How do Iranian physicians cope with electronic prescribing systems? An explanatory sequential mixed-methods study

Despite the widespread implementation of electronic prescribing systems, their effective use largely depends on physicians’ engagement with these technologies. In Iran’s developing healthcare context, electronic prescribing has been rapidly introduced; however, there is limited evidence on how physicians engage with and cope with these systems in everyday clinical practice. Addressing this gap is essential to inform effective implementation and optimization of electronic prescribing systems. This explanatory sequential mixed-methods study was conducted in 2024 in hospitals and clinics affiliated with Yazd University of Medical Sciences. In the quantitative phase, a survey was administered to assess physicians’ perceptions of electronic prescribing systems. The results of the quantitative phase informed the qualitative phase, in which semi-structured interviews were conducted to explore physicians’ experiences and to explain key barriers and facilitators underlying the survey findings. A total of 225 physicians participated in the quantitative phase, and purposive maximum variation sampling was used for the qualitative interviews. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed through thematic analysis. Most participants were general practitioners (68.5%), and 84.9% reported that paper prescriptions are prone to errors. Physicians rated technical and behavioral aspects of electronic prescribing systems relatively high (4.07 ± 0.76), perceived usefulness as moderate (3.56 ± 0.78), and organizational support as lower (3.00 ± 0.96). Qualitative findings helped explain these patterns: physicians appreciated the technical benefits but encountered workflow, managerial, and organizational challenges. To cope, they adopted strategies such as workarounds, peer support, gradual adaptation, and selective use of system features. These coping strategies were shaped by multiple factors, including technical, practical, legal, organizational, managerial, and socio-cultural dimensions, reflected in 24 sub-themes. Iranian physicians’ coping with electronic prescribing systems is influenced by multiple factors, including technical design, workflow challenges, organizational support, and socio-cultural context. The findings indicate that while physicians recognize the technical benefits of these systems, they adopt strategies such as workarounds, peer support, and gradual adaptation to manage difficulties. Enhancing system usability and providing targeted, continuous training may support physicians’ coping strategies and improve the effective use of electronic prescribing systems in clinical practice.