title: Incidence and cost of medications dispensed despite electronic medical record discontinuation.
abstract: OBJECTIVE
  To determine the incidence and cost of medications dispensed despite discontinuation (MDDD) of the medications in the electronic medical record within an integrated health care organization.
  
  
  METHODS
  Dean Health System, with medical clinics and pharmacies linked by an electronic medical record, and a shared health plan and pharmacy benefits management company.
  
  
  METHODS
  Pharmacist-led quality improvement project using retrospective chart review.
  
  
  METHODS
  Electronic medical records, pharmacy records, and prescription claims data from patients 18 years of age or older who had a prescription filled for a chronic condition from June 2012 to August 2013 and submitted a claim through the Dean Health Plan were aggregated and cross-referenced to identify MDDD.
  
  
  METHODS
  Descriptive statistics were used to characterize demographics and MDDD incidence. Fisher's exact test and independent samples t tests were used to compare MDDD and non-MDDD groups. Wholesale acquisition cost was applied to each MDDD event.
  
  
  RESULTS
  7,406 patients met inclusion criteria. For 223 (3%) patients with MDDD, 253 independent events were identified. In terms of frequency per category, antihypertensive agents topped the list, followed, in descending order, by anticonvulsants, antilipemics, antidiabetics, and anticoagulants. Nine medications accounted for 59% (150 of 253) of all MDDD events; these included (again in descending order): gabapentin, atorvastatin, simvastatin, hydrochlorothiazide, lisinopril, warfarin, furosemide, metformin, and metoprolol. Mail-service pharmacies accounted for the highest incidence (5.3%) of MDDD, followed by mass merchandisers (4.6%) and small chains (3.9%). The total cost attributable to MDDD was $9,397.74.
  
  
  CONCLUSIONS
  Development of a technology-based intervention to decrease the incidence of MDDD may be warranted to improve patient safety and decrease health care costs.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Baranowski
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Peterson
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Statz-Paynter
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Zorek
mesh_terms: D016527:Drug Costs / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D055695:Electronic Prescribing / Q000191:economics; D005260:Female; D006308:Health Systems Plans / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement