Using default options within the electronic health record to increase the prescribing of generic-equivalent medications: a quasi-experimental study

Abstract

Background: Low-value services, such as prescribing brand-name medications that have existing generic equivalents, contribute to unnecessary health care spending.

Objective: To evaluate the association of an intervention by using the electronic health record with provider prescription of generic-equivalent medications.

Design: Quasi-experimental study.

Setting: General internal medicine (IM) (n = 2) and family medicine (FM) (n = 2) clinics at the University of Pennsylvania from June 2011 to September 2012.

Participants: Attending physicians (IM, n = 38; FM, n = 17) and residents (IM, n = 166; FM, n = 34).

Intervention: In January 2012, the default in the electronic health record was changed for IM providers from displaying brand and generic medications to displaying initially only generics, with the ability to opt out.

Measurements: Monthly prescriptions of brand-name and generic-equivalent β-blockers, statins, and proton-pump inhibitors.

Results: During the preintervention period, FM providers had slightly higher rates of generic medication prescribing (range, 80.8% to 85.5%) than did IM providers (range, 75.4% to 79.6%), but both groups had similar trends. In the postintervention period relative to the preintervention period, IM providers had an increase in generic prescribing compared with FM providers for all 3 medications combined (5.4 percentage points [95% CI, 2.2 to 8.7 percentage points]; P < 0.001), β-blockers (10.5 percentage points [CI, 5.8 to 15.2 percentage points]; P < 0.001), and statins (4.0 percentage points [CI, 0.4 to 7.6 percentage points]; P = 0.002). Results for proton-pump inhibitors (2.1 percentage points [CI, -3.7 to 8.0 percentage points]; P = 0.47) were not significant. Subset analyses revealed similar findings for attending physicians. Among residents, however, results were imprecise, with wide CIs.

Limitation: Observational single-center evaluation, comparison groups that represented different specialties, and a small subset of medication classes studied.

Conclusion: The use of default options was an effective method to increase the odds of prescribing generic medication equivalents for β-blockers and statins.

Primary funding source: U.S. Department of Veterans Affairs and Robert Wood Johnson Foundation.