1Department of Medical Records, College of Health Sciences, Public Authority of Applied Education & Training, Kuwait City, Kuwait; 2Institute of Health Informatics, University College London, London, UK *Corresponding Author’s e-mails: baa.almutairi@paaet.edu.kw and dr.bashayer.almutairi@gmail.com آراء األطباء عن الوصفة اإللكرتونية بالسجالت الطبية اإللكرتونية يف مراكز الرعاية الصحية األولية يف الكويت ب�شاير عبدهلل املطريي، هرني بوت�س، �شعدون فار�س العازمي abstract: Objectives: This study aimed to evaluate physicians’ perceptions of electronic prescribing in Kuwaiti primary healthcare centres. Methods: This cross-sectional study was conducted between June and August 2017 among 368 physicians from 25 primary healthcare centres in Kuwait. Data were collected from the participants using a self- reported questionnaire, including sociodemographic characteristics, previous experience with computers and awareness, knowledge and use of e-prescribing systems and their functional features. In addition, perceptions of the benefits and levels of satisfaction associated with e-prescribing were explored. Results: A total of 306 physicians completed the survey (response rate: 83%). The majority had positive perceptions regarding the use of e-prescribing, particularly in terms of time-savings (86%), healthcare quality (84%), productivity (80%) and clinical workflow and efficiency (83%). However, many respondents indicated that e-prescribing systems required additional improvements in terms of functionality. Conclusion: Most physicians in primary healthcare centres in Kuwait recognised the importance of e-prescribing to improve the quality of patient care, streamline workflow, increase productivity and reduce medical errors. However, there is a need to improve the design and infrastructure of e-prescribing systems, which may aid in the adoption of such systems in Kuwait. Keywords: Computer-Assisted Drug Therapies; Electronic Prescribing; Electronic Medical Records; Physicians; Primary Healthcare; Kuwait. امللخ�ص: الهدف: هدفت هذه الدرا�شة اإىل تقييم اآراء الأطباء حول تقدمي الو�شفات اإلكرتونيًا يف مراكز الرعاية ال�شحية الأولية يف الكويت. طبيبًا 368 عدد وا�شتهدف الأولية ال�شحية للرعاية مركًزا 25 يف 2017 اأغ�شط�س اإىل يونيو من مقطعي م�شح درا�شة اإجراء مت الطريقة: بطريقة اختيار ع�شوائية بعد دعوتهم للم�شاركة يف الدرا�شة. مت جمع البيانات عن طريق ا�شتبيان ذاتي يت�شمن املعلومات الدميوغرافية، الإلكرتونية الو�شفة اأنظمة الطبيبباإ�شتخدام ومعرفة ادراك مدى عن ومعلومات الكمبيوتر، اأجهزة ا�شتخدام يف اخلربة عن ومعلومات وم�شتويات الإلكرتوين بالو�شف املرتبطة الفوائد حول الأطباء وت�شورات باآراء تتعلق معلومات جمع مت كما الوظيفية. وخ�شائ�شها ر�شاهم عن النظام. النتائج: ا�شتكمل امل�شح ما جمموعه 306 طبيًبا )معدل ا�شتجابة: %83(. قد كانت الإجابات ب�شكل عام اإيجابية يف ما يتعلق با�شتخدام الو�شفات الإلكرتونية، خا�شة فيما يتعلق بتوفريالوقت )%86(، وجودة الرعاية ال�شحية )%84(، والإنتاجية )%80(، و�شري العمل ال�رصيري والكفاءة )%83(. كما اأ�شار معظم امل�شاركني اإىل اأن اأنظمة الو�شف الإلكرتونية حتتاج اإىل ادخال وظائف حم�شنة. اخلال�صة: �شهولة و�شمان املر�شى رعاية جودة لتح�شني الإلكرتونية الدواء و�شف اأنظمة باأهمية الكويتية الأولية الرعاية مراكز يف الأطباء يقر �شري العمل والإنتاجية والتقليل من الأخطاء الطبية. مع ذلك، هناك حاجة لتح�شني ت�شميم البنية التحتية لنظام الو�شفة الإلكرتونية، مما �شي�شهم يف اإعتمادها بفعالية يف الكويت. الأولية؛ ال�شحية الرعاية الأطباء؛ الإلكرتونية؛ ال�شحية ال�شجالت الكرتونية؛ الو�شفة باحلا�شوب؛ املدعومة الدوائية العالجات املفتاحية: الكلمات الكويت. Physicians’ Perceptions of Electronic Prescribing with Electronic Medical Records in Kuwaiti Primary Healthcare Centres *Bashair A. Almutairi,1 Henry W. W. Potts,2 Saadoun F. Al-Azmi1 clinical & basic research Sultan Qaboos University Med J, November 2018, Vol. 18, Iss. 4, pp. e476–482, Epub. 28 Mar 19 Submitted 22 Jun 18 Revision Req. 29 Jul 18; Revision Recd. 19 Sep 18 Accepted 11 Oct 18 Advances in Knowledge - This study found that physicians in Kuwait were generally