E-Prescribing With Decision Support Is Associated With Improvements in Medication Adherence

Objectives: To evaluate whether provider adoption and use of the formulary decision support element of e-prescribing were directly associated with significant prescriber and patient behavior change. Study Design: Retrospective, observational prepost study comparing a treatment group with a control group. Methods: Pharmacy fill information and provider enrollment records from January 2009 to December 2011 were used to compare fill volumes-primary fill and subsequent refill volume by retail and mail order fulfillment channels-of prescribers who had adopted e-prescribing (treatment group) with those who had not (control group). Propensity scores were used to match treatment and control groups by baseline prescribing patterns. Primary outcomes of interest were prepost differences for 90-day retail fills, initial fills (primary adherence), and subsequent refills. Results: E-prescribers demonstrated significantly higher average increases in 90-day retail fills (+ 2.8 fills per provider, P <. 001), primary adherence (+ 12.0 fills per provider, P <. 001), and subsequent adherence (second fill: + 4.5 fills per provider, P <. 001; and third fill: + 2.4 fills per provider, P <. 001) compared with non-e-prescribers. Conclusions: Provider adoption and use of e-prescribing applications with formulary decision support were associated with significant prescriber and patient behavior change in a large, nationally representative population. E-prescribing adoption was positively associated with prescribers' selection of longer supply prescriptions and improvements in adherence. E-prescribing infrastructure may allow for additional provider messaging opportunities designed to improve quality of care and patient outcomes.