Effect of Electronic Prescribing With Formulary Decision Support on Medication Use and Cost
Effect of Electronic Prescribing With Formulary Decision Support on Medication Use and Cost
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DOI：
10.1001/archinte.168.22.2433
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发表时间：
2008-12-08
影响因子：
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通讯作者：
Weissman, Joel S.
中科院分区：
文献类型：
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作者：
Fischer, Michael A.;Vogeli, Christine;Weissman, Joel S.
背景：电子处方(电子处方)与处方决策支持(FDS)促使处方医生开出成本较低的药物，并可能有助于控制医疗成本。2004年4月，马萨诸塞州两家大型保险公司开始向社区诊所提供带有FDS的电子处方系统。方法：使用18个月(2003年10月1日至2005年3月31日)的管理数据，我们进行了一项同时对照的事后研究。我们首先比较了电子处方开始前后3个处方层次处方比例的变化，然后建立了多变量纵向模型，在控制干预者和对照处方者之间的基线差异时，估计了电子处方的具体效果。结果：在研究期间，超过150万名患者开出了1740万张处方。控制开处方者之间的基线差异和随时间变化的多变量模型估计，电子处方对应于一级处方3.3%的增长(95%可信区间，2.7%-4.0%)。2级和3级(名牌药)的处方比例相应下降。干预组电子处方占已填写处方的20%。根据私营保险公司的平均成本，我们估计以这种速度使用FDS电子处方可以导致每10万名患者节省845,000美元。更高水平的电子处方使用将增加这些节省。结论：临床医生使用电子处方和FDS明显更有可能开出一级药物，潜在的经济节省是可观的。与FDS一起广泛使用电子处方系统可能会减少药物支出。
Background: Electronic prescribing (e-prescribing) with formulary decision support (FDS) prompts prescribers to prescribe lower-cost medications and may help contain health care costs. In April 2004, 2 large Massachusetts insurers began providing an e-prescribing system with FDS to community-based practices.Methods: Using 18 months (October 1, 2003, to March 31, 2005) of administrative data, we conducted a prepost study with concurrent controls. We first compared the change in the proportion of prescriptions for 3 formulary tiers before and after e-prescribing began, then developed multivariate longitudinal models to estimate the specific effect of e-prescribing when controlling for baseline differences between intervention and control prescribers. Potential savings were estimated using average medication costs by formulary tier.Results: More than 1.5 million patients filled 17.4 million prescriptions during the study period. Multivariate models controlling for baseline differences between prescribers and for changes over time estimated that e-prescribing corresponded to a 3.3% increase (95% confidence interval, 2.7%-4.0%) in tier 1 prescribing. The proportion of prescriptions for tiers 2 and 3 (brand-name medications) decreased correspondingly. e-Prescriptions accounted for 20% of filled prescriptions in the intervention group. Based on average costs for private insurers, we estimated that e-prescribing with FDS at this rate could result in savings of $845 000 per 100 000 patients. Higher levels of e-prescribing use would increase these savings.Conclusions: Clinicians using e-prescribing with FDS were significantly more likely to prescribe tier 1 medications, and the potential financial savings were substantial. Widespread use of e-prescribing systems with FDS could result in reduced spending on medications.