title: E-learning in order to improve drug prescription for hospitalized older patients: a cluster-randomized controlled study.
abstract: The aim of the study was to evaluate the effect of an e-learning educational program meant to foster the quality of drug prescription in hospitalized elderly patients.
  
  
  
  Twenty geriatric and internal medicine wards were randomized to intervention (e-learning educational program) or control (basic geriatric pharmacology notions). Logistic regression analysis was used in order to assess the effect of the intervention on the use of potentially inappropriate medication (PIM, primary outcome) at hospital discharge. Secondary outcomes were a reduced prevalence of at least one potential drug-drug interaction (DDI) and potentially severe DDI at discharge. Mortality rate and incidence of re-hospitalizations were other secondary outcomes assessed at the 12-month follow-up.
  
  
  
  A total of 697 patients (347 in the intervention and 350 in the control arms) were enrolled. No difference in the prevalence of PIM at discharge was found between arms (OR 1.29 95%CI 0.87-1.91). We also found no decrease in the prevalence of DDI (OR 0.67 95%CI 0.34-1.28) and potentially severe DDI (OR 0.86 95%CI 0.63-1.15) at discharge, nor in mortality rates and incidence of re-hospitalization at 12-month follow-up.
  
  
  
  This e-learning educational program had no clear effect on the quality of drug prescription and clinical outcomes in hospitalized elderly patients. Given the high prevalence of PIMs and potential DDIs recorded in the frame of this study, other approaches should be developed in order to improve the quality of drug prescription in this population.
authors.affiliation: Laboratory for Quality Assessment of Geriatric Therapies and Services, Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Franchi
authors.affiliation: Laboratory for Quality Assessment of Geriatric Therapies and Services, Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Tettamanti
authors.affiliation: Laboratory for Quality Assessment of Geriatric Therapies and Services, Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Codjo Dgnefa
authors.initials: CD
authors.lastname: Djade
authors.affiliation: Laboratory for Quality Assessment of Geriatric Therapies and Services, Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pasina
authors.affiliation: A. Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS - Maggiore Hospital Foundation, Milan, Italy.
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
authors.affiliation: Department of Geriatrics, Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
authors.affiliation: FADOI Foundation, Research Department, Milan, Italy.
authors.forename: Gualberto
authors.initials: G
authors.lastname: Gussoni
authors.affiliation: Department of Internal Medicine, Ospedale Fatebenefratelli-AFaR, Rome, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Manfellotto
authors.affiliation: Area of Clinical and Molecular Epidemiology, IRCCS - San Raffaele Pisana, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonassi
authors.affiliation: Department of Medical and Surgery Sciences, IRCCS Policlinico San Donato, University of Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Salerno
authors.affiliation: Laboratory for Quality Assessment of Geriatric Therapies and Services, Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nobili
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D020407:Internet; D016015:Logistic Models; D008297:Male; D010351:Patient Discharge; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015995:Prevalence; D016037:Single-Blind Method
keywords: E-learning; comprehensive geriatric assessment; drug prescription; drug-drug interaction; elderly people; potentially inappropriate medication