Quality improvement toward decreasing high-risk medications for older veteran outpatients

Alan J. Zillich, Kenneth Shay, Barbara Hyduke, Thomas R. Emmendorfer, Alan M. Mellow, Steven Counsell, Mark A. Supiano, Peter Woodbridge, Pamela Reeves

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

OBJECTIVES: To examine the effectiveness of a quality improvement program to decrease prescribing of high-risk medications. DESIGN: Single cohort, pre- and postintervention. SETTING: Regional network of Department of Veterans Affairs medical facilities. PARTICIPANTS: Outpatient veterans aged 65 and older who received one or more high-risk medications and the prescribing clinicians. INTERVENTION: A two-stage intervention was implemented. First, a real-time warning message to prescribers appeared whenever one of the high-risk drugs was ordered; second, a personally addressed letter from the Chief Medical Officer asking prescribers to consider discontinuing the high-risk medication along with a copy of the Beers criteria article, a list of suggested alternatives to high-risk medications, and a list of older patients receiving the high-risk medications who had upcoming appointments with these prescribers. MEASUREMENTS: The primary outcome was the absence of prescribed high-risk medications for all patients in the cohort during the postintervention period. For a subgroup of the cohort whose prescribers received the second-stage intervention, an additional outcome was the absence of prescribed high-risk medications within the subgroup. RESULTS: Two thousand seven hundred fifty-three unique patients were identified in the cohort; 1,396 (50.7%) had high-risk medications discontinued, resulting in a significant decrease in the number of patients prescribed high-risk medications from the preintervention period to the postintervention period (P<.001). Of the 801 patients in the subgroup, 72.0% (n=577) had high-risk medications discontinued (P<.001). CONCLUSION: This multimethod intervention significantly decreased prescribing of high-risk medications to older patients. Further studies are needed to confirm the findings.

Original languageEnglish
Pages (from-to)1299-1305
Number of pages7
JournalJournal of the American Geriatrics Society
Volume56
Issue number7
DOIs
StatePublished - Jul 2008

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Veterans
Quality Improvement
Outpatients
Appointments and Schedules

Keywords

  • Beers criteria
  • Geriatrics
  • Medication prescribing
  • Medication safety

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Quality improvement toward decreasing high-risk medications for older veteran outpatients. / Zillich, Alan J.; Shay, Kenneth; Hyduke, Barbara; Emmendorfer, Thomas R.; Mellow, Alan M.; Counsell, Steven; Supiano, Mark A.; Woodbridge, Peter; Reeves, Pamela.

In: Journal of the American Geriatrics Society, Vol. 56, No. 7, 07.2008, p. 1299-1305.

Research output: Contribution to journalArticle

Zillich, AJ, Shay, K, Hyduke, B, Emmendorfer, TR, Mellow, AM, Counsell, S, Supiano, MA, Woodbridge, P & Reeves, P 2008, 'Quality improvement toward decreasing high-risk medications for older veteran outpatients', Journal of the American Geriatrics Society, vol. 56, no. 7, pp. 1299-1305. https://doi.org/10.1111/j.1532-5415.2008.01772.x
Zillich, Alan J. ; Shay, Kenneth ; Hyduke, Barbara ; Emmendorfer, Thomas R. ; Mellow, Alan M. ; Counsell, Steven ; Supiano, Mark A. ; Woodbridge, Peter ; Reeves, Pamela. / Quality improvement toward decreasing high-risk medications for older veteran outpatients. In: Journal of the American Geriatrics Society. 2008 ; Vol. 56, No. 7. pp. 1299-1305.
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AU - Zillich, Alan J.

AU - Shay, Kenneth

AU - Hyduke, Barbara

AU - Emmendorfer, Thomas R.

AU - Mellow, Alan M.

AU - Counsell, Steven

AU - Supiano, Mark A.

AU - Woodbridge, Peter

AU - Reeves, Pamela

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N2 - OBJECTIVES: To examine the effectiveness of a quality improvement program to decrease prescribing of high-risk medications. DESIGN: Single cohort, pre- and postintervention. SETTING: Regional network of Department of Veterans Affairs medical facilities. PARTICIPANTS: Outpatient veterans aged 65 and older who received one or more high-risk medications and the prescribing clinicians. INTERVENTION: A two-stage intervention was implemented. First, a real-time warning message to prescribers appeared whenever one of the high-risk drugs was ordered; second, a personally addressed letter from the Chief Medical Officer asking prescribers to consider discontinuing the high-risk medication along with a copy of the Beers criteria article, a list of suggested alternatives to high-risk medications, and a list of older patients receiving the high-risk medications who had upcoming appointments with these prescribers. MEASUREMENTS: The primary outcome was the absence of prescribed high-risk medications for all patients in the cohort during the postintervention period. For a subgroup of the cohort whose prescribers received the second-stage intervention, an additional outcome was the absence of prescribed high-risk medications within the subgroup. RESULTS: Two thousand seven hundred fifty-three unique patients were identified in the cohort; 1,396 (50.7%) had high-risk medications discontinued, resulting in a significant decrease in the number of patients prescribed high-risk medications from the preintervention period to the postintervention period (P<.001). Of the 801 patients in the subgroup, 72.0% (n=577) had high-risk medications discontinued (P<.001). CONCLUSION: This multimethod intervention significantly decreased prescribing of high-risk medications to older patients. Further studies are needed to confirm the findings.

AB - OBJECTIVES: To examine the effectiveness of a quality improvement program to decrease prescribing of high-risk medications. DESIGN: Single cohort, pre- and postintervention. SETTING: Regional network of Department of Veterans Affairs medical facilities. PARTICIPANTS: Outpatient veterans aged 65 and older who received one or more high-risk medications and the prescribing clinicians. INTERVENTION: A two-stage intervention was implemented. First, a real-time warning message to prescribers appeared whenever one of the high-risk drugs was ordered; second, a personally addressed letter from the Chief Medical Officer asking prescribers to consider discontinuing the high-risk medication along with a copy of the Beers criteria article, a list of suggested alternatives to high-risk medications, and a list of older patients receiving the high-risk medications who had upcoming appointments with these prescribers. MEASUREMENTS: The primary outcome was the absence of prescribed high-risk medications for all patients in the cohort during the postintervention period. For a subgroup of the cohort whose prescribers received the second-stage intervention, an additional outcome was the absence of prescribed high-risk medications within the subgroup. RESULTS: Two thousand seven hundred fifty-three unique patients were identified in the cohort; 1,396 (50.7%) had high-risk medications discontinued, resulting in a significant decrease in the number of patients prescribed high-risk medications from the preintervention period to the postintervention period (P<.001). Of the 801 patients in the subgroup, 72.0% (n=577) had high-risk medications discontinued (P<.001). CONCLUSION: This multimethod intervention significantly decreased prescribing of high-risk medications to older patients. Further studies are needed to confirm the findings.

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KW - Medication prescribing

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