title: Transient impact of automated glomerular filtration rate reporting on drug dosing for hospitalized older adults with concealed renal insufficiency.
abstract: BACKGROUND
  Older adults with concealed renal insufficiency are at risk of medication dosing errors. It is not known whether automated estimated glomerular filtration rate (eGFR) reporting is associated with reduced dosing errors in this population.
  
  
  OBJECTIVE
  The goal of the present study was to examine the impact on prescribing patterns in older adults with concealed renal insufficiency for a variety of renally cleared medications before and after the addition of automated eGFR reporting.
  
  
  METHODS
  We performed a retrospective chart review at a single tertiary academic medical center among hospitalized patients aged ≥ 70 years with concealed renal insufficiency. Data were examined from the months of July, December, and May before and after the hospital initiated automated eGFR reporting, in 2006-2007 and 2008-2009, respectively. Doses of selected renally cleared medications were classified as appropriate or inappropriate on the basis of published recommendations. Regression models were used to identify demographic, clinical, and care factors associated with dosing appropriateness.
  
  
  RESULTS
  Before implementation of automated eGFR reporting, we observed 260 persons in whom 42.2% of relevant prescriptions were inappropriately dosed; after implementation, there were 280 subjects in whom 36.6% of relevant prescriptions were inappropriately dosed. The multivariable model suggested an overall trend toward less inappropriate dosing after automated eGFR reporting began, compared with rates before (adjusted odds ratio [AOR] = 0.75 [95% confidence interval: 0.52-1.07], P = 0.11). However, a gradient was observed as the academic year progressed. A marked reduction in the rate of inappropriate medication dosing was seen in July after initiation of eGFR reporting compared with the July before initiation (AOR = 0.28; P < 0.01). This effect was attenuated in December (AOR = 0.45; P = 0.05) and gone by May (AOR = 0.85; P = 0.67).
  
  
  CONCLUSIONS
  Automated eGFR reporting alone, without any order entry intervention, was associated only transiently with improved dosing appropriateness for these older adults with concealed renal insufficiency.
authors.affiliation: Division of General and Geriatric Medicine, Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA. jkalender@kumc.edu
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Kalender-Rich
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Mahnken
authors.forename: James B
authors.initials: JB
authors.lastname: Wetmore
authors.forename: Sally K
authors.initials: SK
authors.lastname: Rigler
mesh_terms: D000046:Academic Medical Centers; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001331:Automation; D016009:Chi-Square Distribution; D054796:Drug Dosage Calculations; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D007615:Kansas; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008954:Models, Biological; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D055553:Prescription Drugs / Q000008:administration & dosage* / Q000493:pharmacokinetics; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D055553:Prescription Drugs