Computerized decision support to reduce potentially inappropriate prescribing to older emergency department patients: A randomized, controlled trial

Kevin M. Terrell, Anthony J. Perkins, Paul Dexter, Siu Hui, Christopher Callahan, Douglas K. Miller

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

OBJECTIVES: To evaluate the effectiveness of computer-assisted decision support in reducing potentially inappropriate prescribing to older adults. DESIGN: Randomized, controlled trial. SETTING: An academic emergency department (ED) in Indianapolis, Indiana, where computerized physican order entry was used to write all medication prescriptions. PARTICIPANTS: Sixty-three emergency physicians were randomized to the intervention (32 physicians) or control (31 physicians) group. INTERVENTION: Decision support that advised against use of nine potentially inappropriate medications and recommended safer substitute therapies. MEASUREMENTS: The primary outcome was the proportion of ED visits by seniors that resulted in one or more prescriptions for an inappropriate medication. The main secondary outcomes were the proportions of medications prescribed that were inappropriate and intervention physicians' reasons for rejecting the decision support. RESULTS: The average age of the patients was 74, two-thirds were female, and just over half were African American. Decision support was provided 114 times to intervention physicians, who accepted 49 (43%) of the recommendations. Intervention physicians prescribed one or more inappropriate medications during 2.6% of ED visits by seniors, compared with 3.9% of visits managed by control physicians (P=.02; odds ratio=0.55, 95% confidence interval=0.34-0.89). The proportion of all prescribed medications that were inappropriate significantly decreased from 5.4% to 3.4%. The most common reason for rejecting decision support was that the patient had no prior problems with the medication. CONCLUSION: Computerized physican order entry with decision support significantly reduced prescribing of potentially inappropriate medications for seniors. This approach might be used in other efforts to improve ED care.Trial Registration: Clinical trials.gov Identifier: NCT00297869.

Original languageEnglish
Pages (from-to)1388-1394
Number of pages7
JournalJournal of the American Geriatrics Society
Volume57
Issue number8
DOIs
StatePublished - Aug 2009

Fingerprint

Inappropriate Prescribing
Hospital Emergency Service
Randomized Controlled Trials
Physicians
Emergency Medical Services
African Americans
Prescriptions
Emergencies
Odds Ratio
Clinical Trials
Confidence Intervals

Keywords

  • Aged
  • Clinical
  • Decision support systems
  • Emergency service
  • Geriatrics
  • Hospital
  • Randomized controlled trials

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

@article{4f7b54591d4f490e8dfdc4fcf649b862,
title = "Computerized decision support to reduce potentially inappropriate prescribing to older emergency department patients: A randomized, controlled trial",
abstract = "OBJECTIVES: To evaluate the effectiveness of computer-assisted decision support in reducing potentially inappropriate prescribing to older adults. DESIGN: Randomized, controlled trial. SETTING: An academic emergency department (ED) in Indianapolis, Indiana, where computerized physican order entry was used to write all medication prescriptions. PARTICIPANTS: Sixty-three emergency physicians were randomized to the intervention (32 physicians) or control (31 physicians) group. INTERVENTION: Decision support that advised against use of nine potentially inappropriate medications and recommended safer substitute therapies. MEASUREMENTS: The primary outcome was the proportion of ED visits by seniors that resulted in one or more prescriptions for an inappropriate medication. The main secondary outcomes were the proportions of medications prescribed that were inappropriate and intervention physicians' reasons for rejecting the decision support. RESULTS: The average age of the patients was 74, two-thirds were female, and just over half were African American. Decision support was provided 114 times to intervention physicians, who accepted 49 (43{\%}) of the recommendations. Intervention physicians prescribed one or more inappropriate medications during 2.6{\%} of ED visits by seniors, compared with 3.9{\%} of visits managed by control physicians (P=.02; odds ratio=0.55, 95{\%} confidence interval=0.34-0.89). The proportion of all prescribed medications that were inappropriate significantly decreased from 5.4{\%} to 3.4{\%}. The most common reason for rejecting decision support was that the patient had no prior problems with the medication. CONCLUSION: Computerized physican order entry with decision support significantly reduced prescribing of potentially inappropriate medications for seniors. This approach might be used in other efforts to improve ED care.Trial Registration: Clinical trials.gov Identifier: NCT00297869.",
keywords = "Aged, Clinical, Decision support systems, Emergency service, Geriatrics, Hospital, Randomized controlled trials",
author = "Terrell, {Kevin M.} and Perkins, {Anthony J.} and Paul Dexter and Siu Hui and Christopher Callahan and Miller, {Douglas K.}",
year = "2009",
month = "8",
doi = "10.1111/j.1532-5415.2009.02352.x",
language = "English",
volume = "57",
pages = "1388--1394",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - Computerized decision support to reduce potentially inappropriate prescribing to older emergency department patients

T2 - A randomized, controlled trial

AU - Terrell, Kevin M.

