Computerized decision support to reduce potentially inappropriate prescribing to older emergency department patients: a randomized, controlled trial.
OBJECTIVE
To evaluate the effectiveness of computer-assisted decision support in reducing potentially inappropriate prescribing to older adults.


METHODS
Randomized, controlled trial.


METHODS
An academic emergency department (ED) in Indianapolis, Indiana, where computerized physician order entry was used to write all medication prescriptions.


METHODS
Sixty-three emergency physicians were randomized to the intervention (32 physicians) or control (31 physicians) group.


METHODS
Decision support that advised against use of nine potentially inappropriate medications and recommended safer substitute therapies.


METHODS
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.


CONCLUSIONS
Computerized physician 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.


BACKGROUND
Clinical trials.gov Identifier: NCT00297869.
Terrell
Kevin M
KM
Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA. kterrell@regenstrief.org
Perkins
Anthony J
AJ
Dexter
Paul R
PR
Hui
Siu L
SL
Callahan
Christopher M
CM
Miller
Douglas K
DK
D000368:Aged; D016303:Clinical Pharmacy Information Systems; D020000:Decision Support Systems, Clinical; D004346:Drug Information Services; D004347:Drug Interactions; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004360:Drug Therapy, Computer-Assisted; D004363:Drug Utilization / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007196:Indiana; D016015:Logistic Models; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*