FEKEDE EGZI COLLEGE

DEPARTEMENT OF CLINICAL PHARMCY

A research proposal submitted to the department of clinical pharmacy, Fekede Egzi

College for the partial fulfillment of the requirement for the Bachelor of Degree in
pharmacy (B. PHARM)

Assessment of knowledge, attitudes, and practice toward electronic prescribing adoption

Debre Tabor comprehensive specialized hospital: a survey of prescribers at Debre Tabor
comprehensive specialized hospital, northcentral Ethiopia in 2023 G.C.

JUNE, 2023

Debre Tabor, Ethiopia

Summary

Background: Electronic prescribing is the most recent technological advancement in

medication. e-Prescribing is a computerized system that facilitates or speed up the interaction
between physicians and pharmacist by enabling physicians to create and transfer the medication
prescriptions electronically to pharmacists. Assessing physicians’ attitudes and behaviors that
help to technology adoption has been an area of ongoing research topic today. A few studies
investigate attitudes toward electronic health record adoption in inpatient and academic
ambulatory care settings. Some have investigated adoption readiness using statewide survey
samples of medical practices, others have assessed physicians’ perceptions of quality of care to
the technology.

Objectives: To assess the knowledge, attitudes, and practice toward electronic prescribing
adoption in the Debre Tabor comprehensive specialized hospital, north central Ethiopia from
June 1, 2023 to September 7, 2023

Method: A single center institutional based cross-sectional study will be conducted at DTCSH
on prescriber’s

Work plan and budget: This study will be conducted from June 1, 2023 to September 7, 2023
and different tasks will be carried out to do the research by each group members and it will need
a grand total cost of 3034 ETB.

i
Acknowledgement

First and foremost, we would like to thank our research adviser, Mr.denekew (MPH), for his
guidance, support, and encouragement throughout the entire process. His mentoring and
expertise were invaluable in helping us to shape the direction of our research and to bring our
ideas to fruition. We would also like to express our gratitude to the member of Debre Tabor
comprehensive specialized hospital staffs and also our research team, who provide valuable
input, insights, and assistance at every stage of the project. Their contribution is critical to the
success of this research, and we are deeply grateful for their hard work and dedication. Finally,
we would like to extend our heartfelt thanks to all of the participants in our study, who
generously shared their time, experiences, and insights with us. Their willingness to engage with
our research was essential to the success of this project, and we are deeply grateful for their
participation.

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Table of Contents
Summary......................................................................................................................................................i
Acknowledgement.......................................................................................................................................ii
Acronyms and abbreviation.........................................................................................................................v
1. Introduction.........................................................................................................................................1
1.1 Background..................................................................................................................................1
1.2 statement of the problem..............................................................................................................3
1.3 Literature review..........................................................................................................................4
1.4 Significance of the study..............................................................................................................6
2. Objective.............................................................................................................................................7
2.1 General objective.........................................................................................................................7
2.2 Specific objective........................................................................................................................7
3. Method and Material...........................................................................................................................7
3.1. Study area and period..................................................................................................................7
3.2. Study design................................................................................................................................7
3.3. population....................................................................................................................................8
3.3.1. Source population................................................................................................................8
3.3.2. Study population..................................................................................................................8
3.4 Eligibility criteria.........................................................................................................................8
3.4.1 Inclusion criteria..................................................................................................................8
3.4.2 Exclusion criteria.................................................................................................................8
3.5 Sample size determination and sampling procedure....................................................................8
3.6 Study variables............................................................................................................................9
3.6.1 Dependent variable..............................................................................................................9
3.6.2 Independent variables..........................................................................................................9
3.7 Operational definitions................................................................................................................9
3.8 Data collection procedure............................................................................................................9
3.8.1 Data collection instrument...................................................................................................9
3.8.2 Data quality management.....................................................................................................9
3.9 Data analysis procedures...........................................................................................................10
4 Ethical Consideration........................................................................................................................10
5. Dissemination plan................................................................................................................................10
6. Work Plan and Budget...........................................................................................................................10

