Here to stay': changes to prescribing medication in general practice during the COVID-19 pandemic in New Zealand
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ORIGINAL RESEARCH PAPER
ORIGINAL RESEARCH
‘Here to stay’: changes to prescribing
medication in general practice during the
COVID-19 pandemic in New Zealand
Geraldine Wilson MBChB, FRNZCGP;1 Zoe Windner Medical Student;1 Susan Bidwell PhD, MA, MPH;1
Olivia Currie MBChB, DCH, FRNZCGP;1 Anthony Dowell MBChB, FRNZCGP;2 Andrew Adiguna Halim MD, MHSc;3
Les Toop MBChB, MD, FRNZCGP(Dist);1 Ruth Savage MB BS, MSc, (Clin Pharmacol);1 Umaya Ranaweera MBChB;1
Harrison Beadel MBChB;1 Ben Hudson MB BS, MRCGP, FRNZCGP1,4
1
Department of General Practice, University of Otago, Christchurch, 14 Gloucester Street, Christchurch 8140, New Zealand.
2
Department of Primary Health Care and General Practice, University of Otago, Wellington, 23a Mein Street, Wellington 6242,
New Zealand.
3
Pegasus Health (Charitable) Limited, 401 Madras St, Christchurch 8013, New Zealand.
4
Corresponding author. Email: ben.hudson@otago.ac.nz
J PRIM HEALTH CARE
2021;13(3):222–230.
doi:10.1071/HC21035 ABSTRACT
Received 24 March 2021
Accepted 14 July 2021 INTRODUCTION: The delivery of health care by primary care general practices rapidly changed in
Published 13 August 2021 response to the coronavirus disease 2019 (COVID-19) pandemic in early 2020.
AIM: This study explores the experience of a large group of New Zealand general practice health-
care professionals with changes to prescribing medication during the COVID-19 pandemic.
METHODS: We qualitatively analysed a subtheme on prescribing medication from the General
Practice Pandemic Experience New Zealand (GPPENZ) study, where general practice team
members nationwide were invited to participate in five surveys over 16 weeks from 8 May 2020.
RESULTS: Overall, 78 (48%) of 164 participants enrolled in the study completed all surveys. Five
themes were identified: changes to prescribing medicines; benefits of electronic prescription;
technical challenges; clinical and medication supply challenges; and opportunities for the future.
There was a rapid adoption of electronic prescribing as an adjunct to use of telehealth, minimising
in-person consultations and paper prescription handling. Many found electronic prescribing an
efficient and streamlined processes, whereas others had technical barriers and transmission to
pharmacies was unreliable with sometimes incompatible systems. There was initially increased
demand for repeat medications, and at the same time, concern that vulnerable patients did not have
usual access to medication. The benefits of innovation at a time of crisis were recognised and
respondents were optimistic that e-prescribing technical challenges could be resolved.
DISCUSSION: Improving e-prescribing technology between prescribers and dispensers, initiatives to
maintain access to medication, particularly for vulnerable populations, and permanent regulatory
changes will help patients continue to access their medications through future pandemic disruption.
KEYWORDS: Prescribing; electronic technology; general practice; pandemic.
Introduction There was a swift change to providing care
remotely through use of telehealth,1 which also
The coronavirus disease 2019 (COVID-19) pan-
necessitated changes to the methods used to pre-
demic brought about rapid changes in the delivery
scribe medicines.
of health care by general practices in New Zealand.
CSIRO Publishing
Journal compilation Ó Royal New Zealand College of General Practitioners 2021
222 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International LicenseORIGINAL RESEARCH PAPER
ORIGINAL RESEARCH
When the country went into level 4 ‘lockdown’
from 25 March 2020,2 regulatory changes to pre- WHAT GAP THIS FILLS
scribing medications were introduced to maintain
access to medication while minimising risks of What is already known: There is variation in the use of e-prescribing in
COVID-19 transmission.3 The Director-General New Zealand, suggesting there is potential to improve efficiency,
of Health waived parts of the Medicines Regula- safety and communication for prescribing medicines. During the
tions 1984 to enable signature-exempt prescrip- coronavirus pandemic, several emergency regulatory changes were
tions.3 This was expanded to include all introduced to maintain access to medication while reducing in-person
prescriptions, not just those using the New Zealand contact.
