Prescription Completeness and Selected Prescribing Indicators in Rural Vietnamese Primary Care: An Uncontrolled Before-and-After Study of a Multifaceted E-prescribing Quality Improvement Intervention

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A BSTRACT Objective: The objective of this study was to assess whether a district-led multifaceted e-prescribing quality-improvement intervention improved outpatient prescription completeness and selected prescribing indicators in rural Vietnamese primary care. Methods: In this uncontrolled before-and-after study, 1000 health-insurance outpatient e-prescriptions were sampled before the intervention (September–November 2022) and 1000 after it (March–May 2023) from nine public primary healthcare facilities using the Health Information System of Vietnam Posts and Telecommunications (HIS-VNPT; locally recorded as VNPT-HIS). The intervention (December 2022–February 2023) combined prescriber education, drug-information support, audit-feedback, pharmacist-prescriber cross-checking, and administrative reminders. The primary outcome was complete key dosing-instruction documentation. Secondary outcomes were other mandatory completeness fields and selected the World Health Organization/International Network for Rational Use of Drugs prescribing indicators. Findings: Full address documentation remained low (31/1000 [3.1%] vs. 29/1000 [2.9%]; P = 0.79). Complete key dosing instructions increased from 956/1000 (95.6%) to 974/1000 (97.4%; P = 0.03). Mean medicines per prescription did not change significantly (4.08 ± 1.535 vs. 4.20 ± 1.348; P = 0.07), and all medicines were prescribed by international nonproprietary name. Antibiotic prescribing increased from 335/1000 (33.5%) to 447/1000 (44.7%; P < 0.001), vitamin prescribing from 136/1000 (13.6%) to 190/1000 (19.0%; P = 0.001), and essential-medicine use changed only slightly (1480/4078 [36.3%] vs. 1568/4197 [37.4%]; P = 0.31). Conclusion: E-prescribing may provide an infrastructure for quality improvement but requires clinical decision support and pharmacy review.

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