An electronic chart prompt to decrease proprietary antibiotic prescription to self-pay patients

• HIT Description: Decision support, Electronic prescribing More info...
  
• Purpose of Study: To develop a clinical decision support system (CDSS) to display patient insurance status before prescription writing for outpatient conditions
  
• Years of study: Not Available
  
• Study Design: Pre-post
  
• Outcomes: Impact on efficiency, utilization and costs
  

• Settings: Urban emergency department (ED) with 78,000 annual visits, treating a medically underserved population.
• Intervention: Compare rates of prescribing for proprietary antibiotics before and after introduction of a CDSS that alerts MDs to patient insurance status.
• Evaluation Method: pharmacy and electronic patient data.
• Description: Electronic prescription writing system which displays a prompt when any of 74 antibiotics are selected that shows the patient's insurance status, with bold red letters reminding the provider to check the patient insurance status before writing antibiotic prescriptions.
• Interoperability: Electronic ED chart is linked to prescription-writing software.
• Strategy: Users received a brief in-service when the prescription prompt was introduced to the system, a 30-minute didactic lecture, and a brief email reminder one encouraged to prescribe generic meds if clinically appropriate
• Facilitators: Authors posit that providing a stronger educational program or adding a "forcing" function to the system may have increased success
• Healthcare Utilization: Use of proprietary drugs for self-pay or charity-care patients decreased by 22% (p=0.03). Use of proprietary drugs for those who had respiratory or urinary infections decreased by 30% (p=0.005).
• Changes in healthcare costs: The intervention should have resulted in an average decrease in cost to the patient from $35.37 per prescription to $26.70.