Effects of training physicians in electronic prescribing in the outpatient setting on clinical, learning and behavioural outcomes, a cluster randomized trial

Abstract

Aims

Electronic prescribing systems may improve medication safety, but only when used appropriately. Effects of a task-analysis based training were evaluated in the outpatient setting on clinical, learning and behavioral outcomes, compared with usual educational approach.

Methods

Multicenter, cluster-randomized trial (MEDUCATE trial) with physicians as unit of analysis. Setting: Outpatient clinics of two academic hospitals. Participants: Specialist and residents of internal medicine and their patients. Intervention: Small group session, e-Learning. Primary outcome: proportion of medication discrepancies per physician: measured as discrepancies between medications registered by physicians in the electronic prescribing system and those reported by patients. Clinical consequences: estimated by the proportion of patients per physician with at least one missed drug-drug interaction with potential for causing adverse drug events. A questionnaire assessed physicians' knowledge and skills.

Results

Among 124 participating physicians, for 115 (93%) data for the primary outcome were available. 1094 patients were included. A mean of 48% of registered medications per physician were discrepant with the medications their patients reported in both groups (p=0.14). Due to registration omissions, a mean of 4% of patients per physician had one or more missed drug-drug interactions with the potential to cause a clinically relevant adverse drug event in the intervention group, and 7% in controls (p=0.11). Percentage correct answers on the knowledge and skills-test were higher in the intervention group (57%) compared to controls (51%; p=0.01).

Conclusion

The training equipped outpatient physicians with knowledge and skills for appropriate use of electronic prescribing systems, but had no effect on medication discrepancies.

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