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 6.1 Work plan........................................................................................................................................10
6.2 Budget Break Down..................................................................................................................12
7. References.............................................................................................................................................13
8 Annex.....................................................................................................................................................15
8.1 questionnaire (Data Collection Instrument).....................................................................................15

iv
Acronyms and abbreviation
CDS-eP- clinical decision supporting electronic prescription

CPOE- Computerized Physician Order Entry

EHRs- electronic health records

ETB- Ethiopian birr

ICT- Information and communication technologies

SPSS- Statistically Package for Social Services

DTCSH- Debre Tabor comprehensive specialized hospital

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1. Introduction
1.1 Background
Electronic prescribing (e-Prescribing), is the most recent technological advancement in
medication. e-Prescribing is a computerized system that facilitates or speed up the interaction
between physicians and pharmacist by enabling physicians to create and transfer the medication
prescriptions electronically to pharmacists. (1) e-Prescribing is the process of transmitting a
prescription or prescription-related information electronically from a prescriber directly to a
dispenser, rather than using the traditional paper methods. Previously existing research indicate
that implications of electronic-health, and e-Prescribing, can provide great advantage to
information management, reallocated distributive functions, providing more available time for
counseling and providing improved delivery of pharmaceutical care. Errors especially due to
illegibility of handwritten prescriptions, the constant need for time-consuming clarifications or
discussion with patient and refill requests could also be reduced with e-Prescribing. e-
prescribing also means of increasing security, a potential for collaborative billing, enable to use
time efficiently, for patient safety, make complete patient profile availability(data), and a better
pharmacist patient relationship as reasons for preferring the electronic method. (2)
In general, healthcare in the world, unlike other industries, has slowed in developing innovations
in information technology; but it is apparent that this sector is currently well on its way for
developing. A few federal agencies are actively promoting health information technology; a lot
of vendor firms are emerging; degree programs are mushrooming; and professional organizations
are hopping on the attractive growing of technology. E-Prescribing technology has taken hold as
an advance sector over hand-written drug treatments orders; E-prescription, being one of the
earliest adoptions in CPOE, which get acceptance by certain physicians. Prescribing errors are
the most source of preventable errors in hospitals in the world. E-Prescribing can reduce the
number of errors and indeed impact health outcomes.(3)
Electronic systems for medicine prescribing and administration have been adopted more widely
in the United States. currently, this may because of the need for costing of medication
administration, in an insurance-based health system, and the need for risk management to reduce
clinical risk to a minimum effect, and to optimize audit trails in a highly litigious society. As a
consequence,

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there are many proprietary electronic Prescribing systems, available in the United States.(4)
According to the United State national progress report on “e-prescribing, the total number of
transmitted e-prescriptions to community pharmacies increased by 27% from 2007 to 2012 in the
United States”.(1) for developing this infrastructure, the Federal Government supported the
national adoption of EHRs because of the promise that the adoption and use of health
information technology can increase health system efficiency, improve care quality, and reduce
medication errors.(5)
The electronic prescription system creates connection to information systems in health-care
organizations like in hospitals, health-care centers, and pharmacies sectors. The implementation
of this application can end many problems of paper prescribing process and will bring benefits,
including medication cost savings, reducing medication prescription errors, increasing
prescription legibility of handwritten, improving medication therapy outcomes, reducing
redundant paperwork, electronically accessing to updated pharmacopeia information, and also
hold patient medication history securely.(6)
Over many years, hand-written prescription has been a preferred communication method for
physicians in decisions relating to medication therapy and for transmitting prescription to
pharmacists to distribute medications to the patients. It is also considered as a valuable resource
for the patients counseling on how to use the medicine to achieve the maximum benefit of health
care. In the last decade, electronic prescription is start to adopted and considered as an interested
subject among other electronic health solutions to process the health-related data and record.(7)
ICT based innovations have proposed a wide range of new services for Heath care users and
providers at many health levels. However, “the digitalization process often is neither smooth nor
successful”. The difficulties that national health care systems across the Europe have been faced
creating electronic health becomes an interesting research topic pointing out the complexity of
the issues when ICT specialists, physicians, pharmacy specialists, health managers, lawyers and
politicians are interconnected.(8)
The technology would safely transmit prescription or prescription related information between
stakeholders (prescribers, dispensers, pharmacies, health plans, and health insurers and health
manager) either directly or through an intermediary (including an electronic prescription
network) using electronic media or software.(7)

