Prescription of ocular beta-blockers in patients with obstructive pulmonary disease: Does a central electronic medical record make a difference?

Abstract

OBJECTIVES:

Topical beta-blockers are contraindicated in obstructive pulmonary diseases (OPDs). In this study we aimed to evaluate through central or local electronic medical records (EMRs) the prescription patterns for topical ocular beta-blockers for patients with glaucoma and OPD treated by ophthalmologists.

METHODS:

The study was carried out at the Leumit Health Maintenance Organisation (HMO) in Israel. The physicians at the HMO all work with an EMR, either a central EMR incorporating data from primary-care physicians and consultants, or a local one. The study population included all HMO members who filled at least one prescription for antiglaucoma medications in 2004. The patients were divided into two groups: those with a previous diagnosis of OPD (ICD-9 codes 493) and those with no known diagnosis of OPD.

RESULTS:

7481 patients consumed topical antiglaucoma medications during the study period, and 14.5% had a diagnosis of OPD. 798 OPD patients were treated by ophthalmologists, and of the 61.8% who were treated with topical beta-blockers, only 38 received betaxolol. In comparison with glaucoma patients without OPD, OPD patients received fewer beta-blockers (p < 0.001), more selective beta-blockers (p < 0.0001) and less timolol (p < 0.001). Of the OPD patients treated by ophthalmologists with a central EMR, 59.5% received beta-blockers in comparison with 66.4% treated by ophthalmologists with a local EMR (p = 0.06). OPD patients treated by ophthalmologists with a central EMR received more non-beta-blockers in comparison with patients treated by ophthalmologists with a local EMR (p = 0.02).

CONCLUSION:

Most patients with OPD and glaucoma continued to receive topical beta-blockers, mostly noncardioselective beta-blockers. A central EMR with a comprehensive and highly available medical history reduced the prescription of beta-blockers to OPD patients, but rates remained unacceptably high.

• Authors: Shlomo Vinker, Igor Kaiserman, Dan Andrei Waitman, Shimon Blackman, Eliezer Kitai
• Journal: Clinical drug investigation (Clin Drug Investig) Vol. 26 Issue 9 Pg. 495-500 ( 2006) ISSN: 1173-2563 [Print] New Zealand
• PMID: 17163282 (Publication Type: Journal Article)

Chemical References

• Adrenergic beta-Antagonists

Topics

• Adrenergic beta-Antagonists
• Contraindications
• Drug Utilization
• Glaucoma (drug therapy)
• Humans
• Lung Diseases, Obstructive (complications)
• Medical Records Systems, Computerized