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E-Prescribing and Adverse Drug Events: An Observational Study of the Medicare Part D Population With Diabetes

Gabriel, Meghan Hufstader PhD; Powers, Christopher PharmD; Encinosa, William PhD; Bynum, Julie P.W. MD, MPH

doi: 10.1097/MLR.0000000000000684
Original Articles

Background: Although the adoption of e-prescriptions among physicians has increased substantially under the Medicare Improvements for Patients and Providers Act and Meaningful Use programs, little is known of its impact on patient outcomes.

Objective: To examine the impact of e-prescribing on emergency visits or hospitalizations for diabetes-related adverse drug events (ADEs) including hypoglycemia.

Design: This is a prospective, observational cohort study with patient fixed effects.

Setting: 2011–2013 fee for service Medicare.

Patients: In total, 3.1 million Medicare fee for service, Part D enrolled beneficiaries over age 66 with diabetes mellitus and at least 90 days of antidiabetic medications.

Measurements: E-prescribing was measured as the percentage of all prescriptions a person received transmitted to the pharmacy electronically. The outcome measure was the occurrence of an emergency department (ED) visit or hospitalization for hypoglycemia or diabetes-related ADE.

Results: Unadjusted results show that there were 21 ADEs per 1000 beneficiaries that had ≥75% of their medications e-prescribed. Beneficiaries with lower e-prescribing levels had significantly higher numbers of ADEs. We found a robust association between the greater use of electronic prescriptions in the outpatient setting and the lower risk of an inpatient or ED visit for an ADE event among Medicare beneficiaries with diabetes in our adjusted analysis. At the e-prescribing threshold of 75% and above, significant reductions in ADE risk can be seen.

Limitations: As an observational study, the results show an association but do not prove causation.

Conclusions: Use of e-prescribing is associated with lower risk of an ED visit or hospitalization for diabetes-related ADE.

*Department of Health Management and Informatics, University of Central Florida, Orlando, FL

Centers for Medicare and Medicaid Services, Office of Enterprise Data and Analytics, Baltimore, MD

Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, Rockville, MD

§The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH

IRB approval: this manuscript had to be cleared by CMS before submission.

No direct funding was provided for this study although 2 investigators were employees of the Department for Health and Human Services.

The authors declare no conflict of interest.

Reprints: Meghan Hufstader Gabriel, PhD, Department of Health Management and Informatics, University of Central Florida, 4364 Scorpius Street HPA II, Orlando, FL 32816. E-mail:

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