Fischer Michael A, Vogeli Christine, Stedman Margaret R, Ferris Timothy G, Weissman Joel S
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA 02120, USA.
J Gen Intern Med. 2008 Apr;23(4):358-63. doi: 10.1007/s11606-007-0383-1.
Electronic prescribing (e-prescribing) has the potential to improve the safety and efficiency of medication use, but uptake of e-prescribing in community-based settings has been limited to date. In April 2004, 2 large insurers in Massachusetts began a program to fund e-prescribing systems for targeted clinicians and practices. We studied the adoption and uptake of e-prescribing by the targeted prescribers.
We obtained data on all e-prescriptions written from April 2004 to March 2005. We tabulated the number of clinicians using the e-prescribing system and the number of prescriptions written. We also obtained claims data from the 2 insurance companies and calculated the proportion of each clinician's prescriptions that were written electronically. We developed multivariable models to estimate the impact of different clinician characteristics on the proportional rate of e-prescribing.
During the first 12 months of the e-prescribing program, 1,217 prescribers began using the e-prescribing system. In the final month of the study, over 55,000 e-prescriptions were written for patients covered by the 2 included insurance plans. The proportion of total reimbursed claims per clinician written electronically increased slowly during the study period and was still below 30% by the end of the study period. This number increased to 42% when we restricted the sample to medications normally used for acute indications. Multivariable models showed that younger clinicians, pediatricians, and prescribers in larger practices exhibited higher uptake rates as a proportion of total prescriptions.
Clinician use of e-prescribing increased steadily in the first 12 months of an initiative sponsoring e-prescribing systems. Uptake of e-prescribing was only partial, with younger clinicians and pediatricians more likely to use the system. Research to understand why prescribers vary in their use of e-prescribing and to develop techniques to encourage more wide-spread adoption will be an important priority for future studies.
电子处方有潜力提高用药的安全性和效率，但迄今为止，社区环境中电子处方的采用情况有限。2004年4月，马萨诸塞州的两家大型保险公司启动了一个项目，为目标临床医生和医疗机构提供资金用于电子处方系统。我们研究了目标开处方者对电子处方的采用和使用情况。
我们获取了2004年4月至2005年3月期间所有电子处方的数据。我们将使用电子处方系统的临床医生数量和所开处方数量制成表格。我们还从这两家保险公司获取了理赔数据，并计算了每位临床医生电子开具处方的比例。我们建立了多变量模型来估计不同临床医生特征对电子处方比例率的影响。
在电子处方项目的前12个月，1217名开处方者开始使用电子处方系统。在研究的最后一个月，为参与的两家保险计划所覆盖的患者开具了超过55000份电子处方。在研究期间，每位临床医生电子开具的总报销理赔比例增长缓慢，到研究期末仍低于30%。当我们将样本限制在通常用于急性病症的药物时，这个数字增加到了42%。多变量模型显示，年轻临床医生、儿科医生以及大型医疗机构的开处方者作为总处方的比例表现出更高的使用率。
在一项赞助电子处方系统的倡议的前12个月里，临床医生对电子处方的使用稳步增加。电子处方的采用只是部分性的，年轻临床医生和儿科医生更有可能使用该系统。了解开处方者在电子处方使用上存在差异的原因并开发鼓励更广泛采用的技术的研究将是未来研究的一个重要重点。
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