Effect of electronic prescription on attainment of cholesterol goals

Abstract

Background: Although recent federal mandate provides incentives for physicians to use electronic prescribing (e-prescribing), clinical end points to support its use are lacking.

Hypothesis: E-prescribing should improve low-density lipoprotein (LDL) goal attainment.

Methods: In this retrospective cohort study, we queried the electronic medical records (Allscripts Electronic Health Record [EHR]) of a multispecialty outpatient academic medical practice to identify patient encounters during which consecutive lipid panels were drawn in 2007 (n = 2218). The EHR did not include a clinical decision tool for guideline adherence but did include formulary decision support (FDS), which informs physicians about drug costs specific to each patient. Logistic regression was used to examine whether the odds of reaching LDL goal were influenced by e-prescribing and adjusted for characteristics known to affect prescribing patterns and goal attainment.

Results: Of 796 patients not at LDL goal at baseline, 49% (n = 393) were at goal at follow-up. Patients receiving an e-prescription with FDS were 59% more likely to achieve LDL goal than those with a manual prescription (95% confidence interval [CI]: 1.12-2.25). Superior LDL goal attainment may be from lower cost of medications; patients with an e-prescription were significantly more likely to receive a generic statin than patients with a manual prescription (38% vs 22.9%; P = 0.0004), and for each $10 increase in prescription price, the likelihood of being at goal decreased by 5% (odds ratio = 0.95; 95% CI: 0.93-0.98).

Conclusions: Our study is the first to demonstrate that e-prescribing with FDS is associated with improved LDL goal attainment. Therefore, e-prescribing can deliver tangible clinical gains to patients, likely from improved adherence to more affordable treatment.

Figure 1

Screen shot example of formulary decision support from the Allscripts Electronic Health Record. Green “happy faces” indicate low co‐pay; red “unhappy faces” indicate high co‐pay; yellow “straight faces” indicate medium co‐pay.

Figure 2

Flow chart of patients included in the study.

Figure 3

Bar graph of patients at follow‐up by low‐density lipoprotein (LDL) goal.