Computerized decision support to reduce potentially inappropriate prescribing to older emergency department patients: a randomized, controlled trial

  • Terrell K
  • Perkins A
  • Dexter P
 et al. 
  • 1

    Readers

    Mendeley users who have this article in their library.
  • N/A

    Citations

    Citations of this article.

Abstract

OBJECTIVES: To evaluate the effectiveness of computer-assisted decision support in reducing potentially inappropriate prescribing to older adults. DESIGN: Randomized, controlled trial. SETTING: An academic emergency department (ED) in Indianapolis, Indiana, where computerized physician order entry was used to write all medication prescriptions. PARTICIPANTS: Sixty-three emergency physicians were randomized to the intervention (32 physicians) or control (31 physicians) group. INTERVENTION: Decision support that advised against use of nine potentially inappropriate medications and recommended safer substitute therapies. MEASUREMENTS: 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. CONCLUSION: 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.Trial Registration: Clinical trials.gov Identifier: NCT00297869

Author-supplied keywords

  • Adult
  • Aged
  • Clinical Pharmacy Information Systems
  • Decision Support Systems,Clinical
  • Drug Information Services
  • Drug Interactions
  • Drug Prescriptions
  • Drug Therapy,Computer-Assisted
  • Drug Utilization
  • Emergency Medicine
  • Emergency Service,Hospital
  • Female
  • Humans
  • Inappropriate Prescribing
  • Indiana
  • Logistic Models
  • Male
  • Medication Errors
  • Medicine
  • Patients
  • Physician's Practice Patterns
  • Physicians
  • Research
  • prevention & control
  • secondary
  • statistics & numerical data
  • therapy

Get free article suggestions today

Mendeley saves you time finding and organizing research

Sign up here
Already have an account ?Sign in

Find this document

  • PMID: 19549022

Authors

  • K M Terrell

  • A J Perkins

  • P R Dexter

  • S L Hui

  • C M Callahan

  • D K Miller

Cite this document

Choose a citation style from the tabs below

Save time finding and organizing research with Mendeley

Sign up for free