"Evaluating trends in pharmacist e-prescribing: 2019-2022.

BACKGROUND: Pharmacists have some prescriptive authority in all fifty states through dependent and independent prescribing. Data describing the volume and characteristics of pharmacist prescribing are not widely available, and these insights are critical to gauge the impact of regulations supporting pharmacist prescriptive authority. OBJECTIVE: To identify trends in pharmacist prescribing and compare them to primary care provider (PCP) prescribing trends by analyzing e-prescriptions initiated from electronic health records systems (EHRs) from 2019 through 2022. METHODS: This cross-sectional study used e-prescriptions from a national health information network to identify e-prescriptions ordered by pharmacists and PCPs from January 7, 2019, to January 1, 2023. E-prescriptions ordered by pharmacists and PCPs were analyzed to identify annual volume by prescriber type and most prescribed therapeutic classes. States with the highest volume of e-prescriptions ordered by pharmacists were identified. RESULTS: The number of e-prescriptions prescribed by a pharmacist increased 47% from 2019 (n=814,726) to 2022 (n=1,199,601). The number of pharmacists prescribing in 2019 was 1650, and this increased by 122% to 3664 in 2022. The number of e-prescriptions prescribed by PCPs increased by 4% from 2019 (n=927,890,123) to 2022 (n=965,803,376) while the number of PCPs prescribing increased by 8% from 2019 (n=364,995) to 2022 (n=394,753). CONCLUSION: Pharmacist e-prescribing increased across the four years studied while PCP e-prescribing modestly increased. Factors like access to technology, such as electronic health records, state regulations, and reimbursement impact a pharmacist's ability to prescribe.

Patient Perspectives on Self-Monitoring of Blood Glucose When not Using Insulin: a Cross-sectional Survey.

BACKGROUND: Professional societies have recommended against use of self-monitoring blood glucose (SMBG) in non-insulin-treated type 2 diabetes (NITT2D) to control blood sugar levels, but patients are still monitoring. OBJECTIVE: To understand patients' motivation to monitor their blood sugar, and whether they would stop if their physician suggested it. DESIGN: Cross-sectional in-person and electronic survey conducted between 2018 and 2020. PARTICIPANTS: Adults with type 2 diabetes not using insulin who self-monitor their blood sugar. MAIN MEASURES: The survey included questions about frequency and reason for using SMBG, and the impact of SMBG on quality of life and worry. It also asked, "If your doctor said you could stop checking your blood sugar, would you?" We categorized patients based on whether they would stop. To identify the characteristics independently associated with desire to stop SMBG, we performed a logistic regression using backward stepwise selection. KEY RESULTS: We received 458 responses. The common reasons for using SMBG included the doctor wanted the patient to check (67%), desire to see the number (65%), and desire to see if their medications were working (61%). Forty-eight percent of respondents stated that using SMBG reduced their worry about their diabetes and 61% said it increased their quality of life. Fifty percent would stop using SMBG if given permission. In the regression model, respondents who said that they check their blood sugar levels because "I was told to" were more likely to want to stop (AOR: 1.69, 95%CI: 1.11, 2.58). Those that used SMBG due to habit and to understand their diabetes better had lower odds of wanting to stop (AOR: 0.33, 95%CI: 0.18-0.62; AOR: 0.60, 95%CI: 0.39-0.93, respectively). CONCLUSIONS: Primary care physicians should discuss patients' reasons for using SMBG and offer them the option of discontinuing.

The Association Between Physician Race/Ethnicity and Patient Satisfaction: an Exploration in Direct to Consumer Telemedicine.

BACKGROUND: Patient satisfaction measures have important implications for physicians. Patient bias against non-White physicians may impact physician satisfaction ratings, but this has not been widely studied. OBJECTIVE: To assess differences in patient satisfaction by physician race/ethnicity. DESIGN: A cross-sectional observational study. PARTICIPANTS: Patients seeking care on a large nationwide direct to consumer telemedicine platform between July 2016 and July 2018 and their physicians. MAIN MEASURES: Patient satisfaction was ascertained immediately following the encounter on scales of 1 to 5 stars and scored two ways: (1) top-box satisfaction (5 stars versus fewer) and (2) dissatisfaction (2 or fewer stars versus 3 or more). To approximate the information patients would use to make assumptions about physician race/ethnicity, four reviewers classified physicians into categories based on physician name and photo. These included White American, Black American, South Asian, Middle Eastern, Hispanic, and East Asian. Mixed effects logistic regression was used to assess differences in patient top-box satisfaction and patient dissatisfaction by physician race/ethnicity, controlling for patient characteristics, prescription receipt, physician specialty, and whether the physician trained in the USA versus internationally. KEY RESULTS: The sample included 119,016 encounters with 390 physicians. Sixty percent were White American, 14% South Asian, 7% Black American, 7% Hispanic, 6% Middle Eastern, and 6% East Asian. Encounters with South Asian physicians (aOR 0.70; 95% CI 0.54-0.91) and East Asian physicians (aOR 0.72; 95% CI 0.53-0.99) were significantly less likely than those with White American physicians to result in top-box satisfaction. Compared to encounters with White American physicians, those with Black American physicians (aOR 1.72; 95% CI 1.12-2.64), South Asian physicians (aOR 1.77; 95% CI 1.23-2.56), and East Asian physicians (aOR 2.10; 95% CI 1.38-3.20) were more likely to result in patient dissatisfaction. CONCLUSIONS: In our study, patients reported lower satisfaction with some groups of non-White American physicians, which may have implications for their compensation, professional reputation, and job satisfaction.