Attitude towards electronic-prescription and associated factors among physicians at university of Gondar referral hospital: Institution based cross-sectional study (Preprint)
Authors: Yalgaw Libsuye , Mehiret Gashaw 
Published: November 2021

UNSTRUCTURED

Background: Electronic prescription is described by the United States Centers for Medicare and Medicaid Services as the broadcast utilizing electronic medium, of prescription or prescription-related information between prescriber, distributor, pharmacy benefit manager, or health plan, either openly or through an agent, including an electronic prescribing system. the aim of this study was designed to assess attitudes towards electronic prescription and associated factors among physicians at the University of Gondar referral hospital 2021. Gondar, Ethiopia. OBJECTIVES
General objective
To assess physician attitude towards e-prescription at university of Gondar referal hospital.
Specific objective
To identify physician attitude towards e-prescription at university of Gondar referal hospital 2021
To identify associated factors of physician attitude on e-prescription at university of Gondar referal hospital 2021
METHOD AND MATERIALS
Study area and period
The study was conducted in Gondar referral hospital physicians, fromAugust15/2021toSeptember 2021.
Study design
The hospital-based cross-sectional study was used.
Sources population
All physicians with 6 months of work experience were the source population for this study.
Study population
All physicians in Gondar referral hospital who fulfill inclusion criteria
Sample Size Determination and Sampling Technique
The sample size of the study was the total population of physicians who were working in the University of Gondar referral hospital and the sampling technique was total census.
Data collection tools and procedures
Data collection was supervised for correct application of procedures by supervisors and the investigator. The completeness and consistency of the questionnaire were also be checked at the end of data collection.SPSS version 23 also was used for data analysis. Frequency and Percentage were calculated for all variables which are related to the objective of the study, and Bivariable and multivariable logistic regression were used to identify factors contributing to dependent variables. Odds ratio (OR), with 95% CI and p value< 0.05 were computed to determine the level of significance.
Variables of the study
Dependent variables
	Attitude towards e-prescription (positive or negative)
Independent variables
Socio-demographic characteristics

	Socio-demographic factors: Age, sex, experience, profession, monthly income
	Behavioral factors: Attitude, by preparing questions and asking who scores mean and above have a good attitude, who scores less than the mean have a poor attitude.
	Technical factors: EPS training, past EPS experience, computer skill (literacy), a computer at home
	Organizational factors: Computer access at the office, internet access at the office, presence of IT department in the organization, availability of IT technical person.

