Implementation of European Cross-border Electronic Prescription and Electronic Dispensing Service: Cross-sectional Survey
Authors: Jõgi Reelika , Timonen Johanna , Saastamoinen Leena , Laius Ott , Volmer Daisy 
Published: April 2023

Background
The European cross-border electronic prescription (CBeP) and cross-border electronic dispensing system was first implemented in January 2019 when it became possible to purchase medications from community pharmacies in Estonia using a Finnish ePrescription. In 2020, Estonian ePrescriptions became available to be dispensed in Finnish pharmacies. The CBeP is an important milestone in increasing access to medicines across the European Union, and it has been unstudied to date.

Objective
This study aimed to investigate Estonian and Finnish pharmacists’ experiences of factors influencing access to, and dispensing of, CBePs.

Methods
A web-based survey was conducted among Estonian and Finnish pharmacists between April and May 2021. The survey was distributed to all 664 community pharmacies (n=289, 43.5% in Estonia and n=375, 56.5% in Finland) where CBePs had been dispensed in 2020. The data were analyzed using frequencies and a chi-square test. Answers to open-ended questions were categorized using content analysis and then analyzed by frequency.

Results
In total, 66.7% (84/126) of the responses from Estonia and 76.6% (154/201) of the responses from Finland were included in the study. The majority of Estonian (74/84, 88%) and Finnish (126/154, 81.8%) respondents agreed that CBePs have improved patients’ access to medications. Problems with the availability of medications when dispensing CBePs were reported by 76% (64/84) of the Estonian respondents and 35.1% (54/154) of the Finnish respondents. In Estonia, the most commonly reported availability problem concerned the same active ingredient (49/84, 58%) of the medication not being available in the market, whereas in Finland, the most common issue was the unavailability of equivalent package size in the market (30/154, 19.5%). Encountering ambiguities or errors in the CBePs was reported by 61% (51/84) of the Estonian respondents and 42.8% (66/154) of the Finnish respondents. Mostly, the availability issues and ambiguities or errors were encountered rarely. The most commonly encountered ambiguities or errors were incorrect pharmaceutical form (23/84, 27%) in Estonia and incorrect total amount of medication (21/154, 13.6%) in Finland. Technical problems with using the CBeP system were reported by 57% (48/84) of the Estonian respondents and 40.2% (62/154) of the Finnish respondents. Most of the Estonian and Finnish respondents (53/84, 63%, and 133/154, 86.4%, respectively) had access to guidelines for dispensing CBePs. More than half of the Estonian (52/84, 62%) and Finnish (95/154, 61.7%) respondents felt that they had received sufficient training on dispensing CBePs.

Conclusions
Pharmacists in both Estonia and Finland agreed that CBePs improve access to medications. However, interfering factors, such as ambiguities or errors in CBePs and technical problems in the CBeP system, can reduce access to medications. The respondents had received sufficient training and were informed of the guidelines; however, they felt that the content of the guidelines could be improved.