title: Implementation and Assessment of an Ambulatory Prescribing Guidance Tool to Improve Patient Safety in the Geriatric Population.
abstract: OBJECTIVE
  The purpose of this study was to assess the effects of a clinical decision support (CDS) tool aimed at decreasing the prescribing of glyburide, a potentially inappropriate medication (PIM), in patients 65 years of age and older.
  
  
  METHODS
  Quasi-experimental, pre-post intervention study.
  
  
  METHODS
  Ambulatory care clinics of an academic medical center.
  
  
  METHODS
  The tool appeared to providers when entering new prescriptions or refills for glyburide. Glimepiride, which is a more appropriate sulfonylurea, was suggested as an alternative at order entry.
  
  
  METHODS
  The primary outcome was the prescribing of glyburide orders, measured as a percentage of the total oral diabetic medications ordered in patients 65 years of age and older, during the study period. The secondary outcome measured was the response to the CDS tool (accept versus reject).
  
  
  RESULTS
  The CDS tool alerted providers 101 times during the 90-day postimplementation period. When the tool appeared, patients were transitioned off of glyburide 17.8% of the time. Subanalysis found that when physicians viewed the alert, patients were transitioned off of glyburide 46.2% of the time. As a percentage of the total number of oral diabetic medications, glyburide prescribing was significantly decreased from pre- to postimplementation study period (3.3% vs. 1.2%; P < 0.001).
  
  
  CONCLUSIONS
  A CDS tool can be used in the ambulatory care setting to influence prescribing and provide a safer alternative medication. Additional information is needed to test the use of a CDS tool in conjunction with education to ensure providers are comfortable with and understand implications of a CDS tool.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ruhland
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Bellone
authors.forename: Erin
authors.initials: E
authors.lastname: Wilkes
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000188:drug therapy; D004347:Drug Interactions; D005905:Glyburide / Q000008:administration & dosage; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D008508:Medication Errors / Q000517:prevention & control*; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D063487:Prescription Drug Misuse / Q000517:prevention & control*; D013453:Sulfonylurea Compounds / Q000008:administration & dosage
chemical_list: D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; C057619:glimepiride; D005905:Glyburide