Impact of generic substitution decision support on electronic prescribing behavior.
OBJECTIVE
To evaluate the impact of generic substitution decision support on electronic (e-) prescribing of generic medications.


METHODS
The authors analyzed retrospective outpatient e-prescribing data from an academic medical center and affiliated network for July 1, 2005-September 30, 2008 using an interrupted time-series design to assess the rate of generic prescribing before and after implementing generic substitution decision support. To assess background secular trends, e-prescribing was compared with a concurrent random sample of hand-generated prescriptions.


METHODS
Proportion of generic medications prescribed before and after the intervention, evaluated over time, and compared with a sample of prescriptions generated without e-prescribing.


RESULTS
The proportion of generic medication prescriptions increased from 32.1% to 54.2% after the intervention (22.1% increase, 95% CI 21.9% to 22.3%), with no diminution in magnitude of improvement post-intervention. In the concurrent control group, increases in proportion of generic prescriptions (29.3% to 31.4% to 37.4% in the pre-intervention, post-intervention, and end-of-study periods, respectively) were not commensurate with the intervention. There was a larger change in generic prescribing rates among authorized prescribers (24.6%) than nurses (18.5%; adjusted OR 1.38, 95% CI 1.17 to 1.63). Two years after the intervention, the proportion of generic prescribing remained significantly higher for e-prescriptions (58.1%; 95% CI 57.5% to 58.7%) than for hand-generated prescriptions ordered at the same time (37.4%; 95% CI 34.9% to 39.9%) (p<0.0001). Generic prescribing increased significantly in every specialty.


CONCLUSIONS
Implementation of generic substitution decision support was associated with dramatic and sustained improvements in the rate of outpatient generic e-prescribing across all specialties.
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA. shane.stenner@vanderbilt.edu
Shane P
SP
Stenner
Qingxia
Q
Chen
Kevin B
KB
Johnson
D020000:Decision Support Systems, Clinical; D057915:Drug Substitution / Q000706:statistics & numerical data*; D016568:Drugs, Generic; D055695:Electronic Prescribing; D006801:Humans; D050316:Medical Order Entry Systems; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D012044:Regression Analysis; D017010:Reminder Systems; D012189:Retrospective Studies; D013714:Tennessee; D014584:User-Computer Interface
D016568:Drugs, Generic