Factors and Costs Related to Duplicate Medication Orders in Outpatient Specialist Clinic of a Public Hospital

Abstract

Introduction:
Duplicate medication orders are defined as clinically redundant orders, or prescriptions for identical medications or those belonging to the same pharmacological or therapeutic class within an overlapping period. Such occurrences pose significant risks to patient safety and contribute to the waste of resources. In Malaysia, the implementation of the Pharmacy Information System (PhIS) marks a crucial step in leveraging technology to enhance the efficiency and safety of the local dispensing system. The study aimed to identify duplicate medication orders, assess the associated risks, and quantify the costs resulting from these duplicates.
Methods:
A cross-sectional study was conducted in 2021 among patients newly registered and attending the Outpatient Specialist Clinics or Haemodialysis Unit at Hospital Jerantut. Patient demographic data and medication histories were retrospectively obtained from the patient registry and the Pharmacy Information System (PhIS), respectively. Duplicate medication orders were identified as prescriptions for identical medications or those with clinical redundancy within an overlapping period. The costs associated with these duplications were calculated based on the purchasing cost of the medications. The results were analyzed using descriptive statistics and multiple logistic regression.
Results:
Out of the 570 patients included in the study, 12.3% (n=70) received duplicate medication orders. Multiple logistic regression analysis identified several factors significantly associated with medication duplication: age (OR=1.02, 95% CI=1.00-1.04), the use of gastrointestinal medications (OR=4.07, 95% CI=1.65-10.07), and the number of prescriptions dispensed (OR=9.35, 95% CI=4.21-20.78), with an R² value of 0.353. The total annual cost incurred due to duplicate medication orders was RM970.86.
Conclusion:
The proportion of duplicate medication orders in this study was relatively low. However, increasing age, the use of gastrointestinal medications, and the number of prescriptions dispensed per patient per year were significantly associated with the occurrence of duplicate medication orders. These findings suggest a positive impact of the Pharmacy Information System (PhIS). Nonetheless, continuous improvements to the system are needed, and the role of pharmacists should be further emphasized to ensure the appropriate medication supply to patients. Future studies are recommended to evaluate the cost-effectiveness of the PhIS in addressing medication duplication.