We are now in a stage of digital medicine when we are able to study various digital processes to tease out both their advantages and disadvantages. One major focus in the future will certainly be assessing the effectiveness of telemedicine physician visits. A recent article about e-prescriptions caught my attention (see: Electronic Prescribing Tied to Higher Adherence). Below is an excerpt from it:
Electronic prescribing (e-prescribing) decreases prescription errors and enhances coordination between physician and pharmacist, but what has remained unclear is how it affects patient behavior. Now a new study suggests e-prescribing may enhance patient prescription adherence. In an analysis of nearly 2500 patients, e-prescribing was associated with a significant reduction in primary nonadherence, defined as not filling and picking up all prescriptions within 1 year of the prescription date. The researchers compared rates of nonadherence associated with e-prescriptions and paper prescriptions among new patients attending an outpatient dermatology clinic at a large urban hospital.The risk for primary nonadherence was 17 percentage points lower with e-prescriptions than that associated with paper prescriptions, for a 16% difference after adjusted multivariable analysis....This "represents a 47% reduction in the risk of primary nonadherence for patients who received an e-prescription vs those who received a paper prescription.
It's interesting to speculate why nonadherence would be much lower with e-prescriptions than with paper prescriptions. I am only guessing, but this may be a case of digital literacy at play. The term is defined in the following way:
Digital literacy is the knowledge, skills, and behaviors used in a broad range of digital devices such as smartphones, tablets, laptops and desktop PCs, all of which are seen as network rather than computing devices. Digital literacy initially focused on digital skills and stand-alone computers, but the focus has moved from stand-alone to network devices....Computer literacy preceded digital literacy, and refers to knowledge and skills in using traditional computers (such as desktop PCs and laptops) with a focus on practical skills in using software application packages. Digital skills is more contemporary term but is limited to practical abilities in using digital devices (such as laptops and smartphones).
Clearly, digital literacy is linked to socioeconomic status and education, with those higher on the scale being more familiar and comfortable with digital devices and computer networks. A patient with a lower level of digital literacy might not always understand that his or her prescription is being transmitted electronically to a local drug store for filling and that the process is reliable. In contrast, carrying a paper prescription to the store would be a familiar task. It's also possible that some of the patients receiving e-prescriptions did not fill them (primary nonadherence) because they could not afford to pay for them but this effect should have been the same in both study groups. If there is a lesson here, it's that physicians providing e-prescriptions for patients should not take for granted that the patient understands how the process works and is reliable.