Abstract
Background & Rationale: Duplicate medication is irrational drug use that can cause adverse drug events to patients and wasteful health expenditure. There have been a limited number of studies on duplicate prescribing in Thailand. The objective of this study was to develop a computer software to prevent therapeutic duplicate prescription and to determine its effects in Mahasarakham Hospital. Methodology: This research and development comprised three parts. Part 1 described characteristics and magnitudes of duplicate drug prescribing in the hospital using electronic database of 12 drug groups (39 drug items) during 1 October 2018 – 30 September 2019. Part 2 developed a computer software based on results of part 1 and implemented the software in November 2019. Part 3 examined effects of the software by comparing proportions of duplicate drug prescriptions during, before (November 2017 – April 2018) and after software implementation (November 2019 – April 2020). Results: Of total 218,179 prescriptions, 818 duplicates (0.37%) were found, of which 576 (0.26%) were duplicate medication at the same therapeutic groups and 242 (0.11%) at the same drug item. Moreover, 530 duplicates (0.24%) were detected in the same prescription and 288 duplicates (0.13%) detected in the same patient. The highest duplicate medication rate was found in the gastric secretion inhibitors group (378/36,495 prescriptions, 1.04%), followed by antihistamine (130/13,433 prescriptions, 0.97%) and NSAIDs (184/29,783 prescriptions, 0.62%). These duplicates costed around 19,740 – 79,591 baht/year. The software detected any duplicate medications prescribed in the same therapeutic drug, same patient and same day and alert prescribers/ pharmacists for clarification. After software implementation, the duplicate drug prescribing decreased significantly from 0.27% (266/100,367 prescriptions) to 0.08% (75/95,350 prescriptions) or a 70.3% reduction (OR 0.296, 95%CI: 0.226-0.384, p < 0.001). The excess healthcare cost declined by 4,098 – 18,360 baht/6 months or 8,196 – 36,720 baht/year. Conclusion: The developed computer software was effective in preventing duplicate prescription and reducing unnecessary healthcare cost. Future studies should determine duplicate drug prescription and prevention program at national level to support rational drug use and reduce healthcare cost in Thailand.
