.3% versus 36.9%, P=0.18). Qualitative survey responses supported previously reported research indicating reductions in calls both to and from pharmacies for prescription orders. CONCLUSIONS: An examination of paid pharmacy claims from a large, national managed care organization demonstrated no differences between predominantly e-prescribers and traditional prescribers in measures of formulary compliance or generic drug utilization. Future studies should examine keystroke data at the point of care to observe more detail about drug selection methods."
Objective
"To assess the effects of e-prescribing on formulary compliance and generic utilization."
Tools Used
Type Clinic
Primary care and specialty care
Size
unknown
Geography
Urban, suburban, and rural
Type of Health IT
Electronic prescribing (e-Rx)
Type of Health IT Functions
"This [e-Rx] system provides drug and formulary information during the prescribing process as well as the capability to submit prescriptions electronically. At the time of prescribing on a handheld computer or a [personal computer] PC workstation, the system indicates the formulary status of a drug, using color-coded icons. A green smiling icon indicates a preferred or first-tier drug, a yellow neutral face indicates a second-tier drug, and a red frowning face indicates a nonformulary drug." The system also indicates whether the drug is a generic.
Context or other IT in place
"The survey results indicated that the e-prescribers...had used the...system for e-prescribing for a mean of 2 years and 5 months, and had generated 90% (mean) of their prescriptions using the...e-prescribing system."
Workflow-Related Findings
"No significant difference was found between e-prescribers and the traditional prescribers in formulary adherence, (83.2% vs. 82.8%, respectively; P = 0.32), and neither group differed significantly from the overall...provider universe (82.0%; P=0.24)."
"A subanalysis was conducted to assess whether there was a difference in copayment or coinsurance amount between groups. No statistically significant difference in average copayment amount was observed between e-prescriber claims and traditional prescriber claims."
"Drug-class-specific analyses were also conducted to assess whether differences in formulary compliance would be observed between the study groups. Ten of the most prescribed categories of drugs were assessed.... No differences were observed between groups in terms of formulary compliance for these drug classes."
"The companion surveys of office managers of e-prescribing practices indicated a 53% reduction in calls from pharmacies [and] a 62% reduction in calls to pharmacies."
"The companion surveys of office managers of e-prescribing practices indicated...the belief that e-prescribing made it easier for the office staff to complete new prescriptions (69% of respondents) and to complete refill requests (82% of respondents)."
Study Design
Only postintervention with intervention and control groups
Study Participants
"A sample of 95 providers using predominantly e-prescribing was randomly selected (e-prescriber group). A matched sample of 95 traditional prescribers was selected (traditional prescriber group), matched to the e-prescriber group by zip code and medical specialty...The qualitative survey was distributed to 999 physician practices; 110 surveys were returned, representing an 11% overall response rate: 49 of 398 (12%) surveys were returned by e-prescribers and 61 of 601 (10%) surveys were returned by traditional prescribers."