ePrescription Service (NZePS), providing the
What this study adds: The pandemic crisis boosted uptake and
prescriptions met specified conditions.3 Addition-
acceptance of the benefits of e-prescribing, while highlighting the
ally, the Pharmaceutical Management Agency
largely technical deficiencies in our current systems. The pandemic
(PHARMAC) acted to ensure continuity of medi-
situation highlights the need to update prescribing legislation and plan
cine supply by restricting most medicines to
for maintaining supply of medication, particularly for vulnerable
monthly dispensing4 and relaxing criteria for pre-
populations, through disruptive events.
scribing, by removing Special Authority require-
ments and specialist retail pharmacist
recommendations.5
over a 16-week period from 8 May 2020.10 General
In New Zealand, some practices were already using practitioners, nurse practitioners, practice nurses
the NZePS, which provides a secure link between and practice managers from throughout New
prescriber and dispenser.6 NZePS prescriptions Zealand were invited to participate in GPPENZ.
were already exempt from signatures through an
enduring waiver in place since 2018.7 The NZePS A team of researchers analysed the data using
service is thought to reduce the risk of transcribing descriptive statistics and for open-text data, a the-
errors during dispensing and to improve commu- matic analysis with a constant comparative approach
nication between prescriber and pharmacist, but was used.11 A codebook was developed. For this
there was and remains variation in the uptake and research, prescribing content was specifically coded
use of NZePS throughout New Zealand.6 There is by GW and ZW using Nvivo software (with each
limited research into the effect of changes to pre- peer-reviewing the other’s coding). The primary
scribing during this period. One urban general analysis for this paper was based on a question
practice in Dunedin found requests for repeat pre- related to prescribing medications (Survey Three:
scriptions nearly doubled in the first 2 weeks of the What changes have been made at your practice to the
level 4 lockdown, compared with the same period way prescriptions are managed since the beginning
the year prior.8 Another study, which investigated of the Covid-19 pandemic until now?) and further
patients’ experience of telehealth, found it was more secondary analysis was performed where prescribing
convenient for patients when used for repeat was coded in more general survey questions. A
prescriptions.9 thematic content analysis was conducted drawing
from relevant codes, in a framework developed by
We present the first qualitative analysis of the GW, ZW and SB, and then circulated for review.
experience of changes to prescribing medication
during the COVID-19 pandemic, from a large Ethical approval was obtained from The University
group of primary healthcare professionals of Otago Human Ethics Committee (reference
throughout New Zealand. number D10/114).
Methods Results
This paper is part of the previously described Gen- Participant characteristics and demographics for
eral Practice Pandemic Experience New Zealand the GPPENZ study have been previously described
(GPPENZ) study, which followed the same group of in depth (summary shown Table 1).10 Most parti-
participants through a series of five online surveys, cipants were general practitioners (n ¼ 93, 56.7%),
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Table 1. Participants in the General Practice Pandemic Experience New Zealand for the future. Excerpts from survey responses are
(GPPENZ) Study10 identified by the discipline of the respondent.
Total (%)
Survey 1 164 Changes to prescribing medication
Survey 2 136 (82.9)
The lockdown period and rise in use of telehealth
Survey 3 118 (72) precipitated an immediate change to the way med-
Survey 4 112 (68.3) icines were prescribed in primary care (Table 2).
Survey 5 91 (55.5) Most respondents reported that their practices
Completed all surveys 1–5 78 (48) moved promptly from issuing paper scripts to
contactless (including electronic (e-)) prescribing.
Demographics
Mean age (years) 50
Survey respondents used a variety of methods to
Female 125 (76.2) send prescriptions to pharmacies, with email and
Ethnicity (Total count*) fax used most frequently. Some practices were
European 144 (87.8) already using the NZePS service, but the lockdown
Ma-ori 9 (5.5) provided the impetus for others to enrol in the
system. Respondents reported that the changes to
Pacific Peoples 5 (3.0)
prescribing rules meant that practices not using
Asian 12 (7.3)
NZePS could also send most prescriptions
MELAA 2 (1.2) electronically, direct to pharmacies. When pre-
Occupation scriptions were generated electronically, practices
General practitioner 93 (56.7) still needed to notify the chosen pharmacy and in
Practice nurse 38 (23.2) the case of NZePS, provide the pharmacy with a
barcode. This prompted a small number of
Nurse practitioner 11 (6.7)
respondents’ practices to use new software enabling
Practice manager 18 (11)
more seamless transmission from the practice
Practice manager and Nurse (dual role) 4 (2.4) management system (PMS) to the pharmacy,
Type of practice replacing the additional steps required to email or
Exclusively Urban practice 115 (70.1) fax the prescription. Survey responses showed
some regional differences: Canterbury respondents
*Total count of ethnicities will be greater than the number of respondents because one person can
identify as belonging to multiple ethnicities. could use the local Electronic Referral Management
MELAA (Middle Eastern/Latin American/African). Service (ERMS) to send prescriptions securely to
the pharmacy, but for some, this was complicated.
