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Pharmacy e-Prescription Dispensing Before and After CancelRx Implementation

Pitts SI, Olson S, Yanek LR, Wang N, Woodroof T, Chen AR. Pharmacy e-Prescription Dispensing Before and After CancelRx Implementation. JAMA Intern Med. 2023;183(10):1120–1126. doi:10.1001/jamainternmed.2023.4192

The primary objective of this study was to evaluate the impact of implementing e-prescription cancellation messaging (CancelRx) on medication dispensing after e-prescription discontinuation within the electronic health record (EHR).  Pitts et al. conducted a case series study with an interrupted time series analysis design at an urban academic medical center, spanning from one year before CancelRx implementation on January 15, 2018, to approximately a year after, concluding on December 7, 2019. The study also aimed to investigate variations in medication dispensing patterns based on factors such as pharmacy and medication class.

The study included patients who received at least one e-prescription in ambulatory care within a two-year period surrounding CancelRx’s January 15, 2019 implementation. The analysis covered pre-post comparisons, variations by pharmacy and medication class using EHR and pharmacy software data and excluded reordered prescriptions. Instead of traditional control and intervention groups, the study assessed medication dispensing changes across the entire patient population within the specified timeframe.

The study encompassed 53,298 qualifying e-prescriptions and 17,451 patients, with an average age of 50.6 years, of whom 53.5% were women. Following CancelRx implementation, 85.9% of discontinued e-prescriptions resulted in a CancelRx transaction, leading to a substantial reduction in the proportion of prescriptions dispensed after discontinuation from 8.0% to 1.4% (p < 0.001), with no significant week-to-week variation. This highlights an immediate and enduring decrease in the proportion of e-prescriptions dispensed after discontinuation in the EHR due to CancelRx. The observed variations in dispensing patterns by pharmacy and medication class, both pre- and post-CancelRx implementation, offer insights into potential medication safety impacts. Variations existed in pharmacy behavior, with some showing leniency in dispensing post-discontinuation while others adhered strictly. Medication classes also exhibited differing patterns, indicating the need for tailored monitoring. After CancelRx adoption, these variations persisted, highlighting the diverse response among pharmacies and medication classes and guiding strategies to enhance medication safety. The study recommends broad CancelRx implementation to reduce dispensing errors, but it’s important to acknowledge limitations, including the absence of traditional control and intervention groups and potential specificity to the studied healthcare system. Additionally, the analysis didn’t delve deeply into other factors influencing medication dispensing patterns.

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