Clinicians find triggers and algorithms in e-prescribing software helpful in avoiding inappropriate medications in older adults
Research Activities, June 2012, No. 382
The elderly are particularly at risk for experiencing adverse drug events (ADEs) simply because of the sheer amount of medications they usually take. In addition, there are a number of potentially inappropriate medications (PIMs) prescribed for the elderly that can cause falls and other problems. E-prescribing systems custom designed with various triggers and treatment options may help clinicians avoid PIMs in the elderly by making it easier for them to change decisions at the point of prescribing, concludes a new study. It also found that primary care physicians welcome these triggers and evidence-based treatment algorithms provided they are efficient, trustworthy, and highly focused.
Pharmacists were first asked to review a list of 39 PIMs to identify those most frequently prescribed by their pharmacies. A final list of 15 PIMs was used for this study. In conjunction with an e-prescribing software vendor, the researchers developed treatment algorithms designed to help the primary care physician make alternative medication recommendations. Triggers and alerts were embedded into the e-prescribing system so that physicians did not have to push an extra button to receive PIM information and alternatives. Focus groups of physicians who used e-prescribing software were conducted to obtain their feedback regarding PIMs in the elderly and the triggers and algorithms being developed.
Overall, most physicians agreed that having such triggers and algorithms available to them in e-prescribing software would be useful in their daily practice. However, they requested that these must be carefully designed to be brief, highly focused, and able to be absorbed in 30 seconds or less. The physicians also complained about repetitive alerts or receiving triggers on content they already knew about. They also wanted the data be accurate, useful, and designed to promote efficient information retrieval. The study was supported in part by the Agency for Healthcare Research and Quality (HS17150).
See "Alternatives to potentially inappropriate medications for use in e-prescribing software: Triggers and treatment algorithms," by Anne L. Hume, Pharm.D., Brian J. Quilliam, Ph.D., R.Ph., Robert Goldman, Ph.D., M.A., and others in the BMJ Quality Safety 20, pp. 875-884, 2011.