Seminar Details

The Electronic Prescription Service Release 2 (EPSR2): impact on interactions in the consultation
Thursday, 19th April 2012
1pm - 2pm (12.45 for sandwiches)
Seminar Room 1
Upper 3rd Floor, PCPH, UCL (Royal Free Campus)
Speaker: Fiona Stevenson

The seminar will focus on some research I wish to do on the Electronic Prescription Service. I will outline the proposed research and ask for feedback both on the concept behind the proposed work and the methodology.

An outline of the proposed research is below.

The central role of prescribing in general practice has long been established. Over 1.5 million prescriptions are issued in England daily. The costs associated with prescribing include the physical costs of the medicine, administrative time, professional time spent discussing the prescribing decision in the consultation, as well as the potential costs of non-adherence associated with problems in interactions. Prescriptions have a symbolic value in relation to the legitimisation of illness and the doctor’s legal and professional role, while a prescription also provides a focus for discussion of beliefs about treatment. Effective communication about prescribing works to maximise benefits and mitigate harms.

The Electronic Prescription Service Release 2 (EPSR2), which enables prescriptions to be received electronically by a pharmacy nominated by the patient, is currently being implemented across England. The EPSR2 eliminates the need for a paper prescription. Research thus far has focused on the technicalities of the system with little attention paid to the impact on interactions and the safe, effective and cost effective use of medicines compatible with patients’ health beliefs. Given the large number of prescriptions issued the potential for benefits, or harm, of changes that affect interactions around prescribing is substantial.

Video recording of general practice consultations will be used to assess the effect on interactions of the EPSR2. Observations will also be carried out in associated nominated pharmacies, supplemented with both formal and informal interviews with key stakeholders (GPs, pharmacists, pharmacy staff, patients) about views of electronic prescribing and perceptions of effects on adherence.

We will recruit 5 GP practices, with an associated nominated pharmacy for each practice. Up to 40 patients who report they are consulting for a ‘new’ problem which might require a prescription will be recruited in the waiting room.

Detailed conversation analysis will be used to examine the section of the consultation in which the prescribing decision is negotiated. Interviews and observational data will be analysed using the Normalisation Process Theory, which focuses on the work that individuals and groups have to do for a new practice or technology to be implemented and become integrated and embedded (normalised) into routine practice. Combining methods of analysis in this way will produce a complex understanding of the effects on interactions and adherence of the EPSR2 in practice, with the associated cost implications. We will document possible problems that may be encountered in the future roll out of the EPSR2 and develop advice to patients and practitioners on how to optimise the benefits and avoid any pitfalls.

The main economic benefits will arise from identifying any potential problems in interaction caused by the introduction of the EPSR2 which might otherwise result in increased demand for consultations and problems with adherence.

Page last modified on 03 may 12 13:03 by Rushmi Pelpola