Paper vs. Electronic: How a Dermatology Prescription is Written Affects Adherence

A UNC School of Medicine dermatologist recently conducted a study to determine if the way a prescription was written - either traditionally or electronically - played a role in whether a patient filled and picked up the medication. In the study, published in JAMA Dermatology, Adewole S. Adamson, MD, assistant professor of dermatology, found that the way a prescription was written could influence whether a patient filled the prescription.

Adamson used data from a dermatology clinic in a large urban county health system in Texas to measure primary nonadherence, which is defined as not filling up and picking up all prescriptions within one year of the prescription date. Medication nonadherence is associated with poorer clinical outcomes, yet there weren't many studies prior to Adamson's studies that looked at factors influencing nonadherence in dermatology, he said.

Adamson's study found that there was a 16 percent reduction in primary nonadherence when the prescription was in electronic format compared with a traditional, paper prescription.

"Although it may seem intuitive that primary adherence would increase by removing the patient from the prescription-to-pharmacy routing process, few studies have compared primary nonadherence of patients given traditional prescriptions versus e-prescriptions," Adamson said.

In the study, Adamson conducted a medical records review of a group of new patients who were prescribed dermatologic medication at a single hospital outpatient clinic from January 1, 2011, through December 31, 2013. More than 4,300 prescriptions were written for 2,496 patients. Of those, 803 patients received electronic prescriptions, while 1,693 received paper prescriptions.

Rates of primary nonadherence decreased in patients older than 30, but increased in patients who were 70 and older.

"In this study, we demonstrated that e-prescribing is associated with reduced rates of primary non-adherence," Adamson said. "As the health system transitions from paper prescriptions to directly routed e-prescriptions, it will be important to understand how that experience affects patients, particularly their likelihood of filling prescriptions.

"Primary nonadherence is a common and pervasive problem. Steps should be taken to better understand why primary nonadherence happens and how it can be improved."

Adamson AS, Suarez EA, Gorman AR.
Association Between Method of Prescribing and Primary Nonadherence to Dermatologic Medication in an Urban Hospital Population.
JAMA Dermatol. Published online October 26, 2016. doi: 10.1001/jamadermatol.2016.3491

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