Article

Computerized prescribing alerts and group academic detailing to reduce the use of potentially inappropriate medications in older people.

HMO Research Network Center for Education and Research in Therapeutics, Harvard Medical School and Harvard Pilgrim Healthcare, Boston, MA 02215, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.22). 07/2006; 54(6):963-8. DOI: 10.1111/j.1532-5415.2006.00734.x
Source: PubMed

ABSTRACT To examine the effect of replacing drug-specific computerized prescribing alerts with age-specific alerts on rates of dispensing potentially inappropriate medications in older people and to determine whether group academic detailing enhances the effectiveness of these alerts.
Cluster-randomized trial of group academic detailing and interrupted time-series analysis.
Fifteen clinics of a staff-model health maintenance organization.
Seven practices (113 clinicians, 24,119 patients) were randomly assigned to receive age-specific prescribing alerts plus the academic detailing intervention; eight practices (126 clinicians, 26,805 patients) received alerts alone. Prior implementation of drug-specific alerts established a downward trend in use of target medications that served as the baseline trend for the present study.
The computerized age-specific alerts occurred at the time of prescribing a targeted potentially inappropriate medication (e.g., tertiary tricyclic amine antidepressants, long-acting benzodiazepines, propoxyphene) and suggested an alternative medication. Clinicians at seven sites were randomized to group academic detailing, an interactive educational program delivering evidence-based information.
Number of target medications dispensed per 10,000 patients per quarter, 2 years before and 1.5 years after the replacement of drug-specific with age-specific alerts.
Age-specific alerts resulted in a continuation of the effects of the drug-specific alerts without measurable additional effect (P=.75 for level change), but the age-specific alerts led to fewer false-positive alerts for clinicians. Group academic detailing did not enhance the effect of the alerts.
Age-specific alerts sustained the effectiveness of drug-specific alerts to reduce potentially inappropriate prescribing in older people and resulted in a considerably decreased burden of the alerts.

Full-text

Available from: Nancy Perrin, May 28, 2015
1 Follower
 · 
88 Views
  • Source
  • Source
  • [Show abstract] [Hide abstract]
    ABSTRACT: Dissemination and adoption of clinical decision support (CDS) tools is a major initiative of the Affordable Care Act's Meaningful Use program. Adoption of CDS tools is multipronged with personal, organizational, and clinical settings factoring into the successful utilization rates. Specifically, the diffusion of innovation theory implies that 'early adopters' are more inclined to use CDS tools and younger physicians tend to be ranked in this category. This study examined the differences in adoption of CDS tools across providers' training level. From November 2010 to 2011, 168 residents and attendings from an academic medical institution were enrolled into a randomized controlled trial. The intervention arm had access to the CDS tool through the electronic health record (EHR) system during strep and pneumonia patient visits. The EHR system recorded details on how intervention arm interacted with the CDS tool including acceptance of the initial CDS alert, completion of risk-score calculators and the signing of medication order sets. Using the EHR data, the study performed bivariate tests and general estimating equation (GEE) modeling to examine the differences in adoption of the CDS tool across residents and attendings. The completion rates of the CDS calculator and medication order sets were higher amongst first year residents compared to all other training levels. Attendings were the less likely to accept the initial step of the CDS tool (29.3%) or complete the medication order sets (22.4%) that guided their prescription decisions, resulting in attendings ordering more antibiotics (37.1%) during an CDS encounter compared to residents. There is variation in adoption of CDS tools across training levels. Attendings tended to accept the tool less but ordered more medications. CDS tools should be tailored to clinicians' training levels.
    Applied Clinical Informatics 01/2014; 5(4):1015-25. DOI:10.4338/ACI-2014-05-RA-0048 · 0.39 Impact Factor