Why do Belgian Community Pharmacists Still Treat Electronic Prescriptions as Paper-Based?

Belgium is in a transition phase from paper-based prescriptions to electronic prescriptions (ePrescriptions) during which both the paper and electronic format are valid. Since patients still get a paper proof of the ePrescription, sometimes pharmacists use the ePrescription as paper-based prescription. When the government demands a complete dematerialization, i.e. no more paper-based prescriptions, this will no longer be possible. Therefore, we questioned the frequency and reasons for treating an ePrescription as paper-based. The logged interactions in the national database were used to identify possible reasons. The tarification service Koninklijk Limburgs Apothekers Verbond (KLAV) provided prescriptions of June 2018. KLAV supports tarification for community pharmacies all over Belgium, thereby providing a representative sample for the Belgian community pharmacies. A two-stage cluster random sampling technique was applied to retrieve a subset of 10,000 prescriptions. In this subset we identified 4961 ePrescriptions (49.61%) of which 226 (4.56%, in total 2.26%) were treated as paper-based. Reasons observed for this incorrect handling are (1) non-compliance of the community pharmacist; (2) errors in software or handling of the community pharmacist; (3) errors at the prescriber side or patient tries to fraud; (4) incorrectly revoking the ePrescription; and (5) errors in software of prescriber. The main reasons for treating ePrescriptions as paper-based are non-compliance of the community pharmacist (n = 124, 54.87%) by ignoring its digital nature, and errors in software or handling of the community pharmacist (n = 85, 37.61%). Future research is necessary to investigate user opinions and to measure the impact of introducing ePrescribing in the daily routine.

Electronic Prescriptions: Why Community Pharmacists Still Treat Them as Paper-Based?

Belgium is in a transition from paper-based prescriptions to electronic prescriptions (ePrescriptions). Since patients still receive a paper proof of the ePrescription, this proof is sometimes used as a paper-based prescription. In this study, the frequency of incorrect use of the paper proof was evaluated and possible reasons for incorrect use were hypothesized. In 10,000 prescriptions, 226 ePrescriptions (2.26 %) were handled incorrectly. Possible reasons for this handling are (1) non-compliance of the community pharmacist; (2) errors in software or handling of the community pharmacist; (3) errors at the prescriber side or patient tries to fraud; (4) incorrectly revoking the ePrescription; and (5) errors in prescriber's software. The presence of incentives and penalties might help in preventing this erroneous type of handling.

Implementing an electronic medication overview in Belgium.

BACKGROUND: An accurate medication overview is essential to reduce medication errors. Therefore, it is essential to keep the medication overview up-to-date and to exchange healthcare information between healthcare professionals and patients. Digitally shared information yields possibilities to improve communication. However, implementing a digitally shared medication overview is challenging. This articles describes the development process of a secured, electronic platform designed for exchanging medication information as executed in a pilot study in Belgium, called "Vitalink". FINDINGS: The goal of "Vitalink" is to improve the exchange of medication information between professionals working in healthcare and patients in order to achieve a more efficient cooperation and better quality of care. Healthcare professionals of primary and secondary health care and patients of four Belgian regions participated in the project. In each region project groups coordinated implementation and reported back to the steering committee supervising the pilot study. The electronic medication overview was developed based on consensus in the project groups. The steering committee agreed to establish secured and authorized access through the use of electronic identity documents (eID) and a secured, eHealth-platform conform prior governmental regulations regarding privacy and security of healthcare information. DISCUSSION: A successful implementation of an electronic medication overview strongly depends on the accessibility and usability of the tool for healthcare professionals. Coordinating teams of the project groups concluded, based on their own observations and on problems reported to them, that secured and quick access to medical data needed to be pursued. According to their observations, the identification process using the eHealth platform, crucial to ensure secured data, was very time consuming. Secondly, software packages should meet the needs of their users, thus be adapted to daily activities of healthcare professionals. Moreover, software should be easy to install and run properly. The project would have benefited from a cost analysis executed by the national bodies prior to implementation.

Detecting pre-diabetes and the role of the pharmacist / Detección de pre-diabetes y el papel del farmacéutico

Objective: This study aims to use a pharmacoepidemiological approach to study the drug use of patients during the year prior to diabetes diagnosis (i.e. pre-diabetic patients) and control patients. Drug use might reveal cardiovascular, metabolic and/or endocrinological changes and help to identify indicators for active monitoring of Type 2 diabetes mellitus. Methods: A retrospective case-control study compared drug use of patients with a future diagnosis of diabetes (experimental patients) with patients without a diabetes diagnosis (control patients) based on community pharmacy records. An experimental patient had used oral hypoglycaemic drugs during 2005 or 2006. Experimental and control patients were matched in terms of age, gender and quarter of index date. Drugs were selected based on possible comorbidities of diabetes. Drug use was expressed as a binary variable, indicating whether or not a patient took specific drugs. Drug use was compared between experimental patients during the year prior to diagnosis and control patients using the chisquared test. Results: Our dataset covered 5,064 patients (1,688 experimental and 3,376 control patients). A higher probability of taking cardiovascular drugs was observed for specific subgroups of patients with prediabetes as compared to control patients: this trend was observed for men as well as for women, for various cardiovascular drug classes, and for different age groups (p<0.05), although it was not always statistically significant for the 29-38 age group. For each selected age and gender group, patients with pre-diabetes had a higher probability of taking a combination of a lipid-modifying agent and an antihypertensive drug than control patients (p<0.005). Conclusions: Using community pharmacy data, this study demonstrated that age and a characteristic drug use pattern could contribute to detecting pre-diabetes. There is a potential role for community pharmacists to follow up drug indicators of patients with a view to refer high-risk people for screening by a physician (AU)