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Assessing physicians’ attitudes and behaviors that help to technology adoption has been an area
of ongoing research topic today. A few studies investigate attitudes toward electronic health
record adoption in inpatient and academic ambulatory care settings. Some have investigated
adoption readiness using statewide survey samples of medical practices, others have assessed
physicians’ perceptions of quality of care to the technology.(9)

Today, the necessity of using electronic prescription systems can be felt more than ever due to
their many benefits. Therefore, study on this system as a systematic institution based cross
sectional review will be done. However, since many countries, especially developing countries
including our country Ethiopia, still use manual traditional prescription systems, using the
experiences of leading countries is very necessary and useful to develop and design the
electronic prescription system in the developing countries. Taking into account the above
considerations, the aim of our study is to assess the knowledge ,attitudes and practice toward
electronic prescribing adoption in university of Gondar specialized hospital on prescribers and
staff.(7)

1.2 statement of the problem

Prescription of medications are among the most commonly used treatment in health care, but the
process of managing written prescriptions and related telephone messages consumes substantial
time for prescribers and their staff. Furthermore, these processes are prone to error and
miscommunication, which sometimes result in patient harm(10)

Research showing that handwritten prescriptions are unsafe and associated errors can lead to
tremendous inefficiency for patients and pharmacists. Handwritten prescriptions have several
associated potential dangers, including the potential for misinterpretation errors due to
illegibility.(11)

Not using information technology (IT health) will lead to unimproved the quality, safety, and
efficiency of health care delivery… In addition to the dangers associated with poor legibility, the
need for pharmacy clarification can result in significant extra work for pharmacists as well as
delays for patients in obtaining prescriptions. Not potential benefits include unimproved
efficiency for pharmacists and providers, increase need for pharmacy clarification of prescription
information phone calls, and increase patient wait time for prescriptions.(11)

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There are many different types of errors related to e-prescribing they have been organized into
three broad categories:

Order entry errors from the provider side; for example:-Wrong drug, pharmacy, patient, incorrect
directions, conflicting information, wrong quantity errors Refill errors.(11)

Transcription errors for example:-Incorrect physician or a patient selected by pharmacist

incorrect information entered by pharmacist into pharmacy system.(11)

Dispensing errors for example:-Errors associated with modified prescriptions, Incomplete

processing of all prescriptions for a single patient, Dispensing of discontinued medications
Duplicate dispensing.(11)

Many barriers have hindered the adoption of EHRs and e-prescribing systems, including the
misalignment of financial incentives, the high cost of purchase, implementation and maintenance
of systems; the immaturity of software products and vendors; the lack of integration between
EHR systems(10)

1.3 Literature review

Electronic prescription (e-Prescription) has been discussed in many experts' reports and public
national plans, and it is tested, implemented, or are implementing in several European and
United States countries. However, since many countries, particularly developing countries, still
use manual traditional prescription systems, using the experiences of leading countries is
extremely necessary and useful to develop and design the electronic prescription system in the
different countries. (7)
A study in the united states of America illustrates that a higher proportion of prescribers than
staff use a computer at home for professional use; proportions for personal use were also
somewhat higher for prescribers than staff.(9) However another study in Puerto Rico which is an
unincorporated territory of the United States indicates 78.9% of community pharmacists reported
that they were familiar with the concept of e-prescribing and they understood its meaning.(2)
In one study which is carried out in Swedish majority of the respondents regarded their EHR
have a good attitude -system easy to use in general (81%), and for the prescribing of drugs
(88%). Most respondents believed they were able to provide the patients better service by e-

