JMIR Publications

ABSTRACT

Background:

Electronic prescribing (e-prescribing) is an approach designed to assist in facilitating safe and appropriate prescriptions for patients. Currently, it is unknown to what extent e-prescribing can influence the use of opioids and their specific clinical outcomes. To address this gap, a rapid scoping review was conducted.

Objective:

The objectives of this rapid scoping review were 1) to examine how e-prescribing has been used clinically; 2) to examine the effects of e-prescribing on clinical outcomes, the patient/clinician experience, service delivery, and policy; and 3) to identify current gaps in present literature to inform future studies and/or recommendations.

Methods:

A rapid scoping review was conducted following the guidance of the JBI 2020 scoping review methodology and the World Health Organization guide to rapid reviews. A comprehensive literature search was conducted by an expert librarian from inception until November 16, 2022. The search criteria were as follows: 1) e-prescribing programs targeted to the use/misuse of opioids, including those that were complemented or accompanied by clinically focused initiatives, and 2) a primary research study of experimental, quasi-experimental, observational, qualitative, and/or mixed methods design. An additional criterion of an ambulatory component of e-prescribing (e.g., e-prescribing occurred upon discharge from acute care) was added at the full-text stage. No language limitations or filters were applied. All articles were double screened by trained reviewers. All grey literature was manually searched by a single reviewer. Data was synthesized using a descriptive approach.

Results:

Upon completing screening, 32 peer-reviewed articles and 2 grey literature documents (n=34) met the inclusion criteria. All studies had a quantitative component, with most highlighting e-prescribing from acute care settings to community or within closed hospital systems. Only a single study provided evidence on e-prescribing in a primary care setting. Minimal prescriber, pharmacist and clinical populations characteristics were reported. The main outcomes identified were related to opioid prescribing rates, alerts (e.g., adverse drug events, drug-drug interactions), quantity and duration of opioid prescriptions, adoption of e-prescribing technology, attitudes towards e-prescribing and potential challenges with the implementation of e-prescribing into clinical practice. E-prescribing, including key features such as alerts and dose order sets, may reduce prescribing errors.

Conclusions:

This rapid scoping review highlights initial promising results with e-prescribing and opioid therapy management. It is important that future work explores the experience of prescribers, pharmacists, and patients using e-prescribing for opioid therapy management, with an emphasis on prescribers in the community and primary care. Integrating the thoughts, perceptions, and beliefs of these key stakeholders into the literature is important as they are directly impacted by technology use in healthcare. Developing a common set of quality indicators for e-prescribing with opioids will help inform future research and build a stronger evidence base. Furthermore, understanding implementation considerations will be of importance as the technology is adopted and integrated into clinical practice and health systems.