Previous research has shown how difficult it is for people at the bottom of a typical organization chart complete with multiple functional groups, hierarchical levels, and prescribed reporting lines to drive change.
Among practices with EHRs, there was little change between 2005 and 2007 in the availability of nine of ten EHR features; the notable exception was electronic prescribing, reported as available in 44.7% of practices with EHRs in 2005 and 70.8% in 2007.
The findings concur with variations in antihypertensive prescribing reported in the 2010 NICE implementation uptake report [ 35].
Compared with rates of potentially inappropriate prescribing reported among the elderly in general [ 13, 16- 21, 28], the rates we report are considerably higher.
All six studies examining the effect of CDSS on antibiotic prescribing reported at least one positive outcome, however, four studies demonstrated significant impacts on the majority of outcomes.
There was a significant improvement in antimicrobial prescribing reported for the intervention homes during the three months following the second mailing.
For example, a clinician who had decreased his antibiotic prescribing reported that he tended to ask patients to return for follow-up more frequently to reassure himself they were recovering.
The high rates of antibiotic prescribing reported by this study indicate a need to shift the entire distribution for antibiotic prescribing to lower levels, since there are very few practices that are not prescribing antibiotics to excess, fuelling the development of antibiotic resistance.
However, unless an incentive is introduced to promote increased generic drug utilisation and physicians are motivated and supported in changing their prescribing practices it is unlikely that the trends in PPI prescribing reported in this study will change and potential cost savings will be realised.
The Administrator may require, by general or special orders, any person engaged in any phase of energy supply or major energy consumption to file with the Administrator in such form as he may prescribe, reports or answers in writing to such specific questions, surveys, or questionnaires as may be necessary to enable the Administrator to carry out his functions under this chapter.