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prescribing (92%), and regarded e-prescriptions to be time-saving (91%) and to be safer (83%),
compared to handwritten prescriptions.
Although a majority (73%) of the physicians reported that they were always or often checking
the e-prescription the last time before transmitting, 25% declared that they were seldom or never
doing the last check. The respondents suggested several improvements, among others, to
simplify the drug choice and the cancellation of e-prescriptions.(12) Even if in Swedish
physicians had a good practice up on using electronic prescription they found a difference in
attitudes between physicians that were rare (< 5 eprescriptions/day), intermediate (5–10
eprescriptions/day) and extensive (> 10 eprescriptions/day) users of eprescribing. (12)
A study in Kuwait indicates that more than half (56%) reported having average computer
literacy, as a result of this physicians’ attitude and practice towards e-prescribing systems was
high (94%), with 94% indicating that they understood how to use the system. The vast majority
(95%) were currently using an e-prescribing system, with between 1–17 years of previous
experience. The number of daily prescriptions was between 15–54 prescriptions. The overall
weighted median score for the knowledge dimension of the questionnaire was 3, while the
median score for functionality was 2.3, respectively. (13)
In a cross-sectional survey among GPs in the West of Ireland 70% of the respondents believed
that CDS-eP can improve quality, while nearly 84% considered that using this new mechanism
may reduce prescribing error. 94% of GPs expressed their readiness to learn and use this new
mechanism. About one in five respondents were concerned that this mechanism may reduce their
decision-making power in prescribing.(14) However in another study, 45% of prescribers agreed
that using e-prescription means faster or easier prescribing, as well as another study from turkey
38% reported that e-prescribing was time-saving. (15, 16)
A pre-implementation cross-sectional study in India indicated that 70% claimed their
prescriptions to be legible and 60.7% liked paper prescriptions, only 40% were able to track the
continuity of their prescription. Around 70.8% had computer usage experience for more than 5
years, 23.7% for 1-5 years, and the restless than one year. 79% were comfortable with the use of
computers, and only 57.6% had self-assessed good knowledge of computers. Of the 70.5% who
have heard of e-prescriptions only 14% had hands-on exposure in generating it. In another study
from South Africa, approximately one-third of the responding physicians reported that they use
or have trialed e-prescribing systems. (16, 17)

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In a similar study in India, only 30.4% were afraid that their work would be controlled while
sending e-prescriptions. Even though an almost equal number of participants agreed and
disagreed on the fact that storage of personal healthcare information in a database would be
unethical and would lead to data abuse, 79.4% agreed that this data could be used for research
purposes. More than 50% of the participants disagreed with the statement that e-prescribing
would decrease the economic burden of the healthcare system and also, more than fifty
percentage thought that e-prescribing would help in detecting medication misuse and diversion.
(16)
Attitude regarding the future introduction of e-Prescription in Jordan nearly all of the responding
physicians (98.7%) agreed that developing a computerized system that includes important
information about drugs such as medicines interaction, contraindications, and cost, would
improve the prescribing process. The implementation of an EP system would result in a more
efficient prescribing and dispensing process according to 92% of the responders. (18)
Indian study regarding the future practice of electronic prescribing shows that 71.6% of
prescribers were willing to adopt e-prescribing in the future and 65% felt that it would be the
gold standard for prescribing in the coming years but the practice of electronic prescription
depends on good computer knowledge, that was found to be predictors of positive attitude
towards usefulness of e-prescription.(16)

1.4 Significance of the study

It is common sense that doctors with prescription eligibility should be responsible for rational
drug use.(19) The common problems faced with handwritten prescriptions are poor legibility,
incomplete writing or insufficient information, use of non-standard abbreviation, unintended
omissions, failure to stop a drug timely, dose errors, dosage form errors, and rarely inaccuracy in
writing. (20) Illegible handwriting in prescription writing is a nuisance, which could result in
serious injuries, including the death of the patients. (21) It may compel patients to take the wrong
medicine and wrong dosage and can also lead to unnecessary tests and discomfort. Pharmacists
may dispense wrong drugs. (22) It revealed that 44,000 to 98,000 people die annually in the USA
from medical errors. Out of them, about 7,000 deaths are attributable to sloppy handwriting. (23)
The adoption of electronic prescription is important to reduce prescription error. The result of
this study may provide important information about prescribers' and staff's attitude and

6
knowledge towards electronic prescription that is necessary to know whenever before the
implementation of electronic prescription in this hospital.

