Transition to electronic prescriptions in pharmacies: Workflows, services, and access to medication – A mixed methods approach

Background: Germany's declining number of pharmacies raised concerns about patients' access to medication. To address this, pharmacies have started offering (digital) services, including analog and digital options such as phone consultation or medication delivery. According to existing literature, these services could improve access to medication. However, before the introduction of electronic prescriptions (ePs) in 2022, using these services in Germany was cumbersome. Objectives: Given this context, the aim of the study was to examine the challenges and potentials of electronic prescriptions in German pharmacies. Methods: A two-stage sequential mixed methods approach was used, combining semi-structured interviews with an online survey among 1215 pharmacists. Results: Nearly half of surveyed pharmacists (49.3%) supported the transition to electronic prescriptions, while 37.0% opposed it. Technical errors were widespread (mentioned by 90.5%) and disrupted both dispensing and service workflows. Over half (53.3%) believed ePs worsened in-pharmacy pick-up for patients, while 59.3% saw no major effect on (digital) services. More than one in four (28.5%) observed improvements in medication delivery through digital transfer, but many noted increased competition from large online pharmacies, increased workflow complexity, limited perceived patient demand and low profitability. Conclusion: Electronic prescriptions were associated with many challenges for pharmacists. Although they might have the potential to improve patient access to medications, this remains limited by technical instability, low patient digital literacy, and pharmacists' perceptions of limited usefulness. Enhancing pharmacist and patient experiences by reducing technical errors, ensuring profitability of (digital) services, and improving patients' readiness is essential to realize the potential of ePs.