Increased use of electronic prescribing changed
with the second largest group being practice nurses work roles in practices. Whereas previously, nurses
(n ¼ 38, 23.2%), followed by nurse practitioners often generated repeat prescriptions, which were
(n ¼ 11, 6.7%) and practice managers (n ¼ 18, 11%), then signed by doctors, signatureless prescribing
with a small number in a dual practice nurse– needs to be done by prescribers themselves. There
manager role. Participants working in Canterbury was wide variability between practices. Although
were over-represented in the sample at 37.8% of many mentioned making the types of changes
survey one; however, participants were from described here, many others reported no change in
throughout New Zealand and the participants’ the way prescriptions were generated.
practices were affiliated with 80% of all Primary
Health Organisations (PHOs).10 Respondents also reported changes to usual proto-
cols around prescribing without an in-person
We defined five major themes relating to prescribing: appointment. Practices tended to relax limits on the
changes to prescribing medicines; benefits of elec- number of repeat prescriptions allowed without
tronic prescriptions; technical challenges; clinical seeing a patient in-person, particularly if patients
and medication supply challenges; and opportunities were considered stable. Respondents acknowledged
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Table 2. Illustrative quotations related to changes to prescribing medication
Changes to prescribing medication
Sub-theme Quote(s)
Move to electronic ‘E-scripts now the norm, as is emailing them to the pharmacy.’ [GP 2]
prescribing ‘Doing all electronic prescribing since COVID and it is great!’ [GP 4]
‘70% e-prescribing for green zone; 100% for red zone.’ [GP 40]
‘No physical pieces of paper.’ [GP 54]
Method of transmission to ‘Using NZePS but still printing and faxing mostly - although some doctors are e-mailing directly paperless scripts
pharmacy (non-CD forms) ... Mostly still faxing rather than scanning and e-mailing to pharmacies as they are more responsive to
this and not all pharmacies are accessing e-mails, real time.’ [GP 24]
Use of NZePS ‘Initially paper Rx delivered to pharmacy or faxed, then ERMS of standard unsigned Rx, in past week started NZePS,
currently having to print those to PDF and ERMS but about to sort the tech to email them.’ [GP 70]
Signature-exempt ‘Dispensation of signature allowed script protocols to be simplified.’ [GP 83]
prescriptions ‘Now fully electronic signatureless emailed direct to pharmacy - LOVE IT!’ [P 2]
Controlled drugs ‘Controlled drugs emailed signed copy and mailed to pharmacy.’ [GP 27]
New software innovations ‘Dr info rescript is being utilised for all scripts. Virtually no paper scripts are handed over to the patient, nor left for
collection from reception.’ [GP 47]
Changing roles ‘Doctors now have to do all the repeat scripts as there is not the ability for nurses to prepare scripts before sending.’
