Powers Christopher, Gabriel Meghan Hufstader, Encinosa William, Mostashari Farzad, Bynum Julie
Centers for Medicare and Medicaid Services, Office of Enterprise Data and Analytics, 7500 Security Boulevard, Mailstop B2-29-04, Baltimore, MD
Office of the National Coordinator for Health Information Technology, 200 Independence Avenue SW Suite 745H.2.5, Washington, DC 20201.
J Am Med Inform Assoc. 2015 Sep;22(5):1094-8. doi: 10.1093/jamia/ocv036. Epub 2015 May 6.
Evidence supports the potential for e-prescribing to reduce the incidence of adverse drug events (ADEs) in hospital-based studies, but studies in the ambulatory setting have not used occurrence of ADE as their outcome. Using the "prescription origin code" in 2011 Medicare Part D prescription drug events files, the authors investigate whether physicians who meet the meaningful use stage 2 threshold for e-prescribing (≥50% of prescriptions e-prescribed) have lower rates of ADEs among their diabetic patients. Risk of any patient with diabetes in the provider's panel having an ADE from anti-diabetic medications was modeled adjusted for prescriber and patient panel characteristics. Physician e-prescribing to Medicare beneficiaries was associated with reduced risk of ADEs among their diabetes patients (Odds Ratio: 0.95; 95% CI, 0.94-0.96), as were several prescriber and panel characteristics. However, these physicians treated fewer patients from disadvantaged populations.
有证据支持在医院研究中电子处方具有降低药物不良事件（ADEs）发生率的潜力，但门诊环境中的研究尚未将ADEs的发生作为其研究结果。作者利用2011年医疗保险D部分处方药事件档案中的“处方来源代码”，调查达到电子处方有意义使用第二阶段阈值（电子处方≥50%）的医生，其糖尿病患者中ADEs发生率是否更低。针对开处方者和患者群体特征进行调整后，对医生所负责的糖尿病患者中任何因抗糖尿病药物发生ADEs的风险进行建模。医生为医疗保险受益人开具电子处方与降低其糖尿病患者中ADEs的风险相关（优势比：0.95；95%置信区间，0.94 - 0.96），一些开处方者和患者群体特征也与之相关。然而，这些医生治疗的弱势群体患者较少。
