Abstract
Background: Adverse drug reaction reports used in pharmacosurveillance often lack complete information on treatment indication that is important for benefit-risk analyses and clinical and regulatory decision making. A systematic documentation of treatment indication using electronic prescribing applications provides an opportunity to develop new pharmacosurveillance tools that will allow evaluation of drugs by weighing benefits and risks for specific indications, and evaluate off-label prescribing. In addition, interfacing indications with reminders and clinical guidelines can enhance clinical decision making. We investigated the validity of treatment indications documented using an electronic prescribing system at the time of prescribing.
Objectives: To determine the sensitivity and positive predictive value (PPV) of an electronic prescribing system in documenting treatment indications at the time of drug prescribing, and to investigate the use of treatment indication data to evaluate off-label prescribing in primary-care practice.
Study Design and Setting: We prospectively assessed the validity of documenting treatment indication using an electronic prescribing system by comparing it with treatment indications documented by physician-facilitated medical chart review (‘gold standard’). Sensitivity and PPV were evaluated in 338 patients of 22 community-based primary-care physicians in Quebec, Canada, in 2006.
Results: The sensitivity of the electronic prescribing system in documenting treatment indication was 98.5% (95% CI 96.5, 99.5) and the PPV of the system in accurately identifying the treatment indication was 97.0% (95% CI 94.2, 98.6). The treatment indication data collected using this system allowed assessment of off-label prescribing.
Conclusions: The electronic prescribing system offers a valid method for documenting treatment indication at the time of prescribing. Our results provide strong evidence to support incorporating mandatory recording of treatment indication in integrated electronic prescribing systems to provide a critical piece of information for the evaluation of safety and effectiveness of drugs.
References
Wiholm BE, Olsson S, Moore N, et al. Spontaneous reporting systems outside the US. In: Strom BL, editor. Pharmacoepidemiology. 3rd ed. Chichester: Wiley, 2000: 175–92
Kennedy DL, Goldman SA, Lillie RB. Spontaneous reporting systems outside the US. In: Strom BL, editor. Pharmacoepidemiology. 3rd ed. Chichester: Wiley, 2000: 151–74
Mittmann N, Knowles SR, Gomez M, et al. Evaluation of the extent of under-reporting of serious adverse drug reactions: the case of toxic epidermal necrolysis. Drug Saf 2004; 27(7): 477–87
Hochberg AM, Pearson RK, O’Hara DJ, et al. Drug-versus-drug adverse event rate comparisons: a pilot study based on data from the US FDA Adverse Event Reporting System. Drug Saf 2009; 32(2): 137–46
Currie CJ, MacDonald TM. Use of routine healthcare data in safe and cost-effective drug use. Drug Saf 2000 Feb; 22(2): 97–102
Avorn J. Drug warnings that can cause fits: communicating risks in a data-poor environment. N Engl J Med 2008 Sep 4; 359(10): 991–4
Ornum MV. E-prescribing safely. In: Van Ornum M, editor. Electronic prescribing: a safety and implementation guide. Toronto (ON): Jones and Bartlett Publishers, 2009
Millonig MK, Jackson TL, Ellis WM. Improving medication use through pharmacists’ access to patient-specific health care information. J Am Pharm Assoc (Wash) 2002 Jul; 42(4): 638–45
Tamblyn R, Huang A, Kawasumi Y, et al. The development and evaluation of an integrated electronic prescribing and drug management system for primary care. J Am Med Inform Assoc 2006 Mar 1; 13(2): 148–59
Wang CJ, Marken RS, Meili RC, et al. Functional characteristics of commercial ambulatory electronic prescribing systems: a field study. J Am Med Inform Assoc 2005 May; 12(3): 346–56
Eguale T, Tamblyn R, Winslade N, et al. Detection of adverse drug events and other treatment outcomes using an electronic prescribing system. Drug Saf 2008; 31(11): 1005–16
Vigilance Santé [online]. Available from URL: http://www.vigilance.ca/en/index.html [Accessed 2009 Dec 12]
Health Canada. Health Canada drug product database [online]. Available from URL: http://webprod.hc-sc.gc.ca/dpd-bdpp/index-eng.jsp [Accessed 2009 Jul 7]
Rethans JJ, Martin E, Metsemakers J. To what extent do clinical notes by general practitioners reflect actual medical performance? A study using simulated patients. Br J Gen Pract 1994 Apr; 44(381): 153–6
Whitelaw FG, Nevin SL, Milne RM, et al. Completeness and accuracy of morbidity and repeat prescribing records held on general practice computers in Scotland. Br J Gen Pract 1996 Mar; 46(404): 181–6
Hogan WR, Wagner MM. Accuracy of data in computer-based patient records. J Am Med Inform Assoc 1997 Sep; 4(5): 342–55
Thiru K, Hassey A, Sullivan F. Systematic review of scope and quality of electronic patient record data in primary care. BMJ 2003 May 17; 326(7398): 1070–2
Jordan K, Porcheret M, Croft P. Quality of morbidity coding in general practice computerized medical records: a systematic review. Fam Pract 2004 Aug; 21(4): 396–412
Fleiss JL. Statistical methods for rates and proportions. 2nd ed. New York: Wiley, 1981
Strom BL, Melmon KL, Miettinen OS. Post-marketing studies of drug efficacy: why? Am J Med 1985 Mar; 78(3): 475–80
Radley DC, Finkelstein SN, Stafford RS. Off-label prescribing among office-based physicians. Arch Intern Med 2006 May 8; 166(9): 1021–6
ESI Canada. Therapy class ranking (top 100 ranked by total claim cost): prescriptions filled from 01/2005 through 12/2005 compared to 01/2006 through 12/2006, Quebec [online]. Available from URL: http://www.esi-canada.com/aboutus/news/health_newsflashes/master_rankings_top100_2006_Quebec_updated.pdf [Accessed 2009 Oct 6]
Health Canada. Government of Canada supports electronic health record system that will save time and lives [online]. Available from URL: http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/_2009/2009_14-eng.php [Accessed 2009 Jul 8]
Bristol N. Obama allocates funds for health-care priorities. Lancet 2009 Mar 14; 373(9667): 881–2
ESI Canada. Optimizing the value of health benefits: pharmacy claims: drug claim adjudication [online]. Available from URL: http://esi-canada.com/clients/pharmacyclaims/ [Accessed 2009 Jan 12]
Acknowledgements
This study was carried out by the Clinical and Health Informatics Research Group, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
The study was funded by Ministère de la Santé et des Services Sociaux (MSSS), Québec. Tewodros Eguale is supported by The Canadian Institutes of Health Research (CIHR) Frederick Banting and Charles Best Canada Graduate Scholarship. David Buckeridge is supported by a Canada Research Chair in Public Health Informatics. Robyn Tamblyn, Nancy Winslade and James Hanley have no conflicts of interest to declare.
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Eguale, T., Winslade, N., Hanley, J.A. et al. Enhancing Pharmacosurveillance with Systematic Collection of Treatment Indication in Electronic Prescribing. Drug-Safety 33, 559–567 (2010). https://doi.org/10.2165/11534580-000000000-00000
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DOI: https://doi.org/10.2165/11534580-000000000-00000