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Computerized and age-specific drug alerts can reduce both inappropriate prescribing of drugs and unnecessary drug alerts

Elderly patients are commonly prescribed medications that are potentially harmful to them, such as tertiary tricyclic amine antidepressants, long-acting benzodiazepines, or propoxyphene. To prevent this, computerized order entry (CPOE) systems include drug-specific alerts that warn clinicians about medications that are potentially inappropriate for older people each time the drug is ordered, regardless of the patient's age. Such alerts often annoy physicians when they are prescribing these drugs for younger patients. However, researchers recently modified a CPOE system so that age-specific drug alerts only occurred when clinicians prescribed target drugs to elderly patients. The system then suggested an alternative medication. This approach limited the number of unnecessary alerts faced by prescribers, while still maintaining the effectiveness of the drug-specific alerts.

The study was led by researchers at the HMO Research Network Center for Education and Research in Therapeutics at Harvard Pilgrim Health Care, which is supported by the Agency for Healthcare Research and Quality (HS11843). The research team randomly assigned seven practices to receive age-specific prescribing alerts plus an academic detailing intervention (interactive educational program on medications that can potentially harm the elderly). Eight practices received age-specific alerts alone.

Age-specific alerts resulted in continued effectiveness of the drug-specific alerts over a 1-year period. Group academic detailing did not enhance the effect of the alerts; however, the age-specific alerts led to fewer false-positive alerts for clinicians. During the drug-specific intervention (January to June 2002), each physician received an average of 18 alerts, 14 (82 percent) of which were false-positive (i.e., prescribed for nonelderly patients). During the age-specific intervention (January to June 2004), each physician received an average of four drug alerts, all of which were for elderly patients.

More details are in "Computerized prescribing alerts and group academic detailing to reduce the use of potentially inappropriate medications in older people," by Steven R. Simon, M.D., M.P.H., David H. Smith, R.Ph., Ph.D., Adrianne C. Feldstein, M.D., M.S., and others, in the June 2006 Journal of the American Geriatric Society 54, pp. 963-968.

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