Electronic Prescribing and Decision Support to Improve Rural Primary Care Quality (South Dakota)



The purpose of this research was to examine whether, in rural ambulatory care settings, the use of an e-prescribing system with clinical decision support related to medication management increases patient prescription adherence, improves health outcomes in hypertensive patients, and improves the medication management process. The aims of the study were to:

  • Improve the rate of adherence to prescribed medications among patients with hypertension in rural communities. 
  • Improve adherence to prescribed medications among patients with hypertension through use of e-prescribing tools in rural care settings. 
  • Improve health outcomes for patients with hypertension in rural communities through the use of e-prescribing and associated clinical decision support tools.
  • Enhance patient and provider satisfaction with the e-prescribing tool.
  • Overcome barriers to successful adoption of e-prescribing. 
The project implemented e-prescribing extensively in nine rural ambulatory care clinic settings within the Avera Health System service area; particularly eastern South Dakota, southwest Minnesota, and northwest Iowa. The research focused on blood pressure management of hypertensive patients who were 18 years of age or older. The study model was a staged implementation, first gathering baseline measures, then tracking clinics using e-prescribing as a stand-alone tool, and moving to an integrated electronic medical record (EMR) with e-prescribing. Medical claims data and the e-prescribing patient-fill histories were used to examine whether patient prescription adherence improved. Improved outcomes were measured in blood pressure readings, and changes in treatment for patients with blood pressure higher than 140/90.  Additionally, provider interviews and patient surveys assessed the perception of e-prescribing.
Based on a  population analysis, the implementation of e-prescribing did not appear to have a significant effect on hypertension control. Compared to the baseline pre-implementation, provider perceptions were more positive for both the stand-alone electronic prescribing and the EMR implementations. There did appear to be an increase in patient adherence and an upward trend in the prescribing of generic anti-hypertensive medications.
Grant Number: 
R18 HS017149
Funding Mechanism: 
Ambulatory Safety and Quality Program: Improving Quality through Clinician Use of Health IT (R18)
AHRQ Funded Amount: 
Principal Investigator: 
Veline, James
Avera Health
Sioux Falls
South Dakota
Project Dates: 
September 1, 2007 to August 31, 2011
Project Status: 

Project Categories

Type of Health Information Technology: 
Clinical Decision Support (CDS) System
Care Setting: 
Family Medicine
Internal Medicine
Primary Care
Aspect of Care: 
Chronic Disease Management
Medication Management
Primary Care
Target Population: 
Chronic Care
Last Modified: August 2015

News and Publications

Veline J. Electronic Prescribing and Decision Support to Improve Rural Primary Care Quality - Final Report. (Prepared by Avera Health under Grant No. R18 HS017149). Rockville, MD: Agency for Healthcare Research and Quality, 2011. (PDF, 275.07 KB)
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

Project Activities