Computerized Prescribing Alerts and Group Academic Detailing to Reduce the Use of Potentially Inappropriate Medications in Older People

Authors

  • Steven R. Simon MD, MPH,

    1. From the *HMO Research Network Center for Education and Research in TherapeuticsDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MassachusettsCenter for Health Research, Kaiser Permanente of the Northwest, Portland, Oregon§and Oregon Health & Science University, Portland, Oregon.
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  • David H. Smith RPh, PhD,

    1. From the *HMO Research Network Center for Education and Research in TherapeuticsDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MassachusettsCenter for Health Research, Kaiser Permanente of the Northwest, Portland, Oregon§and Oregon Health & Science University, Portland, Oregon.
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  • Adrianne C. Feldstein MD, MS,

    1. From the *HMO Research Network Center for Education and Research in TherapeuticsDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MassachusettsCenter for Health Research, Kaiser Permanente of the Northwest, Portland, Oregon§and Oregon Health & Science University, Portland, Oregon.
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  • Nancy Perrin PhD,

    1. From the *HMO Research Network Center for Education and Research in TherapeuticsDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MassachusettsCenter for Health Research, Kaiser Permanente of the Northwest, Portland, Oregon§and Oregon Health & Science University, Portland, Oregon.
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  • Xiuhai Yang MS,

    1. From the *HMO Research Network Center for Education and Research in TherapeuticsDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MassachusettsCenter for Health Research, Kaiser Permanente of the Northwest, Portland, Oregon§and Oregon Health & Science University, Portland, Oregon.
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  • Yvonne Zhou PhD,

    1. From the *HMO Research Network Center for Education and Research in TherapeuticsDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MassachusettsCenter for Health Research, Kaiser Permanente of the Northwest, Portland, Oregon§and Oregon Health & Science University, Portland, Oregon.
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  • Richard Platt MD, MS,

    1. From the *HMO Research Network Center for Education and Research in TherapeuticsDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MassachusettsCenter for Health Research, Kaiser Permanente of the Northwest, Portland, Oregon§and Oregon Health & Science University, Portland, Oregon.
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  • Stephen B. Soumerai ScD

    1. From the *HMO Research Network Center for Education and Research in TherapeuticsDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MassachusettsCenter for Health Research, Kaiser Permanente of the Northwest, Portland, Oregon§and Oregon Health & Science University, Portland, Oregon.
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Address correspondence to Steven R. Simon, MD, MPH, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, Sixth Floor, Boston, MA 02215. E-mail: steven_simon@hms.harvard.edu

Abstract

OBJECTIVES: To examine the effect of replacing drug-specific computerized prescribing alerts with age-specific alerts on rates of dispensing potentially inappropriate medications in older people and to determine whether group academic detailing enhances the effectiveness of these alerts.

DESIGN: Cluster-randomized trial of group academic detailing and interrupted time-series analysis.

SETTING: Fifteen clinics of a staff-model health maintenance organization.

PARTICIPANTS: Seven practices (113 clinicians, 24,119 patients) were randomly assigned to receive age-specific prescribing alerts plus the academic detailing intervention; eight practices (126 clinicians, 26,805 patients) received alerts alone. Prior implementation of drug-specific alerts established a downward trend in use of target medications that served as the baseline trend for the present study.

INTERVENTION: The computerized age-specific alerts occurred at the time of prescribing a targeted potentially inappropriate medication (e.g., tertiary tricyclic amine antidepressants, long-acting benzodiazepines, propoxyphene) and suggested an alternative medication. Clinicians at seven sites were randomized to group academic detailing, an interactive educational program delivering evidence-based information.

MEASUREMENTS: Number of target medications dispensed per 10,000 patients per quarter, 2 years before and 1.5 years after the replacement of drug-specific with age-specific alerts.

RESULTS: Age-specific alerts resulted in a continuation of the effects of the drug-specific alerts without measurable additional effect (P=.75 for level change), but the age-specific alerts led to fewer false-positive alerts for clinicians. Group academic detailing did not enhance the effect of the alerts.

CONCLUSION: Age-specific alerts sustained the effectiveness of drug-specific alerts to reduce potentially inappropriate prescribing in older people and resulted in a considerably decreased burden of the alerts.

Ancillary