Effects of an e-Prescribing interface redesign on rates of generic drug prescribing: exploiting default options
Effects of an e-Prescribing interface redesign on rates of generic drug prescribing: exploiting default options
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DOI：
10.1093/jamia/ocv192
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发表时间：
2016-09-01
影响因子：
6.4
通讯作者：
Ancker, Jessica S.
中科院分区：
文献类型：
--
作者：
Malhotra, Sameer;Cheriff, Adam D.;Ancker, Jessica S.
目的增加仿制药的使用，有助于控制医疗费用。然而，教育干预对处方者行为的影响有限，而电子处方警报与高覆盖率和警报疲劳有关。我们的目标是评估一种侵入性较小的干预措施的效果，即重新设计一个提供默认选项的电子处方界面，旨在“推动”开出仿制药的人开出仿制药。方法在一个学术门诊多专科实践中，这项回溯性队列研究评估了定制电子处方界面的效果，该界面在订单录入期间用仿制药替代品牌药物，并允许一次点击覆盖以订购品牌药。结果在具有仿制药的药品中，仿制药的比例在界面重新设计后翻了一番以上，从39.7%突然上升到95.9%(增加了56.2%；95%可信区间，56.0-56.4%；P<；.001)。在重新设计之前，仿制药的开药率因治疗类别而异，泌尿生殖系统产品的开药率低至8.6%，神经肌肉药的开药率低至15.7%。在重新设计后，除了内分泌药物、神经肌肉药物、营养产品和杂品外，所有治疗类别的仿制药开药率都在90%以上。讨论了在门诊医疗环境下改变电子处方界面中的默认选项之后，实践中开出的仿制药比例大幅和持续增加。结论医疗信息技术中的默认选项对用户行为产生了强大的影响，这种影响可以被用来优化决策。
Objective Increasing the use of generic medications could help control medical costs. However, educational interventions have limited impact on prescriber behavior, and e-prescribing alerts are associated with high override rates and alert fatigue. Our objective was to evaluate the effect of a less intrusive intervention, a redesign of an e-prescribing interface that provides default options intended to "nudge" prescribers towards prescribing generic drugs.Methods This retrospective cohort study in an academic ambulatory multispecialty practice assessed the effects of customizing an e-prescribing interface to substitute generic equivalents for brand-name medications during order entry and allow a one-click override to order the brand-name medication.Results Among drugs with generic equivalents, the proportion of generic drugs prescribed more than doubled after the interface redesign, rising abruptly from 39.7% to 95.9% (a 56.2% increase; 95% confidence interval, 56.0-56.4%; P < .001). Before the redesign, generic drug prescribing rates varied by therapeutic class, with rates as low as 8.6% for genitourinary products and 15.7% for neuromuscular drugs. After the redesign, generic drug prescribing rates for all but four therapeutic classes were above 90%: endocrine drugs, neuromuscular drugs, nutritional products, and miscellaneous products.Discussion Changing the default option in an e-prescribing interface in an ambulatory care setting was followed by large and sustained increases in the proportion of generic drugs prescribed at the practice.Conclusions Default options in health information technology exert a powerful effect on user behavior, an effect that can be leveraged to optimize decision making.