Article Figures & Data
Tables
Characteristic Physician A B C D E Practice type Small group* Solo Small group* Solo Residency faculty Average number of patients seen per week 125 108 75 70 40 Payor mix: Medicare/Medicaid 30% Not available 65% 25% Not available Commercial insurance 59% 35% combined 50% Self-pay 11% 0% 25% Scope of practice No OB No OB No OB procedures No OB Full scope Has an EMR No Yes No No Yes Geographic location Suburbs Rural Rural Rural Urban Size of town >50,000–<100,000 <5,000 >5,000–<30,000 <5,000 >250,000 Pharmacies available National chains >2 locally owned National chains >2 locally owned National chains Steps for which practice satisfaction was high 3, 4, 5 1, 5 2 1, 2, 3, 4, 5 1, 3 * Less than 6 clinicians.
Site* Percentage Calling Pharmacy First† Mean (SD) Patient Satisfaction with Method‡ Percentage Reporting <2 Minutes for Initial Contact§ Mean Practice Satisfaction Clinic D‖ 33 4.3 (0.99) 60 4.0 Clinic B‖ 55 4.0 (1.3) 56 4.7 Clinic A 86 3.9 (0.95) 42 2.3 Clinic C 77 3.5 (1.1) 67 3.0 Clinic E‖ 88 3.2 (1.2) 50 4.0 * Table is ordered high to low based on patient satisfaction.
† χ2 = 20.1, df = 4, P < .0001.
‡ F4,128 = 3.5, P = .011; Newman-Keuls post hoc test revealed significant differences between clinics A and E (P = .03); B and E (P = .03); and D and E (P = .02).
§ χ2 = 4.2, df = 4, P = .37.
‖ Self-reported practice satisfaction rates of 4.0 or higher.
Site* Method Used Error Rate (%)† Mean Cost Per Refill for the Communication Step‡ Mean Practice Satisfaction Level Clinic D‖ FAX 0 $0.18 4.0 Clinic B§ FAX/voice mail 2 $0.06 3.7 Clinic C‖ FAX 2 $0.13 4.0 Clinic A§ FAX/phone 8 $0.17 2.3 Clinic E FAX/phone 10 $0.33 3.3 * Table is ordered low to high based on error rate.
† χ2= 12.6, df = 4, P = .013.
‡ Includes chart retrieval.
§ Self-reported practice satisfaction rates of 4.0 or higher.
Site* Decision-Maker Written Protocol EMR† Error Rate (%)‡ Mean Cost for Refill Decision Mean Practice Satisfaction Level Clinic A§ MA No No 0 $0.10 4.7 Clinic C MD No No 0 $0.21 2.5 Clinic D§ MD No No 0 $0.82 5.0 Clinic B LPN Yes Yes 4 $0.11 3.7 Clinic E§ MA Yes Yes 10 $0.36 4.0 * Table is ordered low to high based on error rate.
† EMR, electronic medical record; MA, medical assistant; LPN, licensed practical nurse.
‡ χ2 = 19.6, df = 4, P = .001.
§ Self-reported practice satisfaction rates of 4.0 or higher.
Site* Percentage of Patients Reporting Less Than 8 Hours for Total Refill Time† Patient Satisfaction‡ Mean Practice Satisfaction Level Clinic D§ 88 3.9 5.0 Clinic B 70 3.9 3.3 Clinic A§ 76 3.6 4.0 Clinic C 61 3.6 3.0 Clinic E 31 3.0 3.3 * Table is ordered high to low based on patient satisfaction.
† χ2=17.6, df = 4, P < .01.
‡ Nonsignificant: F4,124 = 2.2, P = .07.
§ Self-reported practice satisfaction rates of 4.0 or higher.
Site* EMR† Error Rate (%)‡ Mean Practice Satisfaction Level Clinic E Yes 0 3.7 Clinic D§ No 0 5.0 Clinic B§ Yes 1 4.3 Clinic C No 2 3.0 Clinic A§ No 3 4.0 * Table is ordered low to high based on error rate.
† EMR, electronic medical record.
‡ χ2 = 3.3, df = 4, P > .05.
§ Self-reported practice satisfaction rates of 4.0 or higher.
Steps in the Prescription Refill Process Best Method Step 1. Patient access to the system Patients should contact the pharmacy first when a refill is needed. Step 2. Communication with the pharmacy Communication should be by FAX and initiated by the pharmacy. Step 3. Decision-making Least costly method is to have nurse or medical assistant make decisions regarding refills. Training with the physician, including feedback regarding decisions will improve accuracy. Written protocols were associated with increased error rates. Step 4. Notification of the patient The pharmacy should notify the patient regarding the prescription refill decision. Step 5. Documentation Should be done by the decision-maker at the time of the decision. An EMR can make this more efficient.