While facing the growing trend of patients with multiple chronic conditions, health authorities around the globe have intended to improve care coordination between healthcare providers via sharing patients’ health information. A recent study from Taiwanese researchers revealed that a prescription record sharing program entitled “PharmaCloud” platform under a single-payer system might have reduce duplication of medication; however higher inquiry rate did not lead to greater reduction in medication duplication. The study was led by researchers at National Taiwan University College of Public Health and published in International Journal of Medical Informatics in August.
Under the single-payer health system, the National Health Insurance (NHI) Administration introduced a medication record sharing program in 2013 by utilizing prescription claims data nationwide. Mr. Jin-Hung Lin, a doctoral student at the institute of health policy and management, and Dr. Shou-Hsia Cheng, professor and Mr. Lin’s advisor, have investigated the preliminary impact of the PharmaCloud on medication duplication of anti-glycemic medicine among diabetes patients.
They also examined the role of PharmaCloud inquiry rate in this study by employing a pre-post study design with a comparison group with nationwide National Health Insurance (NHI) claims data. A total of 106,508 diabetes patients were included in the analysis. Subjects with PharmaCloud records of anti-glycemic medication being inquired or downloaded more frequently (upper 25th percentile) were classified as the high-inquiry group, while the remaining less-inquired subjects were classified as the low-inquiry group. Generalized equation models with difference-in-difference (DID) analysis were conducted.
They found that after the implementation of the PharmaCloud program, the rates and days of medication duplication have been reduced significantly. However, the DID effect showed that higher inquiry group tended to have higher probability of receiving duplicated medication (odds ratio= 1.11, P<0.001) and longer overlapped days. “The findings were out of expectation.” said Dr. Cheng, and they proposed 2 possible reasons for the unexpected results. “First, the inquiry rate was still low, around 30 percent which could not differentially impact the high and low inquiry rate groups. Second, physicians failed to review the inquired/downloaded medication records during the visits.” On the other hand, by using the medication records retrieved from the sharing platform, hospitals may have enhanced the medication alert function to prevent or prohibit the entry of overlapped medications in their information systems. Thus would decrease the occurrence of medication duplication within the hospitals, especially large scale hospitals with advanced information systems.
Source: Lin JH, Cheng SH. The impact of a medication record sharing program among diabetes patients under a single-payer system: The role of inquiry rate. Int J Med Inform 2018;116:18-23