2. Objective
2.1 General objective

To assess the knowledge, attitudes, and practice toward electronic prescribing

adoption in the Debre Tabor comprehensive specialized hospital, north central
Ethiopia from June 1, 2023 to September 07,2023

2.2 Specific objective

To determine the attitude of the prescribers and staffs on perceived usefulness,
ease of use, and fitness of e-prescribing system
To determine the knowledge of prescribers and staffs towards e-prescribing
system
To assess prescribers and staff who have previous experience for electronic
prescription

3. Method and Material

3.1. Study area and period
The study will be conducted at Debre Tabor comprehensive specialized hospital (DTCSH). It is
located in the South Gondar administrative zone, Amhara region, North central Ethiopia. It is far
from about 657km (400 miles) northwest of Addis Ababa. According to the recent
administration, the town has 3 administration areas. In 2007 population and housing census
report, the total population size of Debre Tabor town was estimated to be 55,596. Currently,
Debre Tabor town has one comprehensive specialized hospital and three government Health
Centers. DTCSH serves more than five million people in the South Gondar zone and people
around the neighboring zones.

3.2. Study design

A single center institutional based cross-sectional study will be conducted at DTCSH on
prescribers

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cross-sectional study

3.3. population
3.3.1. Source population
All prescribers enrolled in human resource in the Debre Tabor comprehensive specialized
hospital.

3.3.2. Study population

All prescribers, who are working in the Debre Tabor comprehensive specialized hospital during
data collection period, were considered as study population.

3.4 Eligibility criteria

3.4.1 Inclusion criteria
All prescribers, who were employed at the Debre Tabor comprehensive specialized hospital.

3.4.2 Exclusion criteria

Those prescribers and staffs on annual and sick leave during the sample collection period.

Prescribers unwilling to participate in the study.

3.5 Sample size determination and sampling procedure

Sample size was determined using single population proportion formula. The proportion taken
from the findings of previous study in the Kerala state of India. As shown on the table below and
95% Confidence Interval, 0.05 margin of error and 10 % for non-response. Based on these
assumptions the actual sample size of the study, population calculated based on the formula
shown below.

n= (Zα/2)2 P(1-P)/d2
n= (1.96)2(0.5) (1-0.5)/ (0.05)2
n= 384.16
10% of nonresponse rate.
Total N=n= 425
N= the number of prescribers to be sampled (sample size).

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 3.6 Study variables
3.6.1 Dependent variable
 Attitude, Knowledge, and practice of electronic prescription
 Experience

3.6.2 Independent variables

 Socio-demographic variable includes: Age, Sex
 profession

3.7 Operational definitions

Prescription: is a written order by the doctor to the pharmacist. It has the status of a legal
document. (16)

Electronic prescription: is a prescription system with the utilization of electronic medical record
which is designed to facilitate medicines prescription service starts from the prescription writing
stage, prescription reading stage, and medicines preparation stage up to prescription hand over,
the medicine use process, monitoring process toward the taking out of prescribed medicines. (24)
Knowledge of electronic prescription:

3.8 Data collection procedure

3.8.1 Data collection instrument
Data will be collected, using a structured format questionnaire by three pharmacy undergraduate
students of Fekede egzi college. The questionnaire will be adapted from a review of different
literature then the questionnaire will be further modified after the pre-test will be conducted. The
Pre-test will be done on 5% of the sample size out of the study population on DTCSH
prescriber's and staff. The checklist will be further modified after a pretest will be conducted.
Data will be collected using pre-tested interviewer-administered structured questionnaires. The
principal investigators will be involved in the data collection.

3.8.2 Data quality management

To assure the quality of collected data the following measure will be taken. The data collection
instrument will be appropriately designed and used. The questionnaire will be pretested. Every

9
 day the collected data will be reviewed and checked for completeness and consistency of the
response.

3.9 Data analysis procedures

The collected data will be edited, entered, and cleaned by using Epi info version 7 and
transferred to SPSS version 20 for further analysis. The relationship between dependent and
independent variables will be examined using a logistic regression model. level of statistical
significance will set at a P-value of 0.05 and a confidence interval of 95%.

