Electronic transmission of prescriptions in primary care: transformation, timing and teamwork

Exploring patient perspectives on Iran's Electronic Prescription System: a Qualitative Inquiry

Background

Electronic prescriptions represent a fundamental shift in service delivery, healthcare management, and associated costs, offering numerous advantages. However, akin to other electronic systems, they also present challenges. This study aimed to investigate patients' understanding of the challenges associated with electronic prescriptions in Iran.

Methods

This study used a qualitative research design, utilizing individual and semi-structured interviews with patients referred to selected pharmacies across all 11 districts of Shiraz City. The data were analyzed using MAXQDA software (version 10), and descriptive statistics for demographic data were calculated using SPSS version 19.

Results

The study revealed that the participants generally demonstrated a certain level of familiarity with electronic prescribing systems. However, it was evident that many were unaware of the potential implications of such technology for their relationships with healthcare providers. This underscores the urgent need for patient understanding in the context of the electronic prescription system. While patients were relatively familiar with the functionality of electronic prescribing systems, they lacked a comprehensive understanding of how using these systems could affect their interactions with healthcare providers.

Conclusion

Patients are significant beneficiaries of the electronic prescribing system. By addressing their needs and concerns, they can develop a positive attitude toward this system. Their active engagement can pave the way for the system's ease of use, increase its acceptance, and ultimately enhance the quality of healthcare services.

A Preliminary Scoping Review of the Impact of e-Prescribing on Pharmacists in Community Pharmacies

OBJECTIVE

This scoping review aims to map the available literature and provide an overview of the published articles discussing the impact of electronic prescribing on medication errors and pharmacy workflow.

METHODS

The literature search was conducted using PubMed®, Web of Science®, and the Cochrane Database of Systematic Reviews®, as well as grey literature reports, using the search terms and related components of "pharmacists", "electronic prescribing", "medication errors", and "efficiency". The search included all articles that were published from January 2011 to September 2023. Twenty-two relevant articles were identified and fully reviewed, ten of which were included in this review.

RESULTS

Electronic prescribing (e-prescribing) provides a solution for some of the challenges that are associated with handwritten and paper prescriptions. However, the implementation of e-prescribing systems has been recognized as a source of new unforeseen medication errors in all the reviewed articles. Productivity in community pharmacies has been affected with receiving electronic prescriptions (e-prescriptions) and having to deal with the issues that arise from them. The pharmacists' interventions were not eliminated with e-prescriptions compared to other prescription formats. The most frequently reported reason for intervention was related to incomplete instructions in the field of directions of use. Other common challenges with e-prescriptions were related to missing information, quantity, inappropriate dose, dosage form, and drug.

DISCUSSION

This review demonstrates the scarcity of research about the impact of electronic prescribing on medication error and efficiency in community pharmacies. In the literature, most of the studies had mainly focused on hospital pharmacies. The literature search demonstrated that there are still some barriers to overcome with e-prescribing systems and that medication errors were not fully eliminated with e-prescriptions. New errors have been identified with e-prescriptions, all of which caused delays in processing, which affected the productivity of the pharmacy staff, and could have negatively impacted patients' safety if not properly resolved.

CONCLUSION

e-Prescribing solved some of the challenges associated with illegibility of handwritten prescriptions. However, more time is required to allow e-prescribing systems to mature. Further training for prescribers and pharmacists is also recommended before and after the implementation.

Benefits and barriers associated with e-prescribing in community pharmacy - A systematic review

Background

The utilization of electronic prescribing is growing, prompted by lockdown measures during the COVID-19 pandemic. However, despite this increasing adoption, there is a notable dearth of consolidated evidence regarding the challenges and opportunities associated with the integration of electronic prescribing systems within the daily clinical practices of community pharmacists.

Objective

This paper aims to systematically review the community pharmacists' perspectives on barriers and facilitators to electronic prescribing, addressing the significant need for understanding how electronic prescribing impacts the workflow and decision-making processes of pharmacists, ultimately influencing the quality of patient care.

Methods

PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched from January 1, 2000, to October 25, 2022, using search terms related to electronic prescribing, computerised physician order entry, community/retail pharmacies, and pharmacists.

Results

A total of 28 studies were included in the systematic review. In these studies, community pharmacists perceived that design, interoperability, attitude towards e-prescribing technology, information quality, workflow, productivity, and accessible resources facilitated e-prescribing. In addition, the included studies emphasized the importance of technological support for the successful implementation of electronic prescribing systems. The system's design characteristics significantly improve e-prescribing technology's favourable effects. According to our review, it has been proposed that a poorly designed e-prescribing system can have a negative impact on the quality of care, implementation, and user satisfaction. In contrast, a well-designed system can significantly contribute to improvements.

Conclusions

The review highlighted that e-prescribing has both barriers and facilitators, with the quality of the system and its implementation influencing these factors. Technical issues and user acceptance (patient/prescribers/pharmacists) can act as barriers or enablers, highlighting the need for comprehensive consideration and monitoring of e-prescribing to identify and address potential issues.