{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:17:12Z","timestamp":1787847432538,"version":"build-2784847793"},"reference-count":43,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n The prospective prescription review system can improve prescription rationality, but its effectiveness in high-volume specialty care settings is not well established.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n We aimed to evaluate the effectiveness of the prospective prescription review system in reducing irrational prescriptions and to analyze factors associated with successful interception.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective cohort study analyzed all outpatient and emergency prescriptions issued between January 1 and December 31, 2024, at an eye, ear, nose, and throat tertiary hospital in Shanghai, China. Among 2,559,342 prescriptions, 123,914 (4.84%) flagged as irrational by the prospective prescription review system were included.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The overall interception success rate was 32.99% (40,877\/123,914). The prescription rationality rate increased from 95.23% (2,476,305\/2,600,219) to 96.79% (2,477,144\/2,559,342) after excluding intercepted prescriptions (\n \n . Higher review levels were strongly associated with higher interception success rates: 0.99% (517\/52,146) for reminder, 54.2% (37,039\/68,341) for warning, and 96.91% (3321\/3427) for mandatory (\n P<\/jats:italic>\n <.001). Revised prescriptions had a higher interception success rate than prescriptions without revision (35,008\/50,418, 69.44% vs 5869\/73,496, 7.99%;\n P<\/jats:italic>\n <.001). Prescriptions without documented reasons showed a higher interception success rate than those with documented reasons (40,086\/98,070, 40.87% vs 791\/25,844, 3.06%;\n P<\/jats:italic>\n <.001). Physician acceptance of pharmacist disapproval was associated with a successful interception rate of 85.63% (137\/160), compared with 3.33% (2\/60) when the disapproval was rejected (\n P<\/jats:italic>\n <.001). Multivariable logistic regression showed that inappropriate dosage or frequency (odds ratio [OR] 3.11, 95% CI 2.99-3.24) and inappropriate prescription quantity (OR 2.09, 95% CI 2-2.18) were most likely to be intercepted, whereas inappropriate indications (OR 0.04, 95% CI 0.03-0.04) and radiation oncology (OR 0.01, 95% CI 0.01-0.02;\n P<\/jats:italic>\n <.001) were more likely to be issued. Pharmacist-led rule revision for mometasone furoate nasal spray led to a 1000-fold increase in identified irrational prescriptions (from 2-4 per month to 3022 in May). The interrupted time series analysis showed that the April revision was associated with an immediate and statistically significant increase in the monthly overall interception success rate (intervention coefficient = 0.15;\n \n ).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The prospective prescription review system substantially reduced irrational prescriptions and improved prescription rationality. Higher review levels were associated with higher interception rates, and physicians\u2019 attitudes also played a critical role. Paired-organ dose standardization emerged as an important consideration in ophthalmology and otolaryngology practice. Collaboration between the prospective prescription review system and pharmacists is essential for optimizing prescription review outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/87017","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:18:10Z","timestamp":1787843890000},"page":"e87017-e87017","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of the Prospective Prescription Review System in Reducing Irrational Prescriptions at a Tertiary Specialty Hospital: Retrospective Cohort Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0878-5768","authenticated-orcid":false,"given":"Fengmin","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7073-847X","authenticated-orcid":false,"given":"Min","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6562-3036","authenticated-orcid":false,"given":"Jianwen","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5689-9989","authenticated-orcid":false,"given":"Jingchao","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4185-7732","authenticated-orcid":false,"given":"Taomin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"issue":"7","key":"R1","doi-asserted-by":"publisher","first-page":"1428","DOI":"10.1111\/jgs.15384","article-title":"Electronic medication administration records in long-term care facilities: a scoping review","volume":"66","author":"Fuller","journal-title":"J Am Geriatr Soc"},{"issue":"10","key":"R2","doi-asserted-by":"publisher","first-page":"1223","DOI":"10.1001\/jama.293.10.1223","article-title":"Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review","volume":"293","author":"Garg","journal-title":"JAMA"},{"issue":"7494","key":"R3","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1136\/bmj.38398.500764.8F","article-title":"Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success","volume":"330","author":"Kawamoto","journal-title":"BMJ"},{"issue":"2","key":"R4","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1093\/jamia\/ocw145","article-title":"Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic review and meta-analysis","volume":"24","author":"Prgomet","journal-title":"J Am Med Inform Assoc"},{"issue":"12","key":"R5","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.1001\/archinte.163.12.1409","article-title":"Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review","volume":"163","author":"Kaushal","journal-title":"Arch Intern Med"},{"issue":"15","key":"R6","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1001\/jama.280.15.1339","article-title":"Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review","volume":"280","author":"Hunt","journal-title":"JAMA"},{"issue":"6","key":"R7","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1007\/s00228-008-0612-5","article-title":"SFINX-a drug-drug interaction database designed for clinical decision support systems","volume":"65","author":"B\u00f6ttiger","journal-title":"Eur J Clin Pharmacol"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1016\/j.artmed.2016.02.001","article-title":"Evaluation of a machine learning capability for a clinical decision support system to enhance antimicrobial stewardship programs","volume":"68","author":"Beaudoin","journal-title":"Artif Intell Med"},{"key":"R9","unstructured":"Notice on issuing the standards for prescription review in medical institutions [Web page in Chinese]. 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