Information flow and knowledge sharing among patients, providers, and community pharmacists in an outpatient prescription setting.

摘要

Healthcare delivery is a complex combination of information flows between patients and a network of caregivers. The component of healthcare delivery that is the focus of this dissertation is that of outpatient prescription coordination, including information flows and alignments to support effective and safe prescription delivery. This dissertation involves research utilizing a system-of-systems perspective to evaluate information flow paths and coordination between patients, providers, and pharmacists used in the outpatient medication process. Electronic prescribing (e-prescribing) occurs when the provider electronically sends the prescription directly to the pharmacy and the pharmacy receives the prescription electronically. With multiple paths available to prescribe a medication, this research elaborates a multi-modal information flow model between patients, providers, and pharmacists based on prescription type (new, refills, and renewal).;This research also focused on the preference of the patients, providers, and pharmacists for each information flow path based on prescription types to determine if the key players viewed the information flow paths as having similar relative advantages. E-prescribing was the preferred path for new prescriptions among all participants. However, there were significant differences between providers and pharmacists for phone and voicemail usage and a significant difference between providers, pharmacists and patients for fax usage. For refill and renewal prescriptions, the patient was primarily identified by all players as the player responsible for initiating these prescription events.;This dissertation highlights the current misalignments between expected processes for outpatient prescribing set forth by current United States mandates and the actual processes used to complete new, refill, and renewal prescriptions. Although e-prescribing systems are assumed to facilitate the renewal process, patients have no direct access to e-prescribing systems but are seen as the primary player triggering refills and renewals. Improvements in e-prescribing implementations and support for preferred flows would allow for better alignment of all three key players (patients, providers, and pharmacists) and improved care and medication management for the public.