accepting of the introduction of electronic prescribing as part of an electronic medical record system, recognising the value and potential of such systems to improve efficiency, reduce medical errors and improve patient safety. - However, physicians in Kuwait identified several deficiencies in the implemented e-prescribing systems. Application to Patient Care - There is a need to address identified deficiencies in e-prescribing systems being implemented in Kuwait in order to optimise the quality of care provided to patients and reduce the potential for prescription errors. doi: 10.18295/squmj.2018.18.04.008 Bashair A. Almutairi, Henry W. W. Potts and Saadoun F. Al-Azmi Clinical and Basic Research | e477 Prescribing medicines is an important part of public healthcare services; as such, systems that optimise the prescription process are ess- ential.1 Electronic prescribing is defined as a computer- based method of creating, transferring, sorting and doc- umenting prescriptions electronically.2 A successful e-pre- scribing system functions as an interoperational plat- form between physicians and pharmacies to facilitate the exchange of treatment information.3 E-prescribing systems often form part of a larger electronic medical record (EMR) system allowing physicians access to a broad range of patient information, including medical histories and details of diagnoses and treatment, in addition to prescription information.4 Prescription errors are a common yet avoidable cause of increased morbidity and mortality.5–7 Although the implementation of new technologies may initially be challenging, adopting e-prescribing systems can help to reduce the frequency of medication errors, thereby enhancing patient safety and the overall quality of treat- ment, particularly in primary care settings and for patients with long-term drug regimens.8–10 The successful adopt- ion of e-prescribing systems has been reported in many regions worldwide, including the USA, UK, European Union and Canada.10,11 The main barriers to implement- ation include cost, time, lack of efficiency, negative per- ceptions of technology and its impact on care, lack of prior experience with computers, low computer literacy, limitations in interoperability, difficulty of data entry/ correction and the ability of the system to complete desired tasks.11–15 Furthermore, there may be concerns regarding differences in healthcare policies and the enforcement of local privacy and data protection laws.16 According to Sicotte et al., preferred style of information acquisition, successful integration of e-prescribing into day-to-day practice and previous computer experience all contribute to a better understanding of technology and can positively influence the usage and adoption of e-prescribing systems.17 In Kuwait, healthcare services are offered at the primary, secondary and tertiary level via health centres, regional general hospitals and specialty hospitals. There are a total of 97 primary healthcare centres located throughout the country.18 Each residential area has at least one primary healthcare centre, with some centres also incorporating specialised clinics catering to patients with diabetes, dermatological and ophthalmological prob- lems and those requiring antenatal care, among others. Although these centres operate on an independent basis, they are overseen by the Central Directorate of Primary Healthcare in the Kuwaiti Ministry of Health (MOH).18,19 In 2000, a national health information EMR system was developed by the MOH and subsequently implemented in all primary healthcare centres in 2001. The EMR system was specifically designed to support end-users (i.e. physicians, nurses and pharmacists) by providing access to a complete and accurate database of relevant patient information.20 This study aimed to evaluate phys- icians’ perceptions of e-prescribing in Kuwaiti primary healthcare centres. Methods This cross-sectional