4 Ethical Consideration
This research will be conducted after the ethical clearance obtained from the research and ethical
committee of department of clinical pharmacy, fekede egzi college before the collection of data
using formatted questionnaires. The verbal informed consent will be obtained from study
participant after the objective of the study made clear and permission for cooperation was asked
politely. The confidentiality of study participants will be maintained by using codes. Verbal
informal voluntary consent will be taken from a participant.

5. Dissemination plan
After the research is finalized, the result will be submitted to the department of clinical
pharmacy, fekede egzi college and this result would be disseminated to DTCSH administrative
offices and used when the hospital tried to implement an electronic prescription system.

6. Work Plan and Budget

6.1 Work plan
Table 1: the whole activities performed in the study with their specific duration of period and
responsible body.

No. Task Responsible Duration (June 01 to Sep 07,2023)

Body June July August September
1. Topic Researchers
selection and and
approval department
of clinical

10
 pharmacy
Research
protocol Researchers
development
2. Proposal Researchers
development
and
Submission
3. Approval of Advisor
proposal
4. Pre–test Researchers
5. Designing of Researchers
the final
questionnaire
6. Obtaining Department
ethical of clinical
clearance pharmacy
7. Data Researchers,
collection data
collectors
8. Data Researchers
processing and
summarizing
(Data entry
into software)
9. Data Researchers
management
and analysis
10. Report writing Researchers
11. Developing Researchers
the final report

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 12. Research Department
defense and clinical
submission pharmacy
and
Researchers

6.2 Budget Break Down

Table 2: show budget break down

No. Budget category Unit Quantity Total Remark

Price price
(ETB) (ETB)

1) Expenses for stationery and materials

1 Pen 20.00 3 60.00

2 Pencil 10.00 3 30.00

3 Paper 500.00 3 pack 1500.00

4 Flash disk 350.00 1 350.00

5 Phone credit 15.00 10 150.00

Sub-total 2090 ETB

2) Service costs

1 Printing 5 90pgs 450 ETB

2 Photocopy and Binding 50 4pads 200 ETB

Sub-total 650 ETB

Table 3: shows total cost break down

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 Description of the cost
No. Cost in Remark
ETB
2 Expenses for stationery and materials 2090 ETB
3 Service costs 650 ETB
Sub-total 2740 ETB
Grand total (10%) 3034 ETB

7. References
1. Tremblay MC. A review of the literature and proposed classification on e-prescribing: Functions,
assimilation stages, benefits, concerns, and risks. 2015.
2. Clauson KA, Alkhateeb FM, Lugo KD, Khanfar NM. E-prescribing: attitudes and perceptions of
community pharmacists in Puerto Rico. International journal of electronic healthcare. 2011;6(1):34-46.
3. Salmon JW, Jiang R. E-prescribing: history, issues, and potentials. Online journal of public health
informatics. 2012;4(3).
4. electronic Aat, care: paip, a survey of prescribers and stafGoundrey-Smith S. History and Context
of Electronic Prescribing in the US and UK. Principles of Electronic Prescribing: Springer; 2012. p. 25-
46.
5. Johnson C, Johnston D, Crowley P, Culbertson H, Rippen H, Damico D, et al. EHR Usability
Toolkit: A Background Report on Usability and Electronic Health Records. Rockville, MD: Agency for
Healthcare Research and Quality; 2011. 2018.
6. Farre A, Bem D, Heath G, Shaw K, Cummins C. Perceptions and experiences of the
implementation, management, use and optimisation of electronic prescribing systems in hospital settings:
protocol for a systematic review of qualitative studies. BMJ open. 2016;6(7).
7. Samadbeik M, Ahmadi M, Sadoughi F, Garavand A. A copmarative review of electronic
prescription systems: Lessons learned from developed countries. Journal of research in pharmacy
practice. 2017;6(1):3.
8. wide IactIbihpa, range of new services for Heath care users and providers. However tdpo, Europe
insnsTdtnhcsa, pointing hbfceheHbairt, out the complexity of the issues when ICT specialists p,
pharmacy specialists, health, managers lapai.
9. Devine E, Patel R, Dixon D, Sullivan S. Assessing attitudes toward electronic prescribing
adoption in primary care: a survey of prescribers and staff. Journal of Innovation in Health Informatics.
2010;18(3):177-87.
10. Tan KS. Internet‐based ICT adoption: evidence from M2009.
11. Abramson EL. Causes and consequences of e-prescribing errors in community pharmacies2015.
12. Hellström L, Waern K, Montelius E, Åstrand B, Rydberg T, Petersson G. Physicians' attitudes
towards ePrescribing – evaluation of a Swedish full-scale implementation. BMC Medical Informatics and
Decision Making. 2009;9(1):37.