Operational definitions
o	Attitude: is a persistent disposition to act either positive or negative towards e-prescription Score will categorize < 50%”negative”, and>= 50% positive attitude(14).
o	Electronic prescription: defined as a technology applies on drug prescription either online or offline used to computer, tablet, and handphone systems used to prescribing by physicians(15).
Data processing and analysis
Primarily the data was checked for its completeness, consistency, and validity. After checking the collected data, then the data was entered into EPI-info version 7.2.1 and transferred to SPSS version 20 statistical software for analysis. Data will be cleaned and coded for completeness, consistency, and minimized errors. Both Bivariable and multivariable logistic regression was used to identify factors and variables with a p-value of 0.20 and less that would fit the logistic model for multivariable analysis. Spss version 20 statistical software was used and frequencies and odds ratio was determined. Factors associated with the outcome variable at Bivariable analysis had been identified and the variables with a p-value of 0.20 and less would fit the logistic model for multivariable analysis to determine the relative prediction level of independent variables to the outcome variable. P-value less than 0.05 at 95% confidence interval had been considered as statistically significant. Model goodness-of-fit would be checked by Hosmer Lemeshow test. Multicollinearity was checked by Durbin-Watson, tolerance, and Variance Inflation Factors. Chi-square has also been calculated to test any association between dependent and independent variables. Lastly, the result was presented in the form of texts, figures, and tables by using frequency and summary statics such as mean, standard deviation, and percentage to relevant variables.
Data quality control
The quality of data was done and the questioner was assessed for its clarity; the completeness and evaluate the validity and content of the questionnaire and modified accordingly. Close supervision was also made during the data collection and appropriate feedback was provided. The training was given to the data collectors for one day by the principal investigator and the training was focused on the objective, how to obtain consent, keeping the confidentiality of the information they gathered. The collected data has been cheeked for its completeness every day before the following day of data collection by supervisors and the principal investigator and corrective measures had been taken according to the finding during supervision.
Data presentations
After the data was analyzed the findings of the result were presented in descriptive and analytic forms. Descriptive analyzed statistical results were presented by texts, graphs, diagrams, and tables but the analytic form of findings was presented by text form of the odds ratio.
Result
Socio-demographic characteristics of the respondents
Out of 171 study participants, 152(88.8%) were involved in this study and it produces a response rate of 88.8 %. The mean age of the study participants was 34.5(±SD) years which ranges from (23-56).
The majority of respondents, 95(62.5%) were male, and more than half of the respondents, 75 (49.3%) were aged between (20-35), and nearly half of the respondents, 65 (42.8%) had degree holders. Regarding the profession, 59(38.8%) were General practitioners (GP), and the mean monthly salary of the respondents was 12,214.43(305.36$) Ethiopian birr. Concerning work experience 71(46.7% were working 1-5years at the university of Gondar referral hospital (Table1).
The attitude of Physicians towards e-prescription
Based on the operational definition the overall score of attitudes to e-prescription of physicians from the University of Gondar referral hospital was 76.8% [95% CI: 66.7-84.2]. The findings of physicians to e-prescription were consistent with the operational definition. The findings of e-prescription of physicians showed that physicians expressed a high level of satisfaction with improving quality of care and reducing error 150 (98.6%), Improve the quality of work-life 150(98.6%), give benefitsoutweighthecost152(100%). On the other hand, Administrativerigidityisa possiblebarrier38 (25%), Notfeasible82(53.9%), Improve patient's satisfaction20 (13.2 %) were reported as unsatisfied (Table2).
Organizational and technical characteristics of respondents
The majority of respondents 111(73.02%) were had their personal computer, half of the respondents 67 (44.07%) of them reported that they have a computer at their office, 35 (23.02%) respondents had internet at the office,36(23.6%) respond that have a computer at home, 8(5.2%)were a response that organization has to stand by generator, 117(76.9%)were reported organization has active or functional IT department, and 90(59.2%) were Organization have IT, technical person, on the other hand, 152 (100%) of respondents were not taking training on e-prescription and working with e-prescribing ever before, and the study subjects were used computer for data recording, report generating, reading, and video accessing are 142(93.4%),147(96.7%),69(45.4%), and 118(77.6%)respectively(Table 3).
Factors associated with e-prescription
Findings based on the analytical part ,which results variables such as sex of the respondents [OR:2.696(1.194-6.091)], age of the respondents [OR:0.421(0.073-2.437], profession of the respondents[OR:3.7(.561-24.42], educational status of the respondents [OR:1.878(.0.8744.033],monthly salary [OR: 7.0(2.66-18.45],working experience of the respondents[OR:1.82(.845-3.918], working practice at this hospital of the respondents[OR:.245(.029-2.060], Decrease burden on physicians [OR:.447(.783-3.513]were having a p-value less than 0.2, but variables such as sex, the profession of the respondents, educational status of the respondents, work experience of the respondents, working practice at this hospital, and decrease burden on physicians were disappeared from the final stage of multivariable analysis. Regarding multivariable logistic analysis two variables like age of the respondents who have age <35year old 2.48 times more likely practicing e-prescription than age >35years old [AOR: 2.48 (95%CI:1.055-5.830 p:value=0.003], and a monthly salary of the respondents who have monthly salary<9056.00 birrs 8.29 times more likely practicing electronic prescription than salary >9056.00 birrs [AOR: 8.29(3.002-22.89 p:value=0.001] had to have a significant association with e-prescription. (Table 4).
Conclusion
the overall score attitudes of physicians on e-prescription from the organization in the study area was good in the university of Gondar referral hospital. variables for multivariable analysis variables like age and the monthly salary of the respondents had to have a significant association with e-prescription. monthly salary of the respondents was significantly associated with e-prescription of monthly salary less than 9,056.00 of the respondents from the University of Gondar referral hospital compared with those who had monthly salary more than 11,305.00 with attitudes ready to adapt e-prescription of the respondents from the working organization.