study was conducted between June and August 2017 in 25 primary healthcare centres in Kuwait. The required sample size for the study was based on a finite population of 1,685 physicians. As a conservative estimate, it was assumed that 50% of users would be satisfied with the current e-prescribing system. Taking into account a 4.6% error, the number of partic- ipants was calculated to be 350 at a 95% confidence level. Adjusting for a 5% non-response rate, a total of 368 Kuwaiti physicians were selected by a two-stage stratified random sampling method, considering the proportional allocation of the total population in the study area. In the first stage, a total of 25 primary healthcare centres were randomly selected, comprising five centres from each of the five main regions of Kuwait (Ahmadi, Asmimah, Farwaniya, Hawalli and Jahra). Subsequently, during the second stage, physicians from each of the selected centres were randomly chosen and invited to participate in the survey. A two-part English-language questionnaire was developed to elicit information from the participants. The first section focused on sociodemographic factors and computer experience (13 items), while the second consisted of 48 items to determine the physicians’ per- ceptions of e-prescribing in four categories: knowledge (four items), functionality (18 items), benefits (18 items) and satisfaction (eight items). All of the questions were closed-ended and were scored on a three-point Likert scale, with one indicating disagreement with the item, two neither agreement nor disagreement and three agreement. A pilot study of 10 physicians who were not included in the final study pre-tested the questionnaire to ensure the clarity and relevance of the items. The quest- ionnaires were physically distributed to the selected physicians during their work shifts and collected one week later by the same researcher. Data were analysed using the Statistical Package for the Social Sciences (SPSS), Version 24.0 (IBM Corp., Armonk, New York, USA). Responses for each item in the second section of the questionnaire were averaged over the total number of items in the category. As the scores for each dimension were not normally distributed, the results were expressed as minimums, maximums, medians and interquartile ranges (IQRs), with an over- all unweighted or weighted score. Mann-Whitney U, Physicians’ Perceptions of Electronic Prescribing with Electronic Medical Records in Kuwaiti Primary Healthcare Centres e478 | SQU Medical Journal, November 2018, Volume 18, Issue 4 Kruskal-Wallis and Spearman’s rank correlation tests were used to calculate associations at a 5% significance level. The study was approved by the Standing Committee for the Coordination of Medical & Health Research at the Kuwaiti MOH (#537/2017). All participants were informed of the study’s purpose, the anonymity of their data and that participation was voluntary in nature. Written consent was obtained from all participants prior to their inclusion in the study. Results A total of 306 participants took part in the survey (response rate: 83%). Most respondents were female (59%), 30–39 years old (49%), married (84%), had a postgraduate degree (58%) and had worked for between 6–11 years (40%). The majority (71%) had received their medical education outside of Kuwait and 61% had taken computer courses during medical school. More than half (56%) reported having average computer literacy. Awareness of e-pres- cribing 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 (median: 7 years; IQR: 5–11 years). The number of daily prescriptions was between 15–54 prescriptions (median: 42 prescriptions; IQR: 36–47 prescriptions) [Table 1]. The overall weighted median score for the knowledge dimension of the questionnaire was 3, while the median score for functionality was 2.3. Median weighted scores for the benefits and satisfaction dimensions were 2.7 and 2.5, respectively [Table 