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Study: E-prescriptions improved control of harmful drug combinations 

Some doctors prescribed blood thinners with anti-inflammatory drugs, raising the risk of haemorrhaging, the study says.

Aspiriineja purkissa.
The study Image: David Burton / AOP

The adoption of electronic prescriptions has improved the control of certain harmful medicine combinations, but facilitated easy access to some sedatives, according to a new study.

The analysis looked at users of the blood thinner warfarin and as well as non-steroidal anti-inflammatory drugs prescribed to them (NSAIDs) between 2007 and 2014. It also included a review of the gradual implementation of the e-prescription system throughout Finland between 2010 and 2014.

Researchers say that the simultaneous use of warfarin and NSAIDs is one of the most common and harmful drug combinations. Treatment guidelines advise against the combination of these medicines because of the increased risk of haemorrhaging and related complications.

The study noted that before the national e-prescription system was taken into use, it was fairly common for doctors to co-prescribe these two drugs. Furthermore, co-prescriptions tended to occur primarily in rural areas.

According to researchers from the VATT economic research unit, Jyväskylä University, Turku University and the University of Pennsylvania, the use of e-prescriptions reduced the combined use of warfarin and anti-inflammatory drugs by 35 percent in rural municipalities.

"In comparison to providers’ pre-existing incompatible health information systems, the e-prescribing systems allowed physicians involved in a patient’s care to obtain more comprehensive information on prescriptions. Our results demonstrate the potential of such integrated information systems in mitigating coordination failures and improving the quality of care," VATT senior researcher Tanja Saxell said in a statement.

The research team found that the co-prescription problem was largely due to prescriptions being issued by general practitioners, and drugs prescribed by multiple doctors. It said that the change that occurred after the rollout of the e-prescription system was especially due to improvements in medical care provided by non-specialist physicians in municipalities where safety enhancements were observed. Similar improvements were not detected in more urban municipalities.

"A plausible explanation for the results is that the lack of specialised physicians in rural regions not only limits access to specialist medical services, but also the ability of general practitioners to consult and learn from specialists," Turku University doctoral researcher Mikko Nurminen noted.

E-prescriptions sometimes problematic

The research team also looked at the impact of e-prescriptions on the use of sedatives. A study published in April 2019 indicated that the use of e-prescriptions in primary healthcare increased the use of benzodiazepines -- a class of sedatives -- among patients under the age of 40. The issue was related to prescription renewals, which often recommended large doses of the drugs.

"There were no health improvements among younger patients, although benzodiazepine prescriptions were renewed more. By contrast, the adoption of e-prescriptions increased abuse of the drug and suicide-related visits to specialist hospital care increased by nearly 20 percent," Saxell added.

According to researchers, the extended use of generous doses of sedatives increased the risk of harmful side effects. They noted that patients under the age of 40 already have a higher risk of prescription drug abuse and mental health problems.

However they did not detect similar risks or health impacts when benzodiazepine prescriptions were renewed for older patients, despite the fact that older patients generally have more recurring prescriptions than their younger peers.

The study indicated that between 2017 and 2014 nearly 20 percent of people in Finland had received at least one benzodiazepine prescription.

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