Some regions and autonomous communities in Spain which have (or soon will have) operating electronic prescription processes have found that visits and demand for physical consultations has dropped by between 20 and 50 per cent. But at the same time, it has been found that the introduction of e-prescriptions has coincided with an increase in health spending.
Health centers in Andalusia, Extremadura, Catalonia, the Community of Valencia and Baleares, the autonomous communities where electronic prescription procedures are fully operational, or soon will be fully operational, have begun to observe that the promise of technology is being fulfilled. Doctor’s visits have been reduced by between 20 and 50 per cent depending on the profile of the population being served.
However, doctors are not precisely the professionals who have most benefited from this measure. Josep María Coll, the spokesperson for the Baleares Society of Family and Community Doctors explained to GM that in some community centers prescriptions to chronic patients now carried out by nursing professionals, have changed. In any case, he recognized that the experience has generally been a satisfactory one stating that pressure on physical appointments has lessened. This point of view ties in with that of the President of the Pharmacist’s Council of Extremadura, Cecilio Venegas, who says that the statistics for his community show a drop of up to 50 per cent in visits to some health centers.
But the experience of Catalan doctors is very different. Jorge Soler, a family doctor in Camfic in Lleida, one of the pioneering provinces in the development of e-prescriptions, says definitively that far from relieving the bureaucratic burden on doctors, the arrival of the new technology has resulted in more work: “I don’t know if it has reduced the pressure on visits because we are issuing our prescriptions before we go to the clinic.” Soler says that the doctor must approve any change in the prescriptions to patients although he does admit that some patients can go to the clinic less and so do not take advantage of the visit to address minor ailments or make new requests.
It is difficult to measure in economic terms the savings to the health system generated by a reduction in the number of visits as this cannot yet be quantified exactly. What has been determined, according to Cecilio Venegas, is that in many of these communities the switch to electronic prescriptions has coincided with an increase in health spending. “Right now, we are comparing spending in the months with e-prescriptions and spending before them and there seems to be an increase of almost 10 per cent. This also occurred in Baleares and Andalusia when it was implemented,” states the spokesperson for pharmacists. Venegas adds that although this is an “average” change, it is still striking.
In his opinion, this is occurring due to greater accessibility to medication. “All the prescriptions are being presented at the pharmacy when some were not before,” he notes. One example is folic acid whose sale has exploded. The reason is that doctors are prescribing the treatment to pregnant women throughout pregnancy, whilst previously they might have only used the prescription to purchase the first batch and then paid full price at the till to avoid having to go back to the doctor.
At the Spanish Society for Health Information Technology (SEIS), Alberto Gómez Lafón and Vicente Hernández, members of the board of directors, believe that this is a complaint from regional administrations saying “Basically the increase is a seasonal change and in any case we must carefully study the idea that technology is the cause.” Even so, they believe that it has not occurred in all the autonomous communities.
Experts insist that it “is absolutely necessary to give training courses to workers and pharmacists on how to use the tool, to prevent undesirable effects related to incorrect interpretation (of the technology) of dosages and treatment guidelines as well as setting rules at dispensaries to prevent hoarding of medications.”
For his part, Venegas, notes that it is still necessary to carry out small adjustments: doctors, for example, will have to refine the dosage aspect,” he warns. In Baleares, for example, there are still frequent technical problems which are the main source of complaints from workers and must be resolved.
Adjustments to the mechanism notwithstanding, the other advantages provided are clear. For the SEIC the reduction in the number of errors in prescriptions and at dispensaries is one of the most important, as is the reduction in the journey-time of citizens, something especially important in rural areas. For doctors, it helps therapeutic treatment providing them, for example, with information about whether patients are collecting their prescriptions.
