[The computerised prescription in Primary Care and its impact on drug spending using time series analysis]

Evaluation of electronic prescription implementation in polymedicated users of Catalonia, Spain: a population-based longitudinal study

OBJECTIVES

To assess whether electronic prescribing is a comprehensive health management tool that may contribute to rational drug use, particularly in polymedicated patients receiving 16 or more medications in the public healthcare system in the Barcelona Health Region (BHR).

DESIGN

16 months of retrospective study followed by 12 months of prospective monitoring.

SETTING

Primary healthcare in BHR, Catalonia, Spain.

PARTICIPANTS

All insured patients, especially those who are polymedicated in six basic health areas (BHA). Polymedicated patients were those with a consumption of ≥16 drugs/month.

INTERVENTIONS

Monitoring demographic and consumption variables obtained from the records of prescriptions dispensed in pharmacies and charged to the public health system, as well as the resulting drug use indicators. Territorial variables related to implementation of electronic prescribing were also described and were obtained from the institutional data related to the deployment of the project.

MAIN OUTCOME MEASURES

Trend in drug use indicators (number of prescriptions per polymedicated user, total cost per polymedicated user and total cost per prescription) according to e-prescription implementation.

RESULTS

There was a significant upward trend in the number of polymedicated users, number of prescriptions and total cost (p<0.05), which seemed independent from the implementation of electronic prescribing when comparing the preimplementation and postimplementation period. Prescriptions per user and cost per user showed a decrease between the preimplementation and postimplementation period, being significant in two BHAs (p<0.05).

CONCLUSIONS

Results suggest that after the implementation of electronic prescribing, the rationality of prescribing in polymedicated patients improved. In addition, this study provides a very valuable approach for future impact assessment.

[Introduction of the electronic prescription in a primary care district: impact on pharmaceutical expenditure and the factors determining its use]

Objetivo

Analizar las implicaciones del uso de receta electrónica sobre el gasto farmacéutico (GF) así como explorar factores determinantes de su utilización.

Métodos

Construcción de 2 modelos de regresión múltiple, tomando en uno de ellos como variable dependiente el GF y en el otro el porcentaje de prescripción mediante receta electrónica, incluyendo datos referidos a 9 centros de atención primaria de Andalucía.

Resultados

Cada incremento en un punto de prescripción por principio activo (PPA) se relacionó con una reducción media del GF de 2.079 €/año, mientras que cada incremento porcentual en el uso de receta electrónica se relacionó con un aumento de 1.027 € anuales. También se relacionaron con un mayor GF cada tarjeta ajustada por edad y tipo de farmacia (TAFE) asignada (36,71 €/año), la presión asistencial (2.585 €/año) y la frecuentación (2.17.148 €/año).Los factores que se relacionaron con un mayor uso de receta electrónica fueron un menor índice de ruralidad, una mayor distancia a la capital, una mayor PPA y una menor frecuentación.

Conclusiones

La prescripción mediante receta electrónica parece ser una variable predictora del gasto farmacéutico, relacionándose cada incremento porcentual con un incremento medio anual de 1.027 euros. Esta variable, junto con la prescripción mediante principio activo, el número de TAFE asignadas, la frecuentación y la presión asistencial media, contribuyen a explicar más del 65% de la variabilidad en el GF entre facultativos. El incremento del gasto relacionado con la receta electrónica parece producirse a expensas del aumento en el número de prescripciones por paciente.