Quality improvement toward decreasing high-risk medications for older veteran outpatients.
OBJECTIVE
To examine the effectiveness of a quality improvement program to decrease prescribing of high-risk medications.


METHODS
Single cohort, pre- and postintervention.


METHODS
Regional network of Department of Veterans Affairs medical facilities.


METHODS
Outpatient veterans aged 65 and older who received one or more high-risk medications and the prescribing clinicians.


METHODS
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.


METHODS
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).


CONCLUSIONS
This multimethod intervention significantly decreased prescribing of high-risk medications to older patients. Further studies are needed to confirm the findings.
Zillich
Alan J
AJ
Center for Excellence in Implementing Evidence-Based Practices, Quality and Clinical Informatics Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA.
Shay
Kenneth
K
Hyduke
Barbara
B
Emmendorfer
Thomas R
TR
Mellow
Alan M
AM
Counsell
Steven R
SR
Supiano
Mark A
MA
Woodbridge
Peter
P
Reeves
Pamela
P
D000368:Aged; D000553:Ambulatory Care / Q000639:trends*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006304:Health Status; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D011787:Quality of Health Care / Q000639:trends*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
D004364:Pharmaceutical Preparations