2]. Generally, the majority of physicians had positive perceptions regarding the concept of e-prescribing, reporting that the EMR system was easy to use (85%), efficient (88%) and provided easy access to prescriptions services (81%). Notable benefits of e-prescribing were time-savings (86%), increased healthcare quality (84%), productivity (80%) and clinical workflow and efficiency (83%). However, many of the respondents indicated that e-prescribing systems should have better functionality, Table 1: Sociodemographic characteristics of physicians in primary healthcare centres in Kuwait (N = 306) Characteristic n (%) Age in years 20–29 23 (8) 30–39 149 (49) 40–49 68 (22) 50–59 44 (14) >60 22 (7) Gender Male 124 (41) Female 182 (59) Marital status Single 50 (16) Married 256 (84) Education level Bachelor’s degree 129 (42) Postgraduate degree 177 (58) Location of medical education Kuwait 89 (29) Abroad 217 (71) Previous work experience in years <6 64 (21) 6–11 123 (40) 12–17 46 (15) 18–23 38 (12) >24 35 (11) Prior computer training at medical school Yes 186 (61) No 120 (39) Level of computer literacy Basic 98 (32) Average 172 (56) Excellent 36 (12) Awareness of e-prescribing modules Yes 287 (94) No 19 (6) Use of e-prescribing modules Yes 291 (95) No 15 (5) Awareness of how to use e-prescribing modules Yes 288 (94) No 18 (6) Previous experience using e-prescribing modules in years Median (interquartile range) 7 (5–11) Range 1–17 Number of prescriptions per day Median (interquartile range) 42 (36–47) Range 15–54 Table 2: Dimension scores for a survey assessing perceptions of electronic prescribing systems among physicians in primary health- care centres in Kuwait (N = 306) Dimension Unweighted score Weighted score Range Med (IQR) Range Med (IQR) Knowledge 4–12 12 (11–12) 1–3 3 (2.8–3) Functionality 18–54 42 (37–48) 1–3 2.3 (2.1–2.7) Benefits 18–54 49 (43–53) 1–3 2.7 (2.4–2.9) Satisfaction 8–24 20 (19–21) 1–3 2.5 (2.4–2.6) Med = median; IQR = interquartile range. Bashair A. Almutairi, Henry W. W. Potts and Saadoun F. Al-Azmi Clinical and Basic Research | e479 Table 3: Perceptions of electronic prescribing systems among physicians in primary healthcare centres in Kuwait (N = 306) Item n (%) Disagree Neither Agree Knowledge The EMR e-prescribing system is easy to use 8 (3) 37 (12) 261 (85) It is easy to access e-prescription services and prescribe medications with this system 12 (4) 46 (15) 248 (81) I use the EMR e-prescribing system efficiently for most prescriptions 10 (3) 28 (9) 268 (88) The EMR e-prescribing system clearly displays patient demographic information 23 (8) 80 (26) 203 (66) Functionality The EMR e-prescribing system allows me to create new prescriptions 48 (16) 45 (15) 213 (70) The EMR e-prescribing system allows me to detect prescribing errors 74 (24) 77 (25) 155 (51) The EMR e-prescribing system allows me to receive medication interaction alerts 162 (53) 44 (14) 100 (33) The EMR e-prescribing system allows me to receive medication allergy alerts 41 (13) 34 (11) 231 (75) The EMR e-prescribing system allows me to review patient medication histories 15 (5) 39 (13) 252 (82) The EMR e-prescribing system allows me to track health maintenance items 44 (14) 98 (32) 164 (54) The EMR e-prescribing system allows me to select medications 13 (4) 28 (9) 265 (87) The EMR e-prescribing system allows me to view current medications 20 (7) 34 (11) 252 (82) The EMR e-prescribing system allows me to add an electronic signature 174 (57) 55 (18) 77 (25) The EMR e-prescribing system allows me to obtain medication information 89 (29) 66 (22) 151 (49) The EMR e-prescribing system allows me to review medication reference information 101 (33) 70 (23) 135 (44) The EMR e-prescribing system allows me to prescribe medication safely 80 (26) 81 (26) 145 (47) The EMR e-prescribing system allows me to request repeat medications 52 (17) 64 (21) 190 (62) The EMR e-prescribing system allows me to review formula