Evaluation of the use of an integrated drug information system by primary care physicians for vulnerable population

Kawasumi, Yuko; Tamblyn, Robyn; Platt, Robert; Ernst, Pierre; Abrahamowicz, Michal; Taylor, Laurel

doi:10.1016/j.ijmedinf.2006.12.004

« Previous Next »International Journal of Medical Informatics
Volume 77, Issue 2 , Pages 98-106, February 2008

Evaluation of the use of an integrated drug information system by primary care physicians for vulnerable population

Yuko Kawasumi
- Department of Epidemiology and Biostatistics, McGill University, 1140 Pine Avenue W., Montreal, Quebec H3A1A3, Canada
- Corresponding author. Tel.: +1 514 843 2831x32970; fax: +1 514 843 1551.
Robyn Tamblyn
- Department of Epidemiology and Biostatistics, McGill University, 1140 Pine Avenue W., Montreal, Quebec H3A1A3, Canada
- Department of Medicine, McGill University, Montreal, Canada
Robert Platt
- Department of Epidemiology and Biostatistics, McGill University, 1140 Pine Avenue W., Montreal, Quebec H3A1A3, Canada
Pierre Ernst
- Division of Clinical Epidemiology, Royal Victoria Hospital, Montreal, Canada
Michal Abrahamowicz
- Department of Epidemiology and Biostatistics, McGill University, 1140 Pine Avenue W., Montreal, Quebec H3A1A3, Canada
Laurel Taylor
- Department of Medicine, McGill University, Montreal, Canada

Received 18 May 2006; received in revised form 18 October 2006; accepted 22 December 2006.

Abstract

Objective

To investigate whether an electronic prescribing and integrated drug information system was more likely to be used by primary care physicians for patients of low socioeconomic (SES) patients.

Methods

Prospective 9 months follow-up study was conducted in Montreal, Canada from March to November 2003. The study included 28 primary care physicians and their 4096 respective patients with provincial drug insurance. Utilization rate was defined as the number of times the electronic medication history (EMH) and electronic prescribing system (E-rx) were accessed divided by the total number of medical visits made by those patients. System audit trails (utilization), provincial health insurance databases (visits) were used to measure system utilization rate. For each patient neighborhood-based measures of household income, derived from Statistics Canada, were used to measure socioeconomic status.

Results

The EMH was used 14.5 times per 100 visits. In comparison to high SES patients, there was a significant 70% increase (RR: 1.70; 95%CI: 1.15–2.47) in the EMH utilization for low SES patients. The electronic prescribing system was used 38.5 times per 100 visits and did not vary by patient SES. The EMH utilization rate for low SES patients with multiple emergency room (ER) visits was 2.4 times higher than for high SES patients with <1 ER visit (RR: 2.38; 95%CI: 1.36–4.14). The utilization rate for low SES patients, who took, at least six drugs per day, was four times higher compared to high SES patients with less complex drug management (RR: 4.00; 95%CI: 2.22–7.17).

Conclusions

Primary care physicians were more likely to access electronic information on current drug use for patients of low SES taking multiple medications and with fragmented care.

Keywords: Drug therapy, Computer-assisted, Family physicians, Prescriptions, Drugs, Evaluation methodology, Health services utilization patterns, Socioeconomic status