Evaluation of the use of an integrated drug information system by primary care physicians for vulnerable population.
OBJECTIVE
To investigate whether an electronic prescribing and integrated drug information system was more likely to be used by primary care physicians for patients of low socioeconomic (SES) patients.


METHODS
Prospective 9 months follow-up study was conducted in Montreal, Canada from March to November 2003. The study included 28 primary care physicians and their 4096 respective patients with provincial drug insurance. Utilization rate was defined as the number of times the electronic medication history (EMH) and electronic prescribing system (E-rx) were accessed divided by the total number of medical visits made by those patients. System audit trails (utilization), provincial health insurance databases (visits) were used to measure system utilization rate. For each patient neighborhood-based measures of household income, derived from Statistics Canada, were used to measure socioeconomic status.


RESULTS
The EMH was used 14.5 times per 100 visits. In comparison to high SES patients, there was a significant 70% increase (RR: 1.70; 95%CI: 1.15-2.47) in the EMH utilization for low SES patients. The electronic prescribing system was used 38.5 times per 100 visits and did not vary by patient SES. The EMH utilization rate for low SES patients with multiple emergency room (ER) visits was 2.4 times higher than for high SES patients with <1 ER visit (RR: 2.38; 95%CI: 1.36-4.14). The utilization rate for low SES patients, who took, at least six drugs per day, was four times higher compared to high SES patients with less complex drug management (RR: 4.00; 95%CI: 2.22-7.17).


CONCLUSIONS
Primary care physicians were more likely to access electronic information on current drug use for patients of low SES taking multiple medications and with fragmented care.
Kawasumi
Yuko
Y
Department of Epidemiology and Biostatistics, McGill University, and Division of Clinical Epidemiology, Royal Victoria Hospital, Montreal, Quebec H3A1A3, Canada. yuko.kawasumi@mail.mcgill.ca
Tamblyn
Robyn
R
Platt
Robert
R
Ernst
Pierre
P
Abrahamowicz
Michal
M
Taylor
Laurel
L
D000368:Aged; D004346:Drug Information Services / Q000706:statistics & numerical data*; D011307:Drug Prescriptions; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008297:Male; D010821:Physicians, Family; D011446:Prospective Studies; D011792:Quebec; D012923:Social Class; D035862:Vulnerable Populations