Electronic Prescriptions May Improve Adherence

Steven Fox

September 24, 2012

September 24, 2012 — Clinical and demographic factors may play important roles in determining when or if parents fill prescriptions written for pediatric primary care patients, according to findings from a study of 16,953 prescriptions written in 2 Illinois clinics. The findings also suggest that the use of electronic prescriptions may help boost adherence.

Results of this study are published online September 24 and in the October issue of Pediatrics.

"Filling a prescription is the important first step in medication adherence, but has not been studied in pediatric primary care," Rachel Zweigoron, MD, from Department of Pediatrics, Lurie Children's Hospital, Chicago, Illinois, and colleagues write.

"To our knowledge, this is the first study to evaluate primary medication adherence exclusively among pediatric primary care patients," they continue.

The principal aim of the study was to find out how often prescriptions in a primary care setting went unfilled and to examine what factors might be associated with prescription filling.

Dr. Zweigoron and colleagues conducted a retrospective observational analysis of the 16,953 prescriptions that had been written for 4833 Medicaid patients who had been seen at 2 clinics affiliated with the Lurie Children's Hospital, a large tertiary-care facility. All the prescriptions had been written during a 26-month period from October 1, 2008, through December 1, 2010.

Most of the patients included in the study were black or Hispanic. About three-quarters spoke English.

First, the researchers used electronic medical records to find out what prescriptions had been written. Then, to check on how many of the prescriptions had actually been filled, they compared those figures with insurance claims data from the Illinois Medicaid program.

They report that 78.1% of the prescriptions were eventually filled (within 60 days). Of the filled prescriptions, 69% were filled within 1 day.

Nearly a fifth (18%) of prescriptions were electronically prescribed. "The remaining 82% were computer-generated prescriptions handed directly to patients," the researchers write.

Three classes of prescribed drugs were most often filled: antiinfective drugs, asthma/allergy drugs, and dermatologic drugs. Prescriptions for nutritional supplements were filled the least often.

Prescriptions for black and Hispanic children were filled more often than prescriptions for white children, the investigators say. In addition, those written during sick/follow-up visits had higher rates of being filled than prescriptions written during other types of visits.

The researchers also found that prescriptions submitted electronically were more likely to be filled than those handed to patients, with an odds ratio of 1.49 (95% confidence interval, 1.32 - 1.69).

"Although electronic prescribing has been shown to reduce prescription errors and costs," the authors write, "this is the first study to demonstrate that it may also improve adherence to pediatric primary care prescription filling." Previous studies have shown similar results in adult patients.

The authors speculate that convenience may be an important factor behind the higher adherence rates associated with electronic prescriptions.

"Future studies should be designed to clarify barriers to prescription filling and to develop and test interventions intended to improve primary adherence," the authors conclude. "Qualitative studies asking parents why they did or did not fill a prescription could provide valuable information."

The authors have disclosed no relevant financial relationships.

Pediatrics. 2012;130:620-626.