Study: electronic prescribing can increase medication overuse

Electronic prescribing (e-prescribing) improves medication access by making it easier for patients to order repeat medication. A new study from researchers at the VATT Institute for Economic Research, University of Jyväskylä, University of Turku, and University of Pennsylvania, shows that e-prescribing increases the use of repeat medication but potentially also promotes prescription drug abuse, especially among younger adults.

Investments in e-prescribing are growing around the world. Using comprehensive administrative data and the rollout of a nationwide electronic prescribing system in Finnish primary care, the study evaluates the effects of e-prescribing on pharmaceutical use and health outcomes.

E-prescribing makes it easier to renew or order repeat prescriptions, and patients can renew their prescriptions even without having to see a physician. E-prescribing can thus encourage patients to continue their medication. E-prescribing systems are also designed to limit medication overuse by providing physicians with more comprehensive information on a patient’s prescription history.  The results of the study, however, suggest that e-prescribing can lead to medication overuse and health harms.

Prescription drug abuse increases among younger adults

The study examines patients treated with benzodiazepines, such as Valium and Xanax. The adoption of e-prescribing in primary care increased benzodiazepines use among younger patients under the age of 40. This increase results from repeat prescriptions, especially in higher prescribed doses.

Benzodiazepines are among the most widely used psychotropic drugs in developed countries. These prescription drugs are considered effective treatments for common and often disabling conditions, such as anxiety, panic disorder, and insomnia. Overuse of benzodiazepines is, however, harmful because it can cause adverse health effects such as dependence, abuse, and elevated risk of suicide. Long-term use of benzodiazepines increases these health risks and the easier renewal of prescriptions through e-prescribing can promote medication overuse and thereby cause health harms. In Finland, one million individuals (nearly 20% of the population) have received at least one prescription for benzodiazepines during the period 2007–2014.

“Despite the increase in the repeat use of benzodiazepines among younger patients, we find no evidence of an improvement in these patients’ health. In fact, e-prescribing increases specialised health care admissions related to prescription drug abuse and suicide attempts dramatically, by nearly 20%,” says Tanja Saxell, Senior Researcher at VATT.

Prescription drug abuse disorders and mental health problems are already more prevalent in the younger patient population.

Among older patients aged over 40, e-prescribing has no impact on the use of benzodiazepines or their health outcomes. The study indirectly suggests that older patients might already have lower barriers to continue taking benzodiazepines because it is more common for them to have repeat prescriptions. 

Toward better renewal practices

The researchers emphasize that more attention should be paid to the process of renewing prescriptions for potentially harmful medications, especially in the case of younger adults. Patient monitoring and direct physician-patient interaction could help to screen and prevent potential medication overuse. The physician writing a repeat prescription does not always see the patient and they might not be aware of the health problems triggered by the medication.

“It is possible that patients access repeat prescriptions too easily. This can be a problem, especially with medicines that can cause addiction and other health harms,” says Liisa Laine, researcher at the University of Pennsylvania.

 

The study uses administrative data on benzodiazepine prescriptions from the Social Insurance Institution of Finland over the period 2007–2014. The patient health outcomes are based on the National Institute for Health and Welfare’s administrative data on diagnoses in specialized health care throughout the same period.

The study is part of a larger project, which analyses the effects of health information technology, and of Mikko Nurminen’s doctoral thesis under preparation. The study is funded by the Yrjö Jahnsson Foundation.

 

Study:
Petri Böckerman, Mika Kortelainen, Liisa T. Laine, Mikko Nurminen, and Tanja Saxell: Digital Waste? Unintended Consequences of Health Information Technology 
http://urn.fi/URN:ISBN:978-952-274-235-3