title: Computerized prescribing alerts and group academic detailing to reduce the use of potentially inappropriate medications in older people.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cluster-randomized trial of group academic detailing and interrupted time-series analysis.
  
  
  METHODS
  Fifteen clinics of a staff-model health maintenance organization.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: HMO Research Network Center for Education and Research in Therapeutics, Harvard Medical School and Harvard Pilgrim Healthcare, Boston, MA 02215, USA. steven_simon@hms.harvard.edu
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.forename: Adrianne C
authors.initials: AC
authors.lastname: Feldstein
authors.forename: Nancy
authors.initials: N
authors.lastname: Perrin
authors.forename: Xiuhai
authors.initials: X
authors.lastname: Yang
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Zhou
authors.forename: Richard
authors.initials: R
authors.lastname: Platt
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
mesh_terms: D000368:Aged; D016303:Clinical Pharmacy Information Systems; D020000:Decision Support Systems, Clinical / Q000592:standards*; D011307:Drug Prescriptions / Q000592:standards*; D017723:Drug Utilization Review / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000639:trends; D011785:Quality Assurance, Health Care