Pharmacy e-Prescription Dispensing Before and After CancelRx Implementation.
JAMA Intern Med
; 183(10): 1120-1126, 2023 10 01.
Article
en En
| MEDLINE
| ID: mdl-37669071
ABSTRACT
Importance 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. Objective:
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, andParticipants:
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). Exposure Implementation of CancelRx. Main Outcomes andMeasures:
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.Results:
A total of 53â¯298 qualifying e-prescriptions that were discontinued were identified for 17â¯451 unique patients (mean [SD] age, 50.6 [18.2] years; 9332 women [53.5%]). After CancelRx implementation, 22â¯443 (85.9%) of the 26â¯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 27â¯171) to 1.4% (369 of 26â¯127; P < .001), without a significant week-to-week trend (ß = 0.000158; P = .37). Conclusions and Relevance 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.
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Bases de datos:
MEDLINE
Asunto principal:
Farmacias
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Farmacia
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Servicios Farmacéuticos
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Prescripción Electrónica
Tipo de estudio:
Prognostic_studies
Límite:
Female
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Humans
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Middle aged
Idioma:
En
Revista:
JAMA Intern Med
Año:
2023
Tipo del documento:
Article