information 92 (30) 68 (22) 146 (48) The EMR e-prescribing system allows me to print patient information sheets 48 (16) 35 (11) 223 (73) The EMR e-prescribing system allows me to print medical information sheets 36 (12) 44 (14) 226 (74) The EMR e-prescribing system allows me to perform dosing calculations 143 (47) 73 (24) 90 (29) The EMR e-prescribing system allows me to search by medication name 39 (13) 37 (12) 230 (75) Benefits The EMR e-prescribing system helps to control patient medication lists 68 (22) 66 (22) 172 (56) The EMR e-prescribing system leads to increased prescription accuracy 62 (20) 84 (27) 160 (52) The EMR e-prescribing system helps to streamline workflow and increase efficiency 17 (6) 35 (11) 254 (83) The EMR e-prescribing system contributes to financial savings 29 (9) 77 (25) 200 (65) The EMR e-prescribing system improves communication with pharmacists 32 (10) 50 (16) 224 (73) The EMR e-prescribing system improves communication with patients 37 (12) 69 (23) 200 (65) The EMR e-prescribing system leads to greater patient satisfaction 22 (7) 97 (32) 187 (61) The EMR e-prescribing system results in better security and confidentiality 16 (5) 77 (25) 213 (70) The EMR e-prescribing system results in better protection of the patient’s privacy 21 (7) 68 (22) 217 (71) The EMR e-prescribing system leads to greater patient safety 24 (8) 76 (25) 206 (67) The EMR e-prescribing system contributes to time-savings 13 (4) 31 (10) 262 (86) The EMR e-prescribing system reduces medication errors 28 (9) 79 (26) 199 (65) The EMR e-prescribing system leads to greater efficiency in physician practice 16 (5) 67 (22) 223 (73) The EMR e-prescribing system contributes to higher-quality healthcare 7 (2) 43 (14) 256 (84) The EMR e-prescribing system leads to greater productivity 14 (5) 46 (15) 246 (80) The EMR e-prescribing system improves flexibility without much mental effort 25 (8) 95 (31) 186 (61) The EMR e-prescribing system results in faster task accomplishment 19 (6) 45 (15) 242 (79) The EMR e-prescribing system allows me to treat more patients 21 (7) 68 (22) 217 (71) Satisfaction The EMR e-prescribing system is useful for my job 7 (2) 13 (4) 286 (93) The EMR e-prescribing system makes my job easier 9 (3) 18 (6) 279 (91) The EMR e-prescribing system is not time-consuming 46 (15) 48 (16) 212 (69) The EMR e-prescribing system improves the speed and efficiency of processing orders 12 (4) 41 (13) 253 (83) The EMR e-prescribing system maintains data accuracy 10 (3) 39 (13) 257 (84) The EMR e-prescribing system makes my job much more difficult 214 (70) 45 (15) 47 (15) I require more training to use the EMR e-prescribing system 92 (30) 91 (30) 123 (40) An on-staff support technician is needed to maintain and resolve technical problems 59 (19) 68 (22) 179 (58) EMR = electronic medical record. Physicians’ Perceptions of Electronic Prescribing with Electronic Medical Records in Kuwaiti Primary Healthcare Centres e480 | SQU Medical Journal, November 2018, Volume 18, Issue 4 Table 4: Dimension scores for a survey assessing perceptions of electronic prescribing systems among physicians in primary health- care centres in Kuwait according to sociodemographic characteristics (N = 306) Characteristic Median score (IQR) Knowledge Functionality Benefits Satisfaction Gender Male 3 (2.8–3) 2.3 (2.1–2.7) 2.7 (2.4–2.9) 2.5 (2.3–2.8) Female 3 (2.5–3) 2.3 (2.1–2.6) 2.8 (2.4–2.9) 2.5 (2.4–2.6) Marital status Single 2.8 (2.5–3) 2.4 (2.1–2.6) 2.7 (2.4–2.9) 2.5 (2.3–2.6) Married 3 (2.8–3) 2.3 (2.1–2.7) 2.7 (2.4–2.9) 2.5 (2.4–2.6) Education level Bachelor’s degree 3 (2.8–3) 2.4 (2.1–2.8) 2.7 (2.4–2.9) 2.5 (2.4–2.6) Postgraduate degree 3 (2.5–3) 2.3 (2.1–2.6) 2.7 (2.4–2.9) 2.5 (2.4–2.6) Location of medical education Kuwait 3 (2.8–3) 2.2 (2–2.5) 2.7 (2.3–2.9) 2.5 (2.3–2.6) Abroad 2.8 (2.5–3) 2.4 (2.1–2.7) 2.7 (2.4–2.9) 2.5 (2.4–2.6) Prior computer training at medical school Yes 3 (2.8–3) 2.4 (2.1–2.7) 2.8 (2.4–2.9) 2.5 (2.4–2.6) No 2.8 (2.5–3) 2.3 (2.1–2.6) 2.7 (2.3–2.9) 2.5 (2.3–2.6) Awareness of e-prescribing modules Yes 3 (2.8–3) 2.4 (2.1–2.7) 2.7 (2.4–2.9) 2.5 (2.4–2.6) No 2.8 (2.5–3) 2.1 (1.6–2.6) 2.4 (2.1–3) 2.5 (2.2–2.7) Use of e-prescribing modules Yes 3 (2.8–3) 2.4 (2.1–2.7) 2.7 (2.4–2.9) 2.5 (2.4–2.6) No 2.8 (2–3) 2.1 (1.8–2.6) 2.6 (2.1–3) 2.4 (2–2.5) Awareness of how to use e-prescribing modules Yes 3 (2.8–3) 2.4 (2.1–2.7) 2.7 (2.4–2.9) 2.5 (2.4–2.6) No 2.8 (2.5–3) 2 (1.5–2.6) 2.4 (2.2–2.9) 2.4 (2.3–2.6) IQR = interquartile range. Table 5: Relationship between sociodemographic variables and dimension scores for a survey assessing perceptions of electronic prescribing systems among physicians in primary healthcare centres in Kuwait (N = 306) Variable Knowledge Functionality Benefits Satisfaction R/Z score P value R/Z score P value R/Z score P value R/Z score P value Age −0.041* 0.474 0.102* 0.075 0.000* 0.999 −0.104* 0.068 Gender 0.170* 0.865 0.461† 0.645 0.408† 0.683 0.596† 0.551 Marital status 1.142† 0.253 0.635† 0.525 0.722† 0.470 1.088† 0.277 Education level 0.092† 0.927 1.524† 0.128 0.066† 0.947 0.820† 0.412 Location of medical education 1.205† 0.228 2.434† 0.015 1.473† 0.141 0.168† 0.866 Prior computer training at medical school 0.958† 0.338 1.546† 0.122 2.223† 0.026 0.998† 0.318 Computer literacy 0.050* 0.387 0.015* 0.797 0.071* 0.214 0.011* 0.849 Awareness of e-prescribing modules 1.726† 0.084 2.069† 0.039 1.123† 0.258 0.359† 0.720 Use of e-prescribing modules 2.386† 0.017 1.792† 0.073 0.859† 0.391 2.066† 0.039 Awareness of how to use e-prescribing modules 1.932† 0.053 2.656† 0.008 1.269† 0.204 0.887† 0.375 Previous experience using e-prescribing modules −0.003* 0.958 0.005* 0.353 −0.005* 0.937 0.070* 0.219 Number of prescriptions per day 0.028* 0.629 0.091* 0.112 −0.016* 0.718 −0.049* 0.396 IQR = interquartile range; EMR = electronic medical record. *Using Spearman’s rank correlation coefficient. †Using a Mann-Whitney U test. Bashair A. Almutairi, Henry W. W. Potts and Saadoun F. Al-Azmi Clinical and Basic Research | e481 for instance regarding the ability to add electronic sign- atures (57%), receive medication interaction alerts (53%) and perform dosing calculations (47%). Respondents also highlighted the need for technical support (58%) [Table 3]. Tables 4 and 5 show the relationship between the overall median scores in each of the questionnaire dim- ensions and selected sociodemographic characteristics. The median functionality score of physicians who had received medical education abroad was significantly higher than that of those who had been educated in Kuwait (2.4 versus 2.2; P = 0.015). Physicians who had received computer courses at medical school had a significantly higher median benefits score compared to those who did not (2.8 versus 2.7; P = 0.026). Median functionality scores were also significantly higher among physicians who were aware of e-prescription systems (2.4 versus 2.1; P = 0.039) and who understood how to use them (2.4 versus 2; P = 0.008). Median scores for the satisfaction and knowledge dimensions varied according to use of e-prescribing systems; users had significantly higher satisfaction (2.5 versus 2.4; P = 0.039) and knowl- edge (3 versus 2.8; P = 0.017) scores compared to non- users. All four dimensions of the questionnaire were significantly related with each other (P ≤0.001), with Spearman’s rank correlation coefficients ranging from 0.177–0.350 [Table 6]. Discussion The current study assessed perceptions of e-prescribing among physicians in primary healthcare centres in Kuwait. As physicians are the primary end-users of such systems, they are in the best position to identify factors that affect successful adoption and implementation of the system.21 The majority of physicians in the present study had positive perceptions of e-prescribing, part- icularly with regards to time-savings, ease of use, accessib- ility and increased healthcare