title: Prescription of ocular beta-blockers in patients with obstructive pulmonary disease: Does a central electronic medical record make a difference?
abstract: OBJECTIVE
  Topical beta-blockers are contraindicated in obstructive pulmonary diseases (OPDs). In this study we aimed to evaluate through central or local electronic medical records (EMRs) the prescription patterns for topical ocular beta-blockers for patients with glaucoma and OPD treated by ophthalmologists.
  
  
  METHODS
  The study was carried out at the Leumit Health Maintenance Organisation (HMO) in Israel. The physicians at the HMO all work with an EMR, either a central EMR incorporating data from primary-care physicians and consultants, or a local one. The study population included all HMO members who filled at least one prescription for antiglaucoma medications in 2004. The patients were divided into two groups: those with a previous diagnosis of OPD (ICD-9 codes 493) and those with no known diagnosis of OPD.
  
  
  RESULTS
  7481 patients consumed topical antiglaucoma medications during the study period, and 14.5% had a diagnosis of OPD. 798 OPD patients were treated by ophthalmologists, and of the 61.8% who were treated with topical beta-blockers, only 38 received betaxolol. In comparison with glaucoma patients without OPD, OPD patients received fewer beta-blockers (p < 0.001), more selective beta-blockers (p < 0.0001) and less timolol (p < 0.001). Of the OPD patients treated by ophthalmologists with a central EMR, 59.5% received beta-blockers in comparison with 66.4% treated by ophthalmologists with a local EMR (p = 0.06). OPD patients treated by ophthalmologists with a central EMR received more non-beta-blockers in comparison with patients treated by ophthalmologists with a local EMR (p = 0.02).
  
  
  CONCLUSIONS
  Most patients with OPD and glaucoma continued to receive topical beta-blockers, mostly noncardioselective beta-blockers. A central EMR with a comprehensive and highly available medical history reduced the prescription of beta-blockers to OPD patients, but rates remained unacceptably high.
authors.affiliation: Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. vinker01@zahav.net.il
authors.forename: Shlomo
authors.initials: S
authors.lastname: Vinker
authors.forename: Igor
authors.initials: I
authors.lastname: Kaiserman
authors.forename: Dan Andrei
authors.initials: DA
authors.lastname: Waitman
authors.forename: Shimon
authors.initials: S
authors.lastname: Blackman
authors.forename: Eliezer
authors.initials: E
authors.lastname: Kitai
mesh_terms: D000319:Adrenergic beta-Antagonists; D000075202:Contraindications; D004363:Drug Utilization; D005901:Glaucoma / Q000188:drug therapy*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications*; D016347:Medical Records Systems, Computerized
chemical_list: D000319:Adrenergic beta-Antagonists