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13. Almutairi BA, Potts HW, Al-Azmi SF. Physicians’ Perceptions of Electronic Prescribing with
Electronic Medical Records in Kuwaiti Primary Healthcare Centres. Sultan Qaboos University Medical
Journal. 2018;18(4):e476.
14. Hor CP, O'Donnell JM, Murphy AW, O'Brien T, Kropmans TJ. General practitioners' attitudes
and preparedness towards Clinical Decision Support in e-Prescribing (CDS-eP) adoption in the West of
Ireland: a cross sectional study. BMC medical informatics and decision making. 2010;10(1):1-8.
15. Gіder Ö, Ocak S, Top M. Evaluation of electronic prescription implications in turkey: an
investigation of the perceptions of physicians. Worldviews on Evidence ‐Based Nursing. 2015;12(2):88-
97.
16. Palappallil DS, Pinheiro C. Perceptions of prescribers towards electronic prescription: A pre-
implementation evaluation. Journal of Young Pharmacists. 2018;10(3):313.
17. Cohen JF, Bancilhon J-M, Jones M. South African physicians' acceptance of e-prescribing
technology: an empirical test of a modified UTAUT model. South African Computer Journal.
2013;50(1):43-54.
18. El-Dahiyat F, Kayyali R, Bidgood P. Physicians’ perception of generic and electronic
prescribing: A descriptive study from Jordan. Journal of pharmaceutical policy and practice. 2014;7(1):1-
8.
19. Greenhalgh T. Drug prescription and self-medication in India: an exploratory survey. Social
science & medicine. 1987;25(3):307-18.
20. Velo GP, Minuz P. Medication errors: prescribing faults and prescription errors. British journal of
clinical pharmacology. 2009;67(6):624-8.
21. People Are Die Just Because Of Dr. Handwriting [Internet]. August 02, 2020. Available from:
https://www.wordmotive.com/2020/08/people-are-die-just-because-of-dr.html.
22. It’s time to totally ban handwritten prescription [Internet]. Oct 20, 2018, 2:28 am IST. Available
from: https://www.deccanchronicle.com/nation/in-other-news/201018/its-time-to-totally-ban-
handwritten-prescription.html.
23. Clark PA. Medication errors in family practice, in hospitals and after discharge from the hospital:
an ethical analysis. The Journal of Law, Medicine & Ethics. 2004;32(2):349-57.
24. Hahn A, Lovett A. Electronic prescribing: an examination of cost effectiveness, clinician
adoption and limitations. Universal Journal of Clinical Medicine. 2014;2(1):1-24.

14
8 Annex
8.1 questionnaire (Data Collection Instrument)

Questionnaires
Dear Sir, we are graduating pharmacy students of Fekede egzi College and we are conducting a research
in Debre Tabor comprehensive specialized hospital with the objective of assessment of knowledge,
attitudes, and practice to ward electronic prescribing adoption in Debre Tabor comprehensive
specialized hospital. Therefore, your genuine participation and honest response will help us to get more
information about the problem. The most important of your participation is based on your willingness.
Your responses are completely confidential.
Thank you in advance!
A survey of prescribers
Background information
participants study code: _________

Age: ______ Gender: Male Female

Qualification: Specialist Psychiatry professionals

Resident Anesthesia professional
General practitioner Optometrist
Intern Health officer
Nurse Physiotherapist

Please read the question carefully and encircle the most appropriate response Scale
-1- Strongly disagree 2- Disagree 3-Neutral 4-Agree 5–Strongly Agree

Current prescribing activities

Years of experience: <1 year 1-5 years 6-10 years 11-15 years 16-20 years >20 years

