Generic Drugs Prescribed More With EHR Default Display

Fewer brand-name drugs are prescribed when their generic equivalents are displayed in the electronic health record (EHR) first, according to a study funded by the Robert Wood Johnson Foundation (RWJF) and the US Department of Veterans Affairs that was published in a special issue of the Annals of Internal Medicine.

"Prescribing brand-name medications that have a generic equivalent is a prime example of unnecessary health care spending because, in most cases, generic medications are less expensive, similar in quality, and may actually lead to better outcomes than brand names because of higher rates of patient adherence to generics," said lead study author Mitesh S. Patel, MD, MBA, MS, assistant professor of Medicine and Health Care Management at the University of Pennsylvania who is a graduate of the RWJF Clinical Scholars Program, in a press release. "The results of this study demonstrate that leveraging default options can be very effective way to change behavior."

The study evaluated prescribing behaviors for beta-blockers, statins, and proton-pump inhibitors across 4 ambulatory clinics in the University of Pennsylvania Health System between June 2011 and September 2012.

During the intervention phase, family medicine physicians were shown both brand-name and generic medication options within the EHR prescribing portal, but internal medicine physicians only saw generic options, though they had the ability to opt out.

Compared with the family medicine physicians, the researchers discovered an increase in generic medication prescribing for all 3 studied drug classes among the internal medicine physicians throughout the intervention.

"Not only was changing the default options within the EHR medication prescriber effective at increasing generic medication prescribing, this simple intervention was cost-free and required no additional effort on the part of the physician," Dr. Patel continued. "The lessons from this study can be applied to other clinical decision efforts to reduce unnecessary health care spending and improve value for patients."

The researchers concluded that programming EHRs to display generic drugs by default is an effective method to increase the odds of generic equivalent prescribing and help reduce overall health care costs.