[GP 54]
No change to practice ‘No real difference as our scripts have always been dispensed from a pharmacy 1 h away, so have always done
faxing. We tried to implement NZePS but the technical errors have yet to be resolved.’ [GP 32]
‘No new changes, have not got the escript as pharmacy not set upyonsite pharmacy struggled financially during
covid.’ [GP 46]
Repeat prescriptions ‘We did more repeat prescriptions and deferred the usual reviews until the next 3 monthly repeat.’ [GP 20]
‘I did many phone consults and a lot of phone repeat prescriptions requests. Mostly this was for chronic disease
management in patients who were already stable.’ [GP 78]
Dealing with uncertainty ‘A massive shift in model of care. I’ve always been comfortable with virtual care and the benefits to both provider and
customer/patients. However other doctors who previously would quibble about providing repeat prescriptions were
all of a sudden having to accept a degree of risk and prescribe unseen. Or provide even direct care and advice just on
history alone. We estimate that this was safe and appropriate probably 80% of the time - on a temporary short-term
basis.’ [GP 24]
‘A lot of empirical treatment, e.g. suspected GAS sore throat, just treat for 10 days, as no swabs being done.’ [N 4]
Access to medication ‘Scripts were delivered by pharmacy to patient, either in car park or home delivery later in day.’ [N 4]
‘Empathetic towards people with high health needs and ensured they were safe and well during this y arranging
prescriptions for home delivery etc.’ [N 2]
‘Did a phone audit of over 70s checking for medication supply.’ [P 18]
‘Contacted all our elderly patients at beginning to make sure had support ie someone to do groceries deliver meds
etc.’ [GP 14]
NZePS (New Zealand ePrescription Service); CD (controlled drug); ERMS (Electronic Request Management System); Rx (prescription); PDF (portable
document format); GAS (Group A Streptococcus).
that this shift to non-contact prescribing inevitably Benefits of electronic prescriptions
introduced more uncertainty.
Many respondents were enthusiastic about the
There were many efforts described to ensure changes, noting a wide range of benefits for both
patients had access to medicines. Practices proac- practices and patients (Table 3). To the broad
tively contacted vulnerable patients to ensure they question ‘what do you think has been successful so
had adequate supplies of their medications. Home far?’ regarding changes in response to the COVID-19
deliveries were arranged by practices and pharma- pandemic, numerous respondents highlighted the
cies to enable patients who were especially vulner- switch to e-prescribing. E-prescribing was seen as
able to stay home. an important tool in creating a safe environment to
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Table 3. Illustrative quotations related to benefits of electronic prescriptions
Sub-theme Quote(s)
Successful ‘E-prescriptions (brilliant).’ [GP 11]
innovation ‘E-prescribing! Love it. All the staff love it too. No extra faxing or posting for reception staff.’ [GP 61]
Safe environment ‘Signatureless prescribing, email scripts, minimising handling – overall when it works is much more preferable than paper
scripts being collected etc.’ [GP 29]
Efficiencies ‘It has allowed us to streamline our business and make multiple cost savings (necessary due to lack of income) phone/virtual
consultations, emailing scripts and being able to do more ‘on line’ rather than fax. This has meant massive savings on paper,
ink, postage, and staff time.’ [P 6]
‘Reduced reception workload with ERMS prescription referrals.’ [GP 70]
Continuity of care ‘The change from the restrictions of face to face only for RN prescribing to incorporate e-health options has been good for me.
Many of our students (our clinic cares for students and staff) have returned to their homes elsewhere in NZ so this allows me to
continue to meet their pharmaceutical needs.’ [NP 10]
Long-awaited ‘yThings that we have been asking MOH, ACC, PHO and WINZ to do for a long time such as fund remote consultations or
changes allow e-scripts not needing signing have been pushed through; bureaucrats have been forced to think outside their rigid
ways.’ [GP 87]
‘We have ybeen trying to move to virtual consults and e-scripts etc for many years. This has meant the agencies we deal with
have had to move along this too and so has been really helpful for us to get some momentum.’ [GP 50]
RN (Registered Nurse); MOH (Ministry of Health (New Zealand)); ACC (Accident Compensation Corporation (New Zealand)); PHO (primary health
organisation); WINZ (Work and Income New Zealand)
avoid spread of COVID-19, minimising handling, difficulty in achieving reliable transmission of pre-
and reducing in-person contact. scriptions to the chosen pharmacy and any issues
required time-intensive follow up. Respondents
There were also efficiencies, with time and cost noted that not all pharmacies could receive their
saving for practice staff. The elimination of signa- e-prescriptions. These technical problems under-
tures was singled out by many respondents as a mined confidence in the viability of using electronic
particular benefit. As highlighted in survey one, transmission, with respondents reporting that they
prescribers could work from home further reducing returned to older, more reliable methods in the
the interpersonal contact between practice staff meantime. Respondents also acknowledged that
during the lockdown. Another advantage of pharmacies were working under strain, with a huge
e-prescribing combined with telehealth, was that increase in demand for prescriptions.
