BACKGROUND A vast body of research highlights the development of medications with proven efficacy, yet the translation of these benefits into clinical practice is hindered by low adherence rates, particularly among those with chronic illnesses. Nonadherence not only compromises treatment effectiveness but also amplifies healthcare costs and complicates disease management. Medication adherence rates remain suboptimal, necessitating multifaceted strategies to address patient, physician, and system-related factors in community settings. Electronic prescribing (e-prescribing) emerges as a promising solution, offering numerous advantages such as enhanced efficiency, reduced errors, and improved adherence. However, the comparative impact of electronic versus paper prescriptions on medication adherence remains underexplored, prompting the need for systematic reviews to inform healthcare practices and interventions.
OBJECTIVE The objective of the study is to systematically review and summarize current evidence regarding the effect of e-prescriptions on adherence to prescribed medications compared to paper-based prescriptions.
METHODS This review employed a comprehensive search strategy across multiple databases, with inclusion criteria focused on outpatient studies published since 2010. Data extraction followed a rigorous two-level screening process, where titles, abstracts, and full texts were assessed for eligibility by independent reviewers. Grey literature was also searched using established methods. Data extraction involved collecting information on study methods, participants, interventions, outcomes, and other relevant details.
RESULTS Out of 1801 initially identified articles, 39 underwent full-text review, with 15 included in the qualitative synthesis. These studies, predominantly from the USA, varied in design and sample size. While 60% favored e-prescriptions, 20% favored traditional prescriptions, and 20% found no significant difference. Favorable outcomes for e-prescriptions included improved adherence rates. Studies favoring traditional prescriptions highlighted factors like claim reversals and primary non-compliance. Several studies found no significant difference in adherence between electronic and traditional prescriptions.
CONCLUSIONS While some evidence suggests that e-prescriptions alone reduce primary nonadherence risk, many successful studies showing improved adherence used additional components like electronic health records (EHR) and decision support systems. These components, such as formulary decision support and patient adherence information, were reported to be associated with better adherence outcomes. Conversely, studies with no or unfavorable effects on e-prescriptions often lacked such additional components and focused on issues like prescription abandonment. The review underscores the importance of a comprehensive approach to e-prescription implementation, integrating self-management tools, and behavioral interventions to maximize adherence benefits in community settings.