AU - Perkins, Anthony J.

AU - Dexter, Paul

AU - Hui, Siu

AU - Callahan, Christopher

AU - Miller, Douglas K.

PY - 2009/8

Y1 - 2009/8

N2 - OBJECTIVES: To evaluate the effectiveness of computer-assisted decision support in reducing potentially inappropriate prescribing to older adults. DESIGN: Randomized, controlled trial. SETTING: An academic emergency department (ED) in Indianapolis, Indiana, where computerized physican order entry was used to write all medication prescriptions. PARTICIPANTS: Sixty-three emergency physicians were randomized to the intervention (32 physicians) or control (31 physicians) group. INTERVENTION: Decision support that advised against use of nine potentially inappropriate medications and recommended safer substitute therapies. MEASUREMENTS: The primary outcome was the proportion of ED visits by seniors that resulted in one or more prescriptions for an inappropriate medication. The main secondary outcomes were the proportions of medications prescribed that were inappropriate and intervention physicians' reasons for rejecting the decision support. RESULTS: The average age of the patients was 74, two-thirds were female, and just over half were African American. Decision support was provided 114 times to intervention physicians, who accepted 49 (43%) of the recommendations. Intervention physicians prescribed one or more inappropriate medications during 2.6% of ED visits by seniors, compared with 3.9% of visits managed by control physicians (P=.02; odds ratio=0.55, 95% confidence interval=0.34-0.89). The proportion of all prescribed medications that were inappropriate significantly decreased from 5.4% to 3.4%. The most common reason for rejecting decision support was that the patient had no prior problems with the medication. CONCLUSION: Computerized physican order entry with decision support significantly reduced prescribing of potentially inappropriate medications for seniors. This approach might be used in other efforts to improve ED care.Trial Registration: Clinical trials.gov Identifier: NCT00297869.

AB - OBJECTIVES: To evaluate the effectiveness of computer-assisted decision support in reducing potentially inappropriate prescribing to older adults. DESIGN: Randomized, controlled trial. SETTING: An academic emergency department (ED) in Indianapolis, Indiana, where computerized physican order entry was used to write all medication prescriptions. PARTICIPANTS: Sixty-three emergency physicians were randomized to the intervention (32 physicians) or control (31 physicians) group. INTERVENTION: Decision support that advised against use of nine potentially inappropriate medications and recommended safer substitute therapies. MEASUREMENTS: The primary outcome was the proportion of ED visits by seniors that resulted in one or more prescriptions for an inappropriate medication. The main secondary outcomes were the proportions of medications prescribed that were inappropriate and intervention physicians' reasons for rejecting the decision support. RESULTS: The average age of the patients was 74, two-thirds were female, and just over half were African American. Decision support was provided 114 times to intervention physicians, who accepted 49 (43%) of the recommendations. Intervention physicians prescribed one or more inappropriate medications during 2.6% of ED visits by seniors, compared with 3.9% of visits managed by control physicians (P=.02; odds ratio=0.55, 95% confidence interval=0.34-0.89). The proportion of all prescribed medications that were inappropriate significantly decreased from 5.4% to 3.4%. The most common reason for rejecting decision support was that the patient had no prior problems with the medication. CONCLUSION: Computerized physican order entry with decision support significantly reduced prescribing of potentially inappropriate medications for seniors. This approach might be used in other efforts to improve ED care.Trial Registration: Clinical trials.gov Identifier: NCT00297869.

KW - Aged

KW - Clinical

KW - Decision support systems

KW - Emergency service

KW - Geriatrics

KW - Hospital

KW - Randomized controlled trials

UR - http://www.scopus.com/inward/record.url?scp=68149174981&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=68149174981&partnerID=8YFLogxK

U2 - 10.1111/j.1532-5415.2009.02352.x

DO - 10.1111/j.1532-5415.2009.02352.x

M3 - Article

C2 - 19549022

AN - SCOPUS:68149174981

VL - 57

SP - 1388

EP - 1394

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 8

ER -