Effectiveness of the Prospective Prescription Review System in Reducing Irrational Prescriptions at a Tertiary Specialty Hospital: Retrospective Cohort Study

Abstract Background The prospective prescription review system can improve prescription rationality, but its effectiveness in high-volume specialty care settings is not well established. Objective We aimed to evaluate the effectiveness of the prospective prescription review system in reducing irrational prescriptions and to analyze factors associated with successful interception. Methods This retrospective cohort study analyzed all outpatient and emergency prescriptions issued between January 1 and December 31, 2024, at an eye, ear, nose, and throat tertiary hospital in Shanghai, China. Among 2,559,342 prescriptions, 123,914 (4.84%) flagged as irrational by the prospective prescription review system were included. Results The overall interception success rate was 32.99% (40,877/123,914). The prescription rationality rate increased from 95.23% (2,476,305/2,600,219) to 96.79% (2,477,144/2,559,342) after excluding intercepted prescriptions ( . Higher review levels were strongly associated with higher interception success rates: 0.99% (517/52,146) for reminder, 54.2% (37,039/68,341) for warning, and 96.91% (3321/3427) for mandatory ( P <.001). Revised prescriptions had a higher interception success rate than prescriptions without revision (35,008/50,418, 69.44% vs 5869/73,496, 7.99%; P <.001). Prescriptions without documented reasons showed a higher interception success rate than those with documented reasons (40,086/98,070, 40.87% vs 791/25,844, 3.06%; P <.001). Physician acceptance of pharmacist disapproval was associated with a successful interception rate of 85.63% (137/160), compared with 3.33% (2/60) when the disapproval was rejected ( P <.001). Multivariable logistic regression showed that inappropriate dosage or frequency (odds ratio [OR] 3.11, 95% CI 2.99-3.24) and inappropriate prescription quantity (OR 2.09, 95% CI 2-2.18) were most likely to be intercepted, whereas inappropriate indications (OR 0.04, 95% CI 0.03-0.04) and radiation oncology (OR 0.01, 95% CI 0.01-0.02; P <.001) were more likely to be issued. Pharmacist-led rule revision for mometasone furoate nasal spray led to a 1000-fold increase in identified irrational prescriptions (from 2-4 per month to 3022 in May). The interrupted time series analysis showed that the April revision was associated with an immediate and statistically significant increase in the monthly overall interception success rate (intervention coefficient = 0.15; ). Conclusions The prospective prescription review system substantially reduced irrational prescriptions and improved prescription rationality. Higher review levels were associated with higher interception rates, and physicians’ attitudes also played a critical role. Paired-organ dose standardization emerged as an important consideration in ophthalmology and otolaryngology practice. Collaboration between the prospective prescription review system and pharmacists is essential for optimizing prescription review outcomes.