Roland MO et al. 1985 "Evaluation of a computer assisted repeat prescribing programme in a general practice."
Reference
Roland MO, Zander LI, Evans M, et al. Evaluation of a computer assisted repeat prescribing programme in a general practice. Br Med J (Clin Res Ed) 1985;291(6493):456-458.
Abstract
"After introducing a computer assisted repeat prescribing programme into a south London practice, improvements were made in several aspects of practice organisation. Time was saved by doctors and receptionists; prescriptions were produced more rapidly; information in the records about drugs that were available for repeat prescription was improved; and queries from chemists about prescriptions were reduced. The costs of the system in terms of computer operator time were estimated. Computerising prescribing data provides a source of data that may be used to enable doctors to audit their own prescribing."
Objective
"To quantify the costs and benefits of installing a computer assisted repeat prescribing programme into a general practice."
Tools Used
Type Clinic
Primary care
Type Specific
Family practice
Size
Small and/or medium
Geography
Urban
Other Information
The study took place at the "Lambeth Road Group Practice, a south London practice that provides primary medical care for roughly 9000 patients." There were 658 patients in the study population.
Type of Health IT
Prescription renewal system
Type of Health IT Functions
"In the conventional system requests for repeat prescriptions were noted by the receptionist and passed to the doctor with the patient's medical record together with a prescription on which the name and address of the patient had been entered. The doctor filled in the prescription and signed it. In the computerised system the request was passed to the computer operator without the medical records. If the requested item was authorised by the computer a prescription was generated, which was the signed by the doctor. A dummy prescription containing items that were authorised by the computer was kept in the patient's medical record."
Context or other IT in place
The study site had electronic records of prescriptions ordered for 80 percent of patients; containing approximately 87 percent of their prescriptions.
Workflow-Related Findings
"Over the whole study period there was a reduction in median prescription turnover time from nine to seven hours in both groups combined...During the randomised controlled trial the difference in turnover time between the computerised and the conventional group was not significant, which suggests that factors other than the computer may have been responsible for some of the improvement in turnover time. The repeat prescribing programme resulted in all members of the practice staff thinking about ways in which repeat prescriptions were produced - this may have resulted in at least part of the improvement in turnover time."
"After computerisation the receptionists spent less time processing repeat prescriptions. In particular, there were significant reductions in the time spent extracting records after computerisation...and in writing the headings for prescriptions..."
"There was also a substantial change in the way in which patients made their requests for repeat prescriptions. Before computerisation 46% of requests were made by telephone. After computerisation only 8% of requests were made by telephone, with 83% of requests being made by the patient either sending or bringing their computerised repeat prescription slip (as requested). This represented a considerable benefit to the practice, which had been trying for some time to dissuade patients from asking for repeat prescriptions by telephone."
"The percentage of requests resulting in a query from a chemist fell over the study period from 6.0% before computerisation to 1.1% after computerisation...Further analysis ... shows that this was a steady reduction in queries from chemists in both the computerised and the conventional group throughout the study. Some of the improvement may therefore have resulted from a general improvement in processing repeat prescriptions, in addition to that resulting from the improved accuracy and legibility of computerised prescriptions."
"Using the computer resulted in an improvement in the standard of medical records," by creating a "dummy prescription" that was kept in the paper chart indicating than a medication "was available for repeat prescription."
"During the study period the computer operator spent a mean of five minutes 27 seconds per prescription produced with a mean of 2.42 items per prescription, and mean time per item of two minutes 15 seconds. This time included printing the prescriptions, reauthorising items, and keeping the repeat prescription file up to date."
"A major additional benefit of the repeat prescribing programme is that the doctors now have a source of data on their repeat prescriptions that will enable them to audit their own repeat prescribing."
"The mean duration of time to complete one batch of 10 conventional prescription requests was 12 minutes, 44 seconds compared with only one minute six seconds for 10 computerised prescription requests...In this practice, where the five partners handle an average of 30 requests for repeat prescriptions per day, the computerised system produced an important saving in time."
Study Design
Randomized controlled trial (RCT)
Study Participants
"The records of patients who requested...prescriptions were examined by the patients' doctors to decide who had requested prescriptions that were suitable for issuing without face to face contact between patient and doctor. These 658 patients formed the study population."