Electronic prescription and therapeutic adherence

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This presentation summarizes the achievemente of electronic prescription in Andalusia and its contribution to improve therapeutic adherence in patients with chronic conditions. The Public Healthcare Service of Andalusia has developed a long-term strategy about e-health called "Diraya". All the citizens of Andalusia have a single electronic health record, available at primary care centres, hospitals, pharmacy offices or emergency units. The system has a prescription module. Last year 121 million of electronic prescriptions were done in Andalusia. The system allows to saving costs in many ways: avoiding mistakes and duplications, facilitating the use of international non proprietary name (INN), reducing the number of consultations in primary care, and many other. Accumulated, every 100 euros invested, the system recovers 212 euros. This module and its decision support system may allow to identify patients with potential non-compliance behaviour by checking the treatment prescribed for a single drug and the withdrawal of boxes of this drug at the pharmacy offices. This approach should be complemented by other actions and tools, such as mems apps designed for smartphones and tablets; patient education, phone surveillance, and others.

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Electronic prescription and therapeutic adherence

  1. 1. e‐Prescription as a tool for improving adherenceThe experience of Andalusia Region, Spain
  2. 2. Andalusia: a short viewMain features• 8,437,681 inhabitants (526,942 foreigners) • 21.6 Million of tourists in 2012• Political Autonomy from 1981• Full responsibility at regional level on Public Health and Healthcare Services from 1984The Public Healthcare System of Andalusia1,514 Primary Care Centres47 Public Hospitals (16,821 beds)102,000 Healthcare Workers8,431 M € Budget 2013 (6.00% GDP; 999.19 €/inhabitant)3,602 Pharmacies (Private Offices regulated as a public service)
  3. 3. The Digital Strategy of the Public Healthcare System of Andalusia• A long‐term Strategy: From 1999• A single health record number for all citizens of Andalusia• A single electronic Health Record for every person• A individual smart card for each person as a key for access• Structured information• A regional eHR shared among:• Primary care• Hospitals• Pharmacies• Emergencies• Patients (from 2012)• Nursing homes (coming soon)
  4. 4. Much more than an eHR: A corporate information systemAppointment PrescriptionRadiologyWaiting listsFunctional testsPathologyLab testsInpatient careReferralsOutpatient carePrimary careHospital admissionData warehouseEmergency care8.24 Millionindividual eHR121 Millione‐prescriptionsyearly94 MillionappointmentsyearlyHealth Care Information and Management Integrated System
  5. 5. Ageing, chronic diseases and drug consumption17,923,031,648,473,684,391,616‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75 & +% of people with at least one chronic condition, by age. Andalusia, 20110,20,91,72,33,14,50 ChC 1 ChC 2 ChC 3 ChC 4 ChC 5 ChC +Number of different drugs consumed related to the number of chronic conditions (ChC). Andalusia, 201117.4 % women13.39 %    man People 65 or olderAndalusia, 2012% of Noncompliance in Hypertension: 7.1 % ‐ 55.2 %               Average: 32.3%
  6. 6. White Paper onActive Ageing ComprehensivePlan for attendingpeople withchronic conditionsin AndalusiaStrategic approaches for health ICT,active ageing, chronic diseases and adherenceConsensus document about therapeutic adherence in chronic patientsOmbudsman Report about ICT and older people in Andalusia, 2011
  7. 7. ePrescription module: “Receta XXI”Medical office PharmacyIntranet of the Official College of PharmacistsThe system allows the dispensation of the treatment at any pharmacy in Andalusia during the time established by the doctorSmart card as a keyIntranet of the Public Healthcare SystemInstruction sheet for patientTreatment available on line
  8. 8. ePrescription utilisation and savingsSavings: 533 Millions €from 20012,725,746,657,76370,975,2 77,1 78,68491,1 93,62001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 201248,549,650,1 50,5 50,3 49,944,143,642,92004 2005 2006 2007 2008 2009 2010 2011 2012‐14 %Electronic prescriptions (millions)Appointments at Primary Care (millions)% Prescription by INN (active principle)0,2 1,28,930,566,389,2105,2118,6 121,32004 2005 2006 2007 2008 2009 2010 2011 2012Currently: 94.49% of all prescriptions are electronic
  9. 9. ePrescription: cumulative economic performance050.000.000100.000.000150.000.000200.000.000250.000.000300.000.0001999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010EURPresent value of cumulative costs Present value of cumulative benefitsCase studies. European Commission. http://www.ehr‐impact.eu/cases/cases.html
  10. 10. Decision support tools for prescribing• Single medicines record • Updated catalogue (Nomenclator)• Prescription by International Nonproprietary Name• Help in filling up dosage • Warnings for duplicated prescription• Evidence‐based guide by Scientific Societies and HTA Institutions• Info on drugs• Allergies and contraindications• Help reporting adverse reactions• Interactions• Warning maximum daily doses• Warning therapeutic redundancy • Forms included
  11. 11. ePrescription avoiding duplicationElectronic tools may contribute to minimize prescription errors detecting duplicate drugs or family drugs in the same patient.Use of DSS Prescriptions Duplications %Before 27,088 1,667 6.15%After 22,672 273 1.20%Pilot study on DSS for detecting duplication on the most frequent therapeutic groups
  12. 12. ePrescription usefulness for adherenceElectronic tools may allow GPs to identify  patients with potential noncompliance behaviour and reinforce individual measures of education, assessment and/or motivation.In addition, ePrescriptionmodule may help to monitor these patients.
  13. 13. ePrescription module: role of the pharmacistPharmacy Pharmacist can send an alert to the individual eHR and block a prescription until the Doctor can check it and confirm or notA warning appears at the patient’s eHRand Doctor can check the comments from the pharmacist and confirm this criteria or maintain the drugMedical officeIntranet of the Public Healthcare SystemIntranet of the Official College of Pharmacists91,178,83Confirmed Re‐activated16,220 cases in 2012%%
  14. 14. Survey on ePrescription2009‐20101,193 pharmacists in Spain(984 of them in Andalusia Region)Supported by Almirall©ePrescription:Is globally positive for the pharmacy office 78.8%Increases detection of drug‐related problems 78.7%Improves therapeutic adherence 80.2%Improves therapeutic adherence in older people 79.7%Improves therapeutic adherence in chronic patients 63.3%Allows the pharmacist more ability for monitoring 68.8%Patient feels a better control by the pharmacist 54.1%
  15. 15. Other tools for enhancing adherenceApp for smartphonesor tablets: “Recuerdamed”Access to eHR and current treatment for patientsPatient’s schoolTelemedicineCall centre
  16. 16. Thanks for your attention!José L. ROCHAGeneral Secretary for Quality and InnovationRegional Ministry of Health and Social WelfareGovernment of Andalusia, Spainjosel.rocha@juntadeandalucia.es@joselurro

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