Prevention of inappropriate prescribing in hospitalized older patients using a computerized prescription support system (INTERcheck(®)).
BACKGROUND
Polypharmacy is very common among older adults and can lead to inappropriate prescribing, poor adherence to treatment, adverse drug events and the prevalence of potential drug-drug interactions (DDIs). Electronic prescription database software may help to prevent inappropriate prescribing and minimize the occurrence of adverse drug reactions. INTERcheck(®) is a Computerized Prescription Support System (CPSS) developed in order to optimize drug prescription for elderly people with multimorbidity.


OBJECTIVE
The objectives of this study were (i) to evaluate the applicability of INTERcheck(®) as a means of reviewing the pharmacological profiles of elderly patients hospitalized in an acute geriatric ward in Northern Italy; and (ii) to evaluate the effectiveness of INTERcheck(®) in reducing potentially inappropriate medications (PIMs), potentially severe DDIs and the anticholinergic burden in daily practice.


METHODS
Two samples of elderly patients (aged 65+ years) hospitalized in a geriatric ward in Italy were enrolled throughout 2012. During the first (observation) phase, medications prescribed to 74 patients at admission and discharge were analyzed with INTERCheck(®) without any kind of interference based on information obtained from the software. During the second (intervention) phase, the treatment of 60 patients was reviewed and changed at discharge according to INTERCheck(®) suggestions.


RESULTS
In the observational period, the number of patients exposed to at least one PIM remained unchanged on both admission (n = 29; 39.1 %) and discharge (n = 28; 37.8 %). In the intervention phase, 25 patients (41.7 %) were exposed to at least one PIM at admission and 7 (11.6 %) at discharge (p < 0.001). The number of patients exposed to at least one potentially severe DDI decreased from 27 (45.0 %) to 20 (33.3 %), although the difference was not statistically significant (p = 0.703), while the number of new-onset potentially severe DDIs decreased from 37 (59.0 %) to 9 (33.0 %) [p < 0.001].


CONCLUSIONS
The use of INTERCheck(®) was associated with a significant reduction in PIMs and new-onset potentially severe DDIs. CPSSs combining different prescribing quality measures should be considered as an important strategy for optimizing medication prescription for elderly patients.
Geriatric Unit, Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Simona
S
Ghibelli
Alessandra
A
Marengoni
Codjo D
CD
Djade
Alessandro
A
Nobili
Mauro
M
Tettamanti
Carlotta
C
Franchi
Silvio
S
Caccia
Flavio
F
Giovarruscio
Andrea
A
Remuzzi
Luca
L
Pasina
D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000494:pharmacology; D004347:Drug Interactions; D004360:Drug Therapy, Computer-Assisted / Q000379:methods*; D005260:Female; D005853:Geriatrics; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008297:Male
D018680:Cholinergic Antagonists