the many people who relocated for the lockdown
period were able to have continuity of care regard- Administrative delays and resource constraints also
less of where they were in New Zealand. limited the uptake of e-prescribing. One respondent
noted that not only had they been ‘unable to set up
Many respondents reported their satisfaction that electronic scripts due to hold up at PHO’, they had,
the pandemic had finally brought about changes in addition, been struggling with a ‘broken printer
that primary care had been requesting for a long for six to eight weeks now’ [GP 41]. Others found
time. They drew attention to the benefits of being e-prescribing difficult to integrate with their PMS
forced into a bold change by circumstances. and were ‘looking at whole new PMSy - an
expensive and time intensive change required by the
rapid changes in our work, and a whole new stress
Technical challenges with prescribing
on the practice finances and morale’ [GP 7].
changes
Many respondents experienced frustrations and
Clinical and medication supply
technical difficulties (Table 4). Some practices were
challenges
already used to e-prescribing, but others were not
and had the extra stress of having to learn quickly in There were also clinical concerns related to medi-
a time of crisis. Some respondents reported cines management (Table 5). Prescribers worried
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Table 4. Illustrative quotations related to technical challenges with prescribing changes
Sub-theme Quote(s)
Unreliable transmission ‘The system does not always work and it is the nurses that get the brunt of the patient anger despite not being the
prescriber. One day I had probably 20 phone calls from patients with script issue.’ [N 29]
‘The chemist complains that they don’t always come through or get duplicate faxed – there are [provider] issues with
these scripts.’ [GP 16]
‘Not all pharmacies accept e-scripts and it is harder/more time consuming to produce a physical script now.’ [GP 54]
Incompatible systems ‘E-prescribing developed – has been incredibly frustrating setting set up and running in the practice having been doing
barcoded scripts for months. The change to electronic transmission has been fraught with issues and failures. Pharmacy
recipients are not all well set up for receipt of these.’ [GP 30]
Lack of confidence in ‘These e-prescriptions have all sorts of bugs – we tried two different ones and have been rushed.’ [GP 82]
system ‘Tried e-scripts but too hard to do so went back to paper.’ [GP 57]
‘E-prescription sounded great at first but we ended up reverting back to just faxing prescriptions to pharmacies because
they were inundated with so much work that they would constantly call back for us to send through again or they couldn’t
‘find’ the Rx.’ [P 12]
Strain on pharmacies ‘I think pharmacies are possibly experiencing some challenges with multiple different routes of getting scripts – fax,
e scripts, ERMS.’ [GP 89]
‘One patient was issued completely wrong script by pharmacy, mostly thought to be due to sheer weight of numbers
trying to collect scripts from pharmacy.’ [N 35]
about harm they might cause and whether they were e-prescribing, with many suggesting that it should
practicing safely. There was a level of discomfort for be embedded into future practice (Table 6). Others
some in the number of ‘repeat scripts being given out similarly expressed hopes of moving towards
instead of patients being seen’ [GP 89]. ‘e-prescribing to be fully integrated and used
long term’ [GP 12], ‘scripts direct to pharmacies
Respondents also became aware of patients making as routine’ [GP 81] and ‘here to stay’ [GP 61].
different decisions about when to take medicines.
There were reports that some vulnerable indivi- The enthusiasm for changed prescribing practices
duals and communities were going without medi- was across all respondents, indicating that even
cines or had cut back the amount they were taking respondents who had negative experiences with
because they were ‘y too scared to go out’ [P 7] to e-prescribing during the lockdown recognised the
pick up the medicines from their pharmacy or due limitations had been largely technical and would
to financial pressures. Access to contraception was eventually be resolved when there were ‘easier ways
commonly affected. to electronically send scripts’ [GP 74], when
‘e-prescriptions [were] working seamlessly’ [P 14],
The opposite reaction occurred among patients and when their practice had access to the required
who feared they would not get the medicines they technology. As late as the final survey in August
needed and attempted to stockpile. In some prac- 2020, it was reported ‘we still have no access to video
tices, there was ‘high demand’ [N 34] and ‘panic consultations and e-prescriptions as of yet so that is
buying’ [GP 29] by patients who had heard media something that needs to change’ [GP 41].
reports of supply shortages caused by the pandemic.
