Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Am Med Inform Assoc. 2010 Nov-Dec;17(6):681-8. doi: 10.1136/jamia.2009.002568.
To evaluate the impact of generic substitution decision support on electronic (e-) prescribing of generic medications.
The authors analyzed retrospective outpatient e-prescribing data from an academic medical center and affiliated network for July 1, 2005-September 30, 2008 using an interrupted time-series design to assess the rate of generic prescribing before and after implementing generic substitution decision support. To assess background secular trends, e-prescribing was compared with a concurrent random sample of hand-generated prescriptions.
Proportion of generic medications prescribed before and after the intervention, evaluated over time, and compared with a sample of prescriptions generated without e-prescribing.
The proportion of generic medication prescriptions increased from 32.1% to 54.2% after the intervention (22.1% increase, 95% CI 21.9% to 22.3%), with no diminution in magnitude of improvement post-intervention. In the concurrent control group, increases in proportion of generic prescriptions (29.3% to 31.4% to 37.4% in the pre-intervention, post-intervention, and end-of-study periods, respectively) were not commensurate with the intervention. There was a larger change in generic prescribing rates among authorized prescribers (24.6%) than nurses (18.5%; adjusted OR 1.38, 95% CI 1.17 to 1.63). Two years after the intervention, the proportion of generic prescribing remained significantly higher for e-prescriptions (58.1%; 95% CI 57.5% to 58.7%) than for hand-generated prescriptions ordered at the same time (37.4%; 95% CI 34.9% to 39.9%) (p<0.0001). Generic prescribing increased significantly in every specialty.
Implementation of generic substitution decision support was associated with dramatic and sustained improvements in the rate of outpatient generic e-prescribing across all specialties.
评估通用替代决策支持对电子（e-）处方开通用药物的影响。
作者使用中断时间序列设计分析了 2005 年 7 月 1 日至 2008 年 9 月 30 日期间来自学术医疗中心及其附属网络的回顾性门诊电子处方数据，以评估实施通用替代决策支持前后通用处方的开具率。为评估背景的季节性趋势，将电子处方与同时生成的非电子处方的随机样本进行比较。
干预前后开具的通用药物处方比例，随时间评估，并与无电子处方生成的样本进行比较。
干预后，通用药物处方的比例从 32.1%增加到 54.2%（增加 22.1%，95%置信区间 21.9%至 22.3%），干预后改善的幅度没有减小。在同期对照组中，通用处方比例的增加（干预前、干预后和研究结束时分别为 29.3%、31.4%和 37.4%）与干预不相符。授权处方者（24.6%）的通用处方率变化大于护士（18.5%；调整后的 OR 1.38，95%CI 1.17 至 1.63）。干预两年后，电子处方的通用处方比例仍显著高于同期手工处方（58.1%，95%CI 57.5%至 58.7%）（p<0.0001）。所有专科的通用处方开具率均显著增加。
通用替代决策支持的实施与所有专科门诊电子通用处方率的显著和持续改善相关。
