Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
JAMA Intern Med. 2023 Oct 1;183(10):1120-1126. doi: 10.1001/jamainternmed.2023.4192.
An estimated 1.5% to nearly 5% of medications are dispensed after discontinuation in the electronic health record (EHR), with 34% meeting criteria for high risk of potential harm.
To evaluate the association of the implementation of e-prescription cancellation messaging (CancelRx) with medication dispensing after discontinuation of e-prescriptions in the EHR.
DESIGN, SETTING, AND PARTICIPANTS: This case series with interrupted time series analysis included patients who had at least 1 medication e-prescribed in ambulatory care to a health system pharmacy and discontinued in the 2-year study period from 1 year prior to approximately 1 year after CancelRx implementation (January 15, 2018, to December 7, 2019). Prior to CancelRx implementation, changes to e-prescribed medications within the EHR were not electronically communicated to health system pharmacies, which used separate pharmacy management software. Statistical analysis was performed from November 2020 to June 2023 (primary analysis from March 2021 to May 2022).
Implementation of CancelRx.
The primary outcome was the proportion of e-prescribed medications dispensed and sold to patients by pharmacies within 6 months after discontinuation in the EHR. A medication was defined as dispensed after discontinuation if the timestamp of dispensing was at least 1 minute and less than 6 months after the timestamp of discontinuation in the EHR. A secondary outcome was the proportion of discontinued medications that was reordered within 120 days.
A total of 53 298 qualifying e-prescriptions that were discontinued were identified for 17 451 unique patients (mean [SD] age, 50.6 [18.2] years; 9332 women [53.5%]). After CancelRx implementation, 22 443 (85.9%) of the 26 127 discontinued e-prescriptions resulted in a CancelRx transaction. In interrupted time series analysis, the proportion of prescriptions dispensed after discontinuation decreased from a baseline of 8.0% (2162 of 27 171) to 1.4% (369 of 26 127; P < .001), without a significant week-to-week trend (β = 0.000158; P = .37).
In this case series with interrupted time series analysis, findings suggest that CancelRx implementation was associated with an immediate and persistent reduction in the proportion of e-prescriptions sold after discontinuation in the EHR. Widespread implementation of CancelRx may significantly improve medication safety through the reduction of medication dispensing after discontinuation by prescribers.
据估计，电子健康记录 (EHR) 中约有 1.5%至近 5%的药物在停止使用后被配药，其中 34%符合潜在伤害高风险的标准。
评估电子处方取消消息 (CancelRx) 的实施与 EHR 中电子处方停止使用后药物配药之间的关联。
设计、设置和参与者：这项病例系列研究采用中断时间序列分析，纳入了至少有 1 种药物在门诊护理中开具并在研究期间的 2 年内停止使用的患者，研究时间为 CancelRx 实施前 1 年至实施后约 1 年（2018 年 1 月 15 日至 2019 年 12 月 7 日）。在 CancelRx 实施之前，EHR 中电子开具的药物变化并未通过电子方式通知系统内的药房，而药房使用的是单独的药房管理软件。统计分析于 2020 年 11 月至 2023 年 6 月进行（主要分析于 2021 年 3 月至 2022 年 5 月进行）。
CancelRx 的实施。
主要结果是 EHR 中停止使用后 6 个月内药房配药和销售给患者的电子处方的比例。如果配药的时间戳至少比 EHR 中停止使用的时间戳晚 1 分钟且不超过 6 个月，则定义为停止使用后的药物配药。次要结果是在 120 天内重新配药的停用药物比例。
确定了 17451 名患者的 53298 份符合条件的电子处方（平均[标准差]年龄 50.6[18.2]岁；9332 名女性[53.5%]）。在 CancelRx 实施后，26127 份停用的电子处方中有 22443 份（85.9%）导致了 CancelRx 交易。在中断时间序列分析中，停止使用后处方配药的比例从基线的 8.0%（27171 人中的 2162 人）下降到 1.4%（26127 人中的 369 人；P<0.001），没有明显的每周趋势（β=0.000158；P=0.37）。
在这项采用中断时间序列分析的病例系列研究中，结果表明 CancelRx 的实施与 EHR 中停止使用后电子处方销售比例的立即和持续减少有关。通过减少医生停止使用后配药，取消 Rx 的广泛实施可能会显著提高药物安全性。