quality, productivity and efficiency. In particular, most physicians anticipated that e-prescribing would result in improvements in prescription accuracy, data confidentiality and patient satisfaction and help to reduce prescription errors. The findings of the present study are in line with those of previous research. In a study in Singapore, Tan et al. reported that most doctors were satisfied with specific functions of e-prescribing systems such as the ability to review prescription histories, receive drug inter- action alerts and create prescriptions and e-prescription processing and system speed.22 A Swedish study noted that physicians were satisfied with the clear display of patient information on such systems.23 Thomas et al. found that physicians using an ambulatory e-prescribing system in the USA were optimistic about improved work- flow, efficiency, cost-savings and patient communication.24 Other studies have also reported perceived improve- ments in patient safety, care quality, efficiency, product- ivity and communication with pharmacies.1,9–11,23,25,26 Despite mostly positive perceptions, more than half of the physicians in the current study indicated that e-prescribing systems should have better functionality, such as the ability to add electronic signatures, receive medication interaction alerts and perform dosing calcul- ations. Cohen et al. highlighted a desire for e-prescribing technology to incorporate electronic signatures among physicians in South Africa, while Savage et al. revealed similar issues regarding allergy and interaction alerts and dosing calculations among staff at a district general hospital in the UK.27,28 In addition, a major area of con- cern in the present study was ensuring adequate technical support in the workplace for system maintenance and to overcome technical problems. These results are cons- istent with the findings of other studies regarding the need for greater technical and organisational support for the successful implementation and maintenance of e-prescribing systems.1,3 Jawhari et al. also emphasised the need for on-site technical support.29 The main limitation of the current study was that the sample was not representative of all primary health- care physicians in Kuwait; furthermore, as the quest- ionnaire data were self-reported, the findings may be subject to bias. Conclusion This study found that physicians’ perceptions of e-pres- cribing systems in Kuwaiti primary healthcare centres were mostly positive, particularly with regards to improve- ments in time-savings, efficiency, quality of patient care and safety. These results support the continued adoption and use of e-prescribing systems in Kuwait. However, several deficiencies were identified regarding the func- tionality of e-prescribing systems and the lack of techn- ical support and maintenance. Improvements in these areas may maximise the effective adoption and use of such systems. Table 6: Spearman’s rank correlations between dimensions in a survey assessing perceptions of electronic prescribing systems among phys- icians in primary healthcare centres in Kuwait (N = 306) Dimension Knowledge Functionality Benefits R P value R P value R P value Functionality 0.326 <0.001 - - - - Benefits 0.350 <0.001 0.538 <0.001 - - Satisfaction 0.177 0.001 0.241 <0.001 0.254 <0.001 Physicians’ Perceptions of Electronic Prescribing with Electronic Medical Records in Kuwaiti Primary Healthcare Centres e482 | SQU Medical Journal, November 2018, Volume 18, Issue 4 a c k n o w l e d g e m e n t s The authors would like to thank all of the physicians who participated in this study as well as the directors of the primary healthcare centres for facilitating and supporting the data collection process. c o n f l i c t o f i n t e r e s t The authors declare no conflicts of interest. f u n d i n g No funding was received for this study. References 1. 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