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Please verify. Didn't receive verification mail? You can now login with your mobile number too. Register Mobile Number. The diseases used in previous evaluation studies were unique in that the drugs typically prescribed for treatment were used only for the dis- ease in question. Tuberculosis [1,2] and pertussis [3] have been studied in this way. When a drug is used exclusively for one medical condition then the prescrip- tion rate of that drug is clearly valuable for surveillance of that condition.
How- ever, most drugs, especially antibiotics, are used for multiple diseases and this complicates their use in surveillance. Some new e-prescribing systems require documentation of a therapeutic in- dication for each prescribed drug. These indication data allow us to discover D.
Zeng et al. In this paper, we evaluate the potential utility of data from such an e-prescribing system to de- termine whether antibiotic prescriptions can be used to conduct surveillance for respiratory infection. MOXXI was developed as a portable elec- tronic prescribing system for primary-care physicians to write and transmit pre- scriptions. The MOXXI system requires that a therapeutic indication be entered by the physician at the time of prescribing.
The therapeutic indication may be entered as free-text, or it may be picked from a list. The 90 physicians that participated continuously in MOXXI during the stud- ied time interval were considered the study physician group. A physician was considered to be participating in MOXXI if they had signed the participation form before May 1st, and were using the system regularly during the fol- lowing year.
The physicians progressively consented more patients during the study, and thus the size of the MOXXI patient cohort increased over the study interval. At the start of the interval the MOXXI patient cohort comprised 7, patients, while at the end it comprised 18, patients. Buckeridge, A. Verma, and R. Tamblyn 2. The medical service claims database from RAMQ was used to determine the population of patients who had received a medical service through pub- lic insurance over this interval from one of the study physician group.
A weekly aggregated time-series was created for both the common respiratory tract antibiotics, as well as their therapeutic indi- cations, normalized by the number of patients in the cohort that month. There was also a slight tendency towards more female patients in the MOXXI cohort when compared to the general population Table 2. There were 78, prescriptions each with an associated therapeutic indica- tion recorded for the MOXXI cohort patients over the studied interval.
The sensitivity of all three drugs together is high The time-series for respiratory tract indications peaks during the winter months, following the expected seasonal trend Figure 1. The weekly-aggregated time-series for the three antibiotics and the three therapeutic indications were strongly correlated with the weekly trend in respiratory infections 0.
The table has been normalized by the number of patients and shows only the proportion of patients in a given age range. The table has been normalized by the number of patients. In this study we demonstrated the potential utility of the data captured in these systems for surveillance. The time-series of the top three drug prescriptions and the time-series for respiratory infection indication in summer months and higher incidence in winter months. We also have demon- strated that a set of antibiotics used for respiratory infections, as well as other conditions, follows the same seasonal trend as the indications for respiratory infections.
While our results demonstrate the potential utility of e-prescribing data for surveillance, we also noted important biases in the use of e-prescribing. Most notably, physicians tended to use the e-prescribing software more for elderly pa- tients and females, while the software was used infrequently for young children. These biases could prove important in surveillance. The interval over which the therapeutic indications and prescriptions were studied was relatively short 1 year , and in future work we will use a longer interval to allow more detailed seasonal analysis.
Finally, while the therapeutic indications given in MOXXI were picked by physicians from a list, there has been no validation of these indications against medical charts. Future work may include studying the validity of theraoeytuc indications through chart audit and the ICD-9 code given in the medical service database. Ambulatory e-Prescribing: Evaluating a Novel Surveillance Data Source 5 Conclusions The results of this study suggest that electronic prescribing systems may be useful for the surveillance of respiratory infections.
Therapeutic indications for respiratory infections follow the expected seasonal trend and a set of antibiotics predict these indications accurately.
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