Effect of Electronic Prescribing Compared to Paper-Based (Handwritten) Prescribing on Primary Medication Adherence in an Outpatient Setting: A Systematic Review.

David Aluga, Lawrence Nnyanzi, Nicola King, Elvis Anyaehiechukwu Okolie, Peter Raby

Research output: Contribution to journalArticlepeer-review


Background Electronic prescriptions are often created and delivered electronically to
the pharmacy while paper-based/handwritten prescriptions may be delivered to the
pharmacy by the patients. These differences in the mode of creation and transmission
of the two types of prescription could influence the rate at which outpatients fill new
prescriptions of previously untried medications.
Objectives This study aimed to evaluate literatures to determine the impact of
electronic prescribing compared with paper-based/handwritten prescribing on primary
medication adherence in an outpatient setting.
Methods The keywords and phrases “outpatients,” “e-prescriptions,” “paper-based
prescriptions,” and “primary medication adherence” were combined with their relevant synonyms and medical subject headings. A comprehensive literature search was
conducted on EMBASE, CINAHL, and MEDLINE databases, and Google Scholar. The
results of the search were screened and selected using predefined inclusion and
exclusion criteria. The Critical Appraisal Skills Program (CASP) was used for quality
appraisal of included studies. Data relevant to the objective of the review were
extracted and analyzed through narrative synthesis.
Results A total of 10 original studies were included in the final review, including 1
prospective randomized study and 9 observational studies. Nine of the 10 studies were
performed in the United States. Four of the studies indicated that electronic prescribing
significantly increases initial medication adherence, while four of the studies suggested the
opposite. The remaining two studies found no significant difference in primary medication
adherence between the two methods of prescribing. The variations in the studies did not
allow the homogeneity required for meta-analysis to be achieved.
Conclusion The conflicting findings relating to the efficacy of primary medication
adherence across both systems demonstrate the need for a standardized measure of
medication adherence. This would help further determine the respective benefits of
both approaches. Future research should also be conducted in different countries to
give a more accurate representation of adherence.
Original languageEnglish
Article number1
Pages (from-to)845-855
JournalApplied Clinical Informatics
Issue number4
Publication statusPublished - 25 Aug 2021


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