Indication-based prescribing and prescribing with indications, effects on documentation, medicines use, and clinical...

To describe the effect of indication-based prescribing and prescribing with indications on electronic medication record documentation, appropriate medicines use, and clinical outcomes.

Databases Medline, Embase, CINAHL, and Scopus were systematically searched using two concepts: 'indication' and 'electronic prescribing'. Inclusion criteria included interventional studies introducing indication-based prescribing, or prescribing with indications, using an electronic medication management system. A narrative synthesis was conducted for the following a priori outcomes: indication provision, indication accuracy, prescription appropriateness, appropriate dose or duration of medicine use, deprescribing, total medicine use, and patient outcomes.

From 1,908 abstracts, 24 studies met inclusion criteria. Of the 24 included studies only one study examined prescriptions for all medicines, 16 were focused on prescribing antimicrobial medicines, and four were restricted to blood products. There was substantial heterogeneity in the interventions implemented and the ordering systems used. An improvement was found in indication documentation in three studies, appropriateness of the prescription for the documented indication in four studies, rate of deprescribing in two studies, and a reduction in overuse of antimicrobial medicines and blood products in ten studies. Accuracy of indications was inconsistently defined and measured.

Interventions in electronic medication management systems are being increasingly used to improve indication documentation and promote appropriate medicines use. The generalisability of studies is limited by heterogeneity in intervention and system design. Work is needed to 1) develop agreed international standards to guide system vendors and consistency in practice, and 2) improve standardisation of medicine use terminology in literature to guide reporting.