Prescription Completeness and Selected Prescribing Indicators in Rural Vietnamese Primary Care: An Uncontrolled Before-and-After Study of a Multifaceted E-prescribing Quality Improvement Intervention.

Abstract

Objective: The objective of this study was to assess whether a district-led multifaceted e-prescribing quality-improvement intervention improved outpatient prescription completeness and selected prescribing indicators in rural Vietnamese primary care.

Methods: In this uncontrolled before-and-after study, 1000 health-insurance outpatient e-prescriptions were sampled before the intervention (September-November 2022) and 1000 after it (March-May 2023) from nine public primary healthcare facilities using the Health Information System of Vietnam Posts and Telecommunications (HIS-VNPT; locally recorded as VNPT-HIS). The intervention (December 2022-February 2023) combined prescriber education, drug-information support, audit-feedback, pharmacist-prescriber cross-checking, and administrative reminders. The primary outcome was complete key dosing-instruction documentation. Secondary outcomes were other mandatory completeness fields and selected the World Health Organization/International Network for Rational Use of Drugs prescribing indicators.

Findings: Full address documentation remained low (31/1000 [3.1%] vs. 29/1000 [2.9%]; P = 0.79). Complete key dosing instructions increased from 956/1000 (95.6%) to 974/1000 (97.4%; P = 0.03). Mean medicines per prescription did not change significantly (4.08 ± 1.535 vs. 4.20 ± 1.348; P = 0.07), and all medicines were prescribed by international nonproprietary name. Antibiotic prescribing increased from 335/1000 (33.5%) to 447/1000 (44.7%; P < 0.001), vitamin prescribing from 136/1000 (13.6%) to 190/1000 (19.0%; P = 0.001), and essential-medicine use changed only slightly (1480/4078 [36.3%] vs. 1568/4197 [37.4%]; P = 0.31).

Conclusion: E-prescribing may provide an infrastructure for quality improvement but requires clinical decision support and pharmacy review.