Randomized trial to improve prescribing safety in ambulatory elderly patients.
OBJECTIVE
To determine whether a computerized tool that alerted pharmacists when patients aged 65 and older were newly prescribed potentially inappropriate medications was effective in decreasing the proportion of patients dispensed these medications.


METHODS
Prospective, randomized trial.


METHODS
U.S. health maintenance organization.


METHODS
All 59,680 health plan members aged 65 and older were randomized to intervention (n=29,840) or usual care (n=29,840). Pharmacists received alerts on all patients randomized to intervention who were newly prescribed a targeted medication.


METHODS
Prescription and age information were linked to alert pharmacists when a patient aged 65 and older was newly prescribed one of 11 medications that are potentially inappropriate in older people.


METHODS
Physicians and pharmacists collaborated to develop the targeted medication list, indications for medication use for which an intervention should occur, intervention guidelines and scripts, and to implement the intervention.


RESULTS
Over the 1-year study, 543 (1.8%) intervention group patients aged 65 and older were newly dispensed prescriptions for targeted medications, compared with 644 (2.2%) usual care group patients (P=.002). For medication use indications in which an intervention should occur, dispensings of amitriptyline (P<.001) and diazepam (P=.02) were reduced.


CONCLUSIONS
This study demonstrated the effectiveness of a computerized pharmacy alert system plus collaboration between healthcare professionals in decreasing potentially inappropriate medication dispensings in elderly patients. Coupling data available from information systems with the knowledge and skills of physicians and pharmacists can improve prescribing safety in patients aged 65 and older.
Raebel
Marsha A
MA
Clinical Research Unit, Kaiser Permanente Colorado, Denver, Colorado 80237-8066, USA. Marsha.A.Raebel@kp.org
Charles
Jeanya
J
Dugan
Jennifer
J
Carroll
Nikki M
NM
Korner
Eli J
EJ
Brand
David W
DW
Magid
David J
DJ
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016303:Clinical Pharmacy Information Systems; D011307:Drug Prescriptions / Q000592:standards*; D004360:Drug Therapy, Computer-Assisted / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control*; D010045:Outpatients; D011446:Prospective Studies; D017010:Reminder Systems