Online pharmacy literature
Clin Pharmacol Ther. 2001 Apr;69(4):260-5.
Preventing drug interactions by online prescription screening in community pharmacies and medical practices.
Halkin H, Katzir I, Kurman I, Jan J, Malkin BB.
Tel Aviv University School of Medicine and the Division of Pharmaceuticals, Maccabi Healthcare Services, Israel.
BACKGROUND: Drug interactions have been shown to be preventable by computerized prescription entry and screening only in hospitals and not in community-based practice. METHODS: We retrospectively evaluated the effect of online prescription screening in community pharmacies and physician offices of one health maintenance organization, phased in during 3 consecutive 6-month periods in 1998 to 1999 (period I, system active only in 40% of pharmacies; period II, system active in 90% of pharmacies and 50% of physician offices; period III, system active in 95% of pharmacies and 90% of physician practices), on rates of prescriptions with-, patient exposure to-, and physician prescribing of-potential drug interactions. FINDINGS: Cumulative data included 775,186 patients given at least one prescription, by one or more of 5504 physicians, whose prescriptions were dispensed at 572 pharmacies. Dispensing of drug interaction prescriptions was reduced by 21.1% and by 67.5% in periods II and III compared with period I (odds ratio, 0.79; 95% confidence limit, 0.75-0.83 and odds ratio, 0.28; 95% confidence limit, 0.26-0.30, respectively). Patient exposure decreased only in those receiving 3 to 7 concurrent drugs (odds ratio, 0.80; 95% confidence limit, 0.71-0.90) with no reductions for patients who were given 2 drugs or 8 or more drugs. Only 19% to 25% of physicians wrote prescriptions for drugs that interact, but 85% of these repeated this pattern after being alerted. The proportion of prescriptions of drugs that interact that originated with a single prescriber, as opposed to 2 prescribers, decreased during the 3 periods from 0.81 to 0.74 and 0.69 (P <.001). INTERPRETATION: Computerized prescription entry and drug interaction screening in the community caused a 62.8% reduction in pharmacy-dispensed prescriptions with severe drug interactions and a 20% reduction in patient exposure to prescriptions with severe drug interactions; this reduction was negated by polypharmacy of 8 or more drugs. The effect of interaction alerts on physician prescribing patterns was limited.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11309555&dopt=Abstract
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Health Manag Technol. 2001 May;22(5):50-2.
The bandwagon is outside waiting. Eliminating the obstacles to automated and online prescription systems.
Weinstein AM.
InstantDx, Gaithersburg, MD, USA.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11351823&dopt=Abstract
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Pharmacoeconomics. 1996;9 Suppl 1:9-15.
The role of pharmacoeconomics in disease management. A pharmaceutical benefit management company perspective.
Thomas N.
PCS Health Systems Inc., Clinical Services Division, Minneapolis, Minnesota, USA.
In the US, managed-care organisations (MCOs) have turned to pharmacy benefit management (PBM) companies to contain costs and provide total disease management packages. The demand for pharmacoeconomic research and information by purchasers of healthcare has contributed to the growth of PBM companies and to recent acquisitions by pharmaceutical manufacturers. PBMs influence prescribing via formulary management and drug utilisation review (DUR). Formularies are generally open, and pharmacoeconomic data contribute to formulary management decisions. Prospective and concurrent DURs used in hospitals can soon be integrated into community pharmacy, as PBMs obtain integrated online information about prescribing. PBM prescription databases are used as as educational tools for physicians, providing drug utilisation data, formulary compliance, generic prescribing rates, and guidelines for pharmacotherapy for particular conditions. They can also evaluate medication regimens for patients with particular problems such as drug-drug interactions. However, PBM databases typically lack patient diagnostic, outcome and medical claim data. PBMs will be better placed to move from medication management to disease management when they can obtain these data and link them appropriately to their own prescribing and physician databases.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10160115&dopt=Abstract
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