Effects of an e-Prescribing interface redesign on rates of generic drug prescribing: exploiting default options

Malhotra, Sameer; Cheriff, Adam D.; Gossey, J Travis; Cole, Curtis L.; Kaushal, Rainu; Ancker, Jessica S.

doi:10.1093/jamia/ocv192

Cited by 45 publications

(44 citation statements)

References 37 publications

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“…With the widespread use of electronic medical records and computerized order entry, a simple solution may be to direct a physician to select a generic name by limiting the medication options to generic nomenclature. These ‘default options’ have been shown to be effective at increasing rates of generic prescribing [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Examining patterns in medication documentation of trade and generic names in an academic family practice training centre

et al. 2017

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BackgroundStudies in the United States have shown that physicians commonly use brand names when documenting medications in an outpatient setting. However, the prevalence of prescribing and documenting brand name medication has not been assessed in a clinical teaching environment. The purpose of this study was to describe the use of generic versus brand names for a select number of pharmaceutical products in clinical documentation in a large, urban academic family practice centre.MethodsA retrospective chart review of the electronic medical records of the St. Michael’s Hospital Academic Family Health Team (SMHAFHT). Data for twenty commonly prescribed medications were collected from the Cumulative Patient Profile as of August 1, 2014. Each medication name was classified as generic or trade. Associations between documentation patterns and physician characteristics were assessed.ResultsAmong 9763 patients prescribed any of the twenty medications of interest, 45% of patient charts contained trade nomenclature exclusively. 32% of charts contained only generic nomenclature, and 23% contained a mix of generic and trade nomenclature. There was large variation in use of generic nomenclature amongst physicians, ranging from 19% to 93%.ConclusionsTrade names in clinical documentation, which likely reflect prescribing habits, continue to be used abundantly in the academic setting. This may become part of the informal curriculum, potentially facilitating undue bias in trainees. Further study is needed to determine characteristics which influence use of generic or trade nomenclature and the impact of this trend on trainees’ clinical knowledge and decision-making.

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Section: Discussionmentioning

confidence: 99%

Examining patterns in medication documentation of trade and generic names in an academic family practice training centre

et al. 2017

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“…Consider the strategy of designating a desired behaviour as the default option (from which individuals can opt out), which has successfully increased participation of employees in retirement saving plans,2122 promoted energy conservation,23 and may explain large differences in organ donation consent rates across countries with different policies 24. Defaults have also been used to promote adherence to guidelines with patients dependent on ventilators25 and to increase prescribing of generic drugs 426…”

Section: Nudges Often Require Calibrationmentioning

confidence: 99%

“…Behavioural interventions directed at healthcare professionals seem especially promising given that clinicians increasingly take actions using electronic health records, so that decisions are tracked and nudges can be deployed via modifications to standardised workflows. For instance, setting prescription drugs to their generic equivalents by default, while allowing clinicians to easily opt out, increased the rate of generic prescribing from 40% to 96% in one month 4…”

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confidence: 99%

Details matter: predicting when nudging clinicians will succeed or fail

Fox

Doctor

Goldstein

et al. 2020

BMJ

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“…E-prescribing has also been associated with higher generic prescription-fill rates (Howard et al 2018). In fact, Malhotra et al (2016) found generic prescriptions more than doubled when clinical decision support systems defaulted to the generic drug.…”

Section: Background and Literature Reviewmentioning

confidence: 99%

Estimates of the Price Elasticity of Switching Between Branded and Generic Drugs

Terrizzi

Meyerhoefer

2019

Contemporary Economic Policy

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We estimate price elasticities of switching from branded to generic drugs for two widely used drugs: Prozac and Zocor. We find the price elasticity of switching varies by drug and is between 0.01 and 0.10. While elasticity estimates for Zocor are robust to the inclusion of controls for supply‐side factors, those for Prozac are not. Our results indicate consumers in managed care plans are most responsive to differences in out‐of‐pocket (OOP) cost, and we estimate that a 10% increase in the OOP cost difference between Zocor and generic Simvastatin increases an individual's probability of switching to the generic by approximately 0.3%. This would result in a modest total savings of $36,700 among our sample of 114,218 privately insured Zocor users. Our finding that individuals are relatively unresponsive to the lower prices caused by generic introduction implies that policies targeting supply‐side behavior are likely to have a larger effect on generic uptake than price‐based inducements. If generic‐uptake did occur immediately within the first 18 months after generic introduction, the total savings among individuals and insurance companies within our sample would be approximately $7 million for Zocor and $255,000 for Prozac. (JEL I11, I18)

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Effects of an e-Prescribing interface redesign on rates of generic drug prescribing: exploiting default options

Abstract: Default options in health information technology exert a powerful effect on user behavior, an effect that can be leveraged to optimize decision making.

Cited by 45 publications

References 37 publications

Examining patterns in medication documentation of trade and generic names in an academic family practice training centre

Examining patterns in medication documentation of trade and generic names in an academic family practice training centre

Details matter: predicting when nudging clinicians will succeed or fail

Estimates of the Price Elasticity of Switching Between Branded and Generic Drugs

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