Positively, respondents indicated that the COVID-
19 experience with e-prescribing had resulted in
Opportunities for the future
‘improved pharmacy relationships and co-plan-
E-prescribing was highlighted by numerous ning’ [GP 80] and highlighted the valuable oppor-
respondents as early as the first survey, as being one tunities for greater integration across a range of
of the main successes of the primary care pandemic other services.
response. This was confirmed in the fifth and final
survey where respondents were overwhelmingly The clinical concerns around e-prescribing did not
positive and optimistic about the role of appear to be a barrier for the future, as they were
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Table 5. Illustrative quotations related to clinical and medication supply challenges
Sub-theme Quote(s)
Clinical safety ‘Feeling as if I am practicing sloppy medicine by prescribing without examining people. It feels as if I am taking risks
sometimes. It doesn’t seem sustainable, just a stopgap.’ [GP 6]
Poor access to medication ‘Pharmacy reports many uncollected scripts.’ [P 18]
‘People decided to prolong their medications by reducing dosages. Even clients that knew we were open throughout
the shutdown and were available for phone consultation, did this.’ [NP 10]
‘We have noticed some patients who are high needs have not sought repeat prescription, etc.’ [N 38]
‘Pacific community scared to leave home and get meds.’ [GP 41]
‘People are anxious about job insecurity. Some people have already lost their jobs. Some are not able to pay their bills.
Some people are selective about the medications they will collect.’ [N 25]
Access to contraception ‘Difficulties for some patients who have returned to rural areas and having trouble accessing primary care services
and usual contraceptive pill scripts.’ [GP 83]
‘Two unwanted pregnancies- too much time with partner and other case didn’t get COC as didn’t think chemist
open.’ [GP 80]
Increased demand for ‘We were completely unprepared for the amount of scripts that patients requested before moving to Level 4.
prescriptions Practices I have spoken to advised the same regarding scripts.’ [P 6]
COC (combined oral contraceptive (pill)).
Table 6. Illustrative quotations related to opportunities for the future
Sub-theme Quote(s)
Optimism for E- ‘Using e-prescriptions has made a huge difference in terms of efficiency, especially not having to sign them. Would be great
Prescribing if this were to continue after the crisis.’ [NP 8]
‘We have seen some efficient and safe changes to how we have practiced. Rules from authorities need to be changed in
order to implement some of the changes long-term.’ [GP 15]
‘Our systems are ready to go if we all have to work from home, we have remote access and email scripts sorted. We’re in a
much better place than we were in March when this all started escalating. We’ve had a bit of a break. I think we can pull
together and face it again.’ [GP 25]
Integration across ‘Having moved into virtual consultation yand also now doing full online laboratories and scripts, we now need radiology to
services provide the service. I expect all of these to be of use to us after we move to Level 1 alert.’ [GP 56]
Patient ‘y giving them the power to manage their health in their way with our guidance over the phone and sending prescriptions
empowerment directly to their pharmacy.’ [N 2]
Innovation ‘[Provider] digital scripts have been a revelation y it’s taught me that you don’t need to iron out every problem before trying
something new – just dive in and re-evaluate on a daily basis.’ [GP 47]
largely specific to the early part of the lockdown respondents noted that benefits in innovation and
when consultations had nearly all been virtual. By new ways of working in primary care had emerged
the time of the final survey, practices had opened up from being plunged into a crisis.
to in-person appointments, easing apprehensions
about being unable to examine patients adequately.
Discussion
The pressure to simply roll over repeats rather
than see the patient had eased. Efficiencies of We have described the changes and challenges of
e-prescribing remained and allowed the ‘best of prescribing medication during the early days of the
both worlds’, providing a paperless online process COVID-19 pandemic in New Zealand. The results
while retaining, in parallel, the option for generat- demonstrate the agility of general practice in rapidly
ing a paper prescription for patients, if requested. adapting to change and, as perceived by our study
These changes were viewed as being associated with participants, community pharmacies equally rose to
a sense of empowerment for patients. Several the challenge.