The patient volume load for me is high 1 2 3 4 5

Prescription written by me is clear 1 2 3 4 5

I like paper prescriptions 1 2 3 4 5

15
The pharmacists clear any doubts in my prescription 1 2 3 4 5

I am usually able to track the continuity of my prescription 1 2 3 4 5

Prescription given by me was altered by patients sometimes 1 2 3 4 5

My prescription pads /OP tickets were stolen sometimes 1 2 3 4 5

Pharmacies have incorrectly filled my prescriptions sometimes 1 2 3 4 5

My patients reported lost prescriptions requesting replacement 1 2 3 4 5

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Computer Use –Personal experience

I have been using computers for : <1 year 1 -5 years 6-10 years 11-15 years >15 years

I am comfortable with use of computers 1 2 3 4 5

I use computers/ laptops for professional & personal purposes 1 2 3 4 5

I regularly use computers at home 1 2 3 4 5

I regularly use computers in the hospital 1 2 3 4 5

I have good knowledge regarding the use of computers 1 2 3 4 5

Knowledge about electronic prescription (e prescription)

I have heard about e prescription earlier 1 2 3 4 5

I have heard about e prescription software’s 1 2 3 4 5

Perceived usefulness of e prescription

Having the capability to send e prescription is good 1 2 3 4 5

Compared to paper prescriptions e prescriptions will save time 1 2 3 4 5

Compared to paper prescriptions e prescriptions will be safer 1 2 3 4 5

Compared to paper prescription e prescription means better 1 2 3 4 5

Service to the patients

I like getting alerted about drug-drug interaction 1 2 3 4 5

E prescription will enable me to know that the patient has 1 2 3 4 5

Received the medication from the pharmacy

E prescription will enable to see what other doctors are 1 2 3 4 5

Prescribing to my patient which I would like to Know

I am worried that my work will be controlled when 1 2 3 4 5

Sending e prescription

It is a problem that more and more personal 1 2 3 4 5

Healthcare information is stored and available in databases

I am worried about data abusing 1 2 3 4 5

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It is good that more and more data is available so that 1 2 3 4 5

We can carry out health related research

E prescription reduces costs for health system 1 2 3 4 5

Perceived ease of use of e prescription

My work will be easier if I use e prescription 1 2 3 4 5

E prescribing is fast and will save time 1 2 3 4 5

E prescribing is fast but might cause lot of time wastage 1 2 3 4 5

Due to technical problems

Patients will be worried that I am referring internet 1 2 3 4 5

and prescribing

E prescribing improve patient satisfaction 1 2 3 4 5

I don’t like the fact that patients are not getting 1 2 3 4 5

the prescription in their hand

E prescribing will affect my work flow 1 2 3 4 5

E prescribing will require technical assistance regularly 1 2 3 4 5

It will be easy to renew prescriptions 1 2 3 4 5

I like to see the patients in person and assess them 1 2 3 4 5

rather than automatically fill prescriptions

With e prescription it is easy to identify diversion and 1 2 3 4 5

misuse of medicines

Prescribing through software is complicated 1 2 3 4 5

The pharmacies should be equally equipped with 1 2 3 4 5
Medications for success of e prescription

It will be difficult to change/cancel e prescription 1 2 3 4 5

Someone might log in to my id and send unauthorized 1 2 3 4 5

Prescriptions

Perceived fitness
I will accept e prescribing if it’s adopted in the institution 1 2 3 4 5

I think in 5-10 years e prescribing will be the gold standard 1 2 3 4 5

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I think the facilities in the institution will need drastic 1 2 3 4 5
Modifications

I don’t think e prescribing is ideal for a Centre with high 1 2 3 4 5

Patient load

There needs to be orientation classes and mass training 1 2 3 4 5

before adoption of e prescription in the institution

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Researchers;
1. Eyob terefe
2. Fasika wubneh
3. Bisrat nigussie
4. Birhanu amare
5. Meseret genet
6. Liyuneshi guadie
7. Betelihem mulualem
8. Danawit tadesse
9. Debie fenetaw
10. Belaynew workie

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