Quality Improvement Toward Decreasing High-Risk Medications for Older Veteran Outpatients
Version of Record online: 4 JUN 2008
© 2008, Copyright the Authors. Journal compilation © 2008, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 56, Issue 7, pages 1299–1305, July 2008
How to Cite
Zillich, A. J., Shay, K., Hyduke, B., Emmendorfer, T. R., Mellow, A. M., Counsell, S. R., Supiano, M