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Many respondents moved swiftly towards e- drug-related problems.15 Some practices in our
prescribing as an adjunct to telehealth and this is sample took steps to ensure medication supply to
reflected in Ministry of Health data showing the high-needs patient groups by contacting patients
rapid uptake of general practices activating NZePS in proactively and linking them with local home deliv-
early 2020.6 The move to e-prescribing was framed ery services often run by pharmacy teams, and in
by most of our respondents as a success and a long- some areas, local community groups also provided
awaited change; the greatest challenges appeared to support.16 There appears to be inconsistent provision
be technical, and respondents were optimistic about of home delivery of medicines across New Zealand.
their resolution. Some prescribers made additional In Australia, the Home Medicine Service was formed
software changes to make the process more seamless, in response to the pandemic to support pharmacies to
a finding previously noted in the local literature.12 provide medication home delivery, and it may be that
New Zealand could adopt a similar system.17
Technology issues, including a lack of funding for
information technology (IT) applications and per- A strength of this study is its reporting from a large,
ceptions that vendors were not delivering accept- diverse group of primary care team members from
able products, have been identified as primary throughout New Zealand. These respondents were
barriers to e-health in previous international followed as the pandemic progressed, enabling us to
research.13 In this study, respondents shared con- observe changes over time. The pandemic is viewed
cerns about technology issues undermining benefits by many as a catalyst for the shift to electronic
and sometimes resulting in e-prescribing being provision of health care,18 and this study docu-
abandoned. Prescribers and pharmacists some- ments the primary care prescriber experience at this
times had incompatible systems resulting in unre- important transition point.
liable and work-intensive transmission of
prescriptions. The challenges of setting up inter- The primary limitation in this study is that we did not
operable health IT systems have been described include pharmacy teams. The viewpoint of dispen-
elsewhere.14 Additionally, pharmacists still require sers would provide important context for our find-
a paper copy of NZePS prescriptions to scan the ings and this is an opportunity for future research.
barcode (to access the prescription) and are Our data collection was largely from free-text com-
required to retain a paper copy. So, although pre- ments providing qualitative results; however, it would
scribers saved time by not printing prescriptions, be useful for future research to gather quantitative
this task fell to dispensers. There is still regional data to examine effects of changes to prescribing
variation in the use of NZePS,6 warranting further medications during the COVID-19 pandemic.
investigation into prescriber and dispenser experi-
ences of the system. To maximise benefits, NZePS Prescribing medication in New Zealand general
must be a fully integrated e-prescribing system and practice has undergone considerable change, mov-
funded appropriately. ing swiftly towards e-prescribing. There is a clear
mandate to continue with the acceleration of
Respondents expressed concerns about high-needs available and developing technology, which is
groups (including Māori, Pacific peoples, elderly and consistent and interoperable between prescribers
people living rurally) not accessing medicines as they and dispensers. We highlight the importance of
usually would. These people may be most at risk of planning, policy and actions focused on maintain-
poor health outcomes and if barriers are not ing access to medicines through large-scale dis-
addressed, inequities may be exacerbated. A study of ruptive events, particularly for vulnerable
community pharmacists during COVID-19 in the populations. Our sample is hopeful that at a gov-
Netherlands echoes the concern that vulnerable ernance level, regulatory changes facilitating remote
populations may be more adversely affected by prescribing will be made permanent. With these
logistical changes to prescribing and dispensing.15 changes, we are optimistic that e-prescribing is a
They concluded that decreased opportunity for safe, efficient tool for future primary care and that
medication education and counselling by pharma- patients can safely continue to access their medi-
cists during COVID-19 may adversely affect vulner- cations through any future disruption occurring
able groups who were already at increased risk of during the COVID-19 pandemic.
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Competing interests from: https://pharmac.govt.nz/news-and-resources/covid19/
dispensing-frequency/.
The authors declare no competing interests. 5. Pharmaceutical Management Agency (NZ). COVID-19:
Medicines with amended access criteria. 2020. [cited 2021
January 8]. Available from: https://pharmac.govt.nz/news-
and-resources/covid19/covid-19-information-for-prescri-
Funding bers/covid-19-medicines-with-amended-access-criteria/.
6. Ministry of Health (NZ). New Zealand ePrescription Service.
This research was internally funded and did not 2020. [cited 2021 January 18]. Available from: https://www.
receive any specific funding. health.govt.nz/our-work/digital-health/other-digital-health-
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interviews on patient experiences and preferences. BMC Fam
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University of Otago, Christchurch, for sponsoring 10. Wilson G, Currie O, Bidwell S, et al. Empty waiting rooms: The
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