Gabriel Meghan Hufstader, Powers Christopher, Encinosa William, Bynum Julie P W
*Department of Health Management and Informatics, University of Central Florida, Orlando, FL †Centers for Medicare and Medicaid Services, Office of Enterprise Data and Analytics, Baltimore, MD ‡Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, Rockville, MD §The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH.
Med Care. 2017 May;55(5):456-462. doi: 10.1097/MLR.0000000000000684.
Although the adoption of e-prescriptions among physicians has increased substantially under the Medicare Improvements for Patients and Providers Act and Meaningful Use programs, little is known of its impact on patient outcomes.
To examine the impact of e-prescribing on emergency visits or hospitalizations for diabetes-related adverse drug events (ADEs) including hypoglycemia.
This is a prospective, observational cohort study with patient fixed effects.
2011-2013 fee for service Medicare.
In total, 3.1 million Medicare fee for service, Part D enrolled beneficiaries over age 66 with diabetes mellitus and at least 90 days of antidiabetic medications.
E-prescribing was measured as the percentage of all prescriptions a person received transmitted to the pharmacy electronically. The outcome measure was the occurrence of an emergency department (ED) visit or hospitalization for hypoglycemia or diabetes-related ADE.
Unadjusted results show that there were 21 ADEs per 1000 beneficiaries that had ≥75% of their medications e-prescribed. Beneficiaries with lower e-prescribing levels had significantly higher numbers of ADEs. We found a robust association between the greater use of electronic prescriptions in the outpatient setting and the lower risk of an inpatient or ED visit for an ADE event among Medicare beneficiaries with diabetes in our adjusted analysis. At the e-prescribing threshold of 75% and above, significant reductions in ADE risk can be seen.
As an observational study, the results show an association but do not prove causation.
Use of e-prescribing is associated with lower risk of an ED visit or hospitalization for diabetes-related ADE.
尽管在《医疗保险改善患者和提供者法案》及“有意义使用”计划下，医生采用电子处方的情况大幅增加，但对其对患者治疗结果的影响却知之甚少。
研究电子处方开具对糖尿病相关药物不良事件（ADEs）（包括低血糖）导致的急诊就诊或住院情况的影响。
这是一项具有患者固定效应的前瞻性观察队列研究。
2011 - 2013年按服务收费的医疗保险。
共有310万参加按服务收费的医疗保险D部分、年龄在66岁以上且患有糖尿病并至少服用90天抗糖尿病药物的参保受益人。
电子处方开具情况以一个人收到的所有处方中通过电子方式传输到药房的百分比来衡量。结果指标是因低血糖或糖尿病相关ADE而进行的急诊科（ED）就诊或住院情况。
未经调整的结果显示，每1000名有≥75%的药物通过电子处方开具的受益人中发生21起ADEs。电子处方开具水平较低的受益人发生ADEs的数量明显更多。在我们的调整分析中，我们发现门诊环境中更多地使用电子处方与糖尿病参保受益人因ADE事件住院或到ED就诊的风险较低之间存在密切关联。在电子处方开具阈值达到75%及以上时，可以看到ADE风险显著降低。
作为一项观察性研究，结果显示的是一种关联而非因果关系。
使用电子处方与因糖尿病相关ADE导致的ED就诊或住院风险较低有关。
