School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
Med J Aust. 2010 Feb 15;192(4):192-5. doi: 10.5694/j.1326-5377.2010.tb03477.x.
To assess the impact of two interventions on computer-generated prescriptions for antibiotics--(i) an educational intervention to reduce automatic computerised ordering of repeat antibiotic prescriptions, and (ii) a legislative change prohibiting the "no brand substitution" box being checked as a default setting in prescribing software--and to compare these findings with those of a similar survey we conducted in 2000.
Prospective audit of consecutive prescriptions for four antibiotics (amoxycillin, amoxycillin/clavulanate, roxithromycin, and cefaclor) commonly prescribed for upper respiratory tract infections in community pharmacies in New South Wales and Queensland between 1 November 2008 and 31 January 2009.
rate of repeat prescription ordering on computer-generated versus handwritten prescriptions. Secondary outcome: rate of checking of the "no brand substitution" box on computer-generated versus handwritten prescriptions.
Data were collected on 2807 prescriptions presented to 51 pharmacies (50 in NSW, one in Queensland), of which 2354 were computer-generated. Repeats were ordered on 1633 computer-generated prescriptions (69%) compared with 183 handwritten prescriptions (40%). These proportions were identical to those found in 2000, although the rates of computer prescribing were much higher in this study (84% v 54%). This difference in repeat prescribing was statistically significant (odds ratio adjusted for clustering at pharmacy level, 2.87; 95% CI, 2.32-3.55). Twenty-three (1%) of the computer-generated prescriptions had the "no brand substitution" box checked compared with 3 (0.7%) of the handwritten prescriptions (27% and 1%, respectively, in our previous survey).
The legislative change which disallowed having the "no brand substitution" box checked as a default setting in prescribing software had a dramatic impact on the checking of the "no brand substitution" box. In contrast, there was no sustained effect of educating prescribers about software default settings relating to repeat prescribing of antibiotics. Other actions are required if unnecessary repeat prescriptions for some medicines, such as antibiotics, are to be reduced.
评估两项干预措施对计算机生成的抗生素处方的影响——（i） 教育干预措施，以减少重复抗生素处方的自动计算机化订单，以及（ii） 一项立法变更，禁止将“不允许品牌替代”框作为默认设置在处方软件中勾选——并将这些发现与我们在 2000 年进行的类似调查进行比较。
对 2008 年 11 月 1 日至 2009 年 1 月 31 日期间新南威尔士州和昆士兰州社区药店中常用于治疗上呼吸道感染的四种抗生素（阿莫西林、阿莫西林/克拉维酸、罗红霉素和头孢克洛）的连续处方进行前瞻性审核。
计算机生成与手写处方重复处方的订购率。次要结果：计算机生成与手写处方“不允许品牌替代”框的勾选率。
共收集了 51 家药店（新南威尔士州 50 家，昆士兰州 1 家）的 2807 张处方数据，其中 2354 张为计算机生成。在 1633 张计算机生成的处方（69%）中重复开了处方，而在 183 张手写处方（40%）中重复开了处方。这些比例与 2000 年的调查结果相同，尽管在本研究中计算机开方的比例要高得多（84%比 54%）。这种重复开方的差异具有统计学意义（调整了药房水平聚类的优势比，2.87；95%CI，2.32-3.55）。23 张（1%）计算机生成的处方勾选了“不允许品牌替代”框，而 3 张（0.7%）手写处方勾选了该框（分别为 27%和 1%，我们之前的调查）。
禁止将“不允许品牌替代”框作为默认设置勾选的立法变更对勾选“不允许品牌替代”框产生了巨大影响。相比之下，教育医生有关抗生素重复处方的软件默认设置并没有持续产生影响。如果要减少某些药物（如抗生素）的不必要重复处方，则需要采取其他措施。