Objetivo: Este estudio trata de usar un abordaje farmacoepidemiológico para estudiar el uso de medicamentos durante el año anterior al diagnóstico de diabetes (i.e. pacientes prediabéticos) y pacientes control. El uso de medicamentos podría revelar cambios cardiovasculares, metabólicos y/o endocrinos y ayudar a identificar indicadores para la monitorización activa de la diabetes mellitus tipo 2. Métodos: Un estudio caso-control retrospectivo, basado en los historiales de farmacias comunitarias, comparó el uso de medicamentos de pacientes con un diagnóstico futuro de diabetes (pacientes experimentales) con pacientes sin diagnóstico de diabetes (pacientes control). Un paciente experimental había usado medicamentos durante 2005 o 2006. Los pacientes experimentales y controles fueron emparejados en relación a edad, genero, trimestre de indexación. Los medicamentos fueron seleccionados en base a las posibles comorbilidades de la diabetes. El uso de medicamentos se expresó como una variable binaria, indicando si el paciente había o no tomado un medicamento específico. Se comparó el uso de medicamentos entre los pacientes experimentales durante el año anterior al diagnóstico y los pacientes control utilizando el test chi cuadrado. Resultados: Nuestro fichero incluyó 5.064 pacientes (1.688 experimentales y 3.376 control). En subgrupos específicos de pacientes con prediabetes, se observó una mayor probabilidad de tomar medicamentos cardiovasculares que en los pacientes control: esta tendencia apareció tanto en hombres, como en mujeres, para varios grupos terapéuticos de medicamentos cardiovasculares, y para diferentes grupos etarios (p<0,05), aunque no fue estadísticamente significativo para el grupo de 29-38 años. Para cada grupo seleccionado de edad y género, los pacientes con pre-diabetes tenían una probabilidad mayor de tomar una combinación de anti-hiperlipémico y antihipertensivo que los controles (p<0,005). Conclusiones: Utilizando datos de farmacias comunitarias, este estudio demostró que la edad y un patrón de uso de medicamentos característico puede contribuir a detectar pre-diabetes. Existe un papel potencial del farmacéutico siguiendo los indicadores de medicamentos de pacientes con vistas a remitir a los médicos personas de alto riesgo (AU)

Detecting pre-diabetes and the role of the pharmacist.

OBJECTIVE: This study aims to use a pharmacoepidemiological approach to study the drug use of patients during the year prior to diabetes diagnosis (i.e. pre-diabetic patients) and control patients. Drug use might reveal cardiovascular, metabolic and/or endocrinological changes and help to identify indicators for active monitoring of Type 2 diabetes mellitus. METHODS: A retrospective case-control study compared drug use of patients with a future diagnosis of diabetes (experimental patients) with patients without a diabetes diagnosis (control patients) based on community pharmacy records. An experimental patient had used oral hypoglycaemic drugs during 2005 or 2006. Experimental and control patients were matched in terms of age, gender and quarter of index date. Drugs were selected based on possible co-morbidities of diabetes. Drug use was expressed as a binary variable, indicating whether or not a patient took specific drugs. Drug use was compared between experimental patients during the year prior to diagnosis and control patients using the chi-squared test. RESULTS: Our dataset covered 5,064 patients (1,688 experimental and 3,376 control patients). A higher probability of taking cardiovascular drugs was observed for specific subgroups of patients with pre-diabetes as compared to control patients: this trend was observed for men as well as for women, for various cardiovascular drug classes, and for different age groups (p<0.05), although it was not always statistically significant for the 29-38 age group. For each selected age and gender group, patients with pre-diabetes had a higher probability of taking a combination of a lipid-modifying agent and an antihypertensive drug than control patients (p<0.005). CONCLUSIONS: Using community pharmacy data, this study demonstrated that age and a characteristic drug use pattern could contribute to detecting pre-diabetes. There is a potential role for community pharmacists to follow up drug indicators of patients with a view to refer high-risk people for screening by a physician.

Cardiovascular drug use prior to diagnosis of diabetes: a pilot study in community pharmacy.

OBJECTIVES: The literature indicates that cardiovascular drug use is higher during the years prior to diagnosis of type 2 diabetes mellitus. As there are pharmaco-epidemiological and economic consequences of enhanced medication use prior to diagnosis of diabetes, there is a need for a comparative analysis of the drug-use pattern by patients with a subsequent diagnosis of diabetes and control patients. This pilot study aimed to investigate cardiovascular drug use in patients with a subsequent diagnosis of diabetes using data extracted from 200 community pharmacies in the Belgian township of Hasselt. METHODS: Based on community pharmacy data, a retrospective case-control study compared the drug use of patients with a subsequent diagnosis of type 2 diabetes (cases) with patients without a subsequent diagnosis (controls). Cases were identified if patients started taking metformin (and possibly other drugs used in diabetes) during the 2004-2006 study period. Drug use was expressed as a binary variable, reflecting whether or not a patient took drugs belonging to a specific cardiovascular subclass. KEY FINDINGS: Our dataset consisted of 158 cases with a subsequent diagnosis of type 2 diabetes and 632 control patients. Patients with a subsequent diagnosis of type 2 diabetes had a higher propensity to take cardiovascular drugs prior to diagnosis than control patients. This trend was observed across all cardiovascular drug classes, except for calcium-channel blockers, and was statistically significant for beta-blocking agents and agents acting on the renin-angiotensin system. CONCLUSIONS: A positive association was observed between cardiovascular drug use and subsequent diagnosis of type 2 diabetes. This study emphasizes the potential role for community pharmacy in early identification of diabetes using more targeted screening based on cardiovascular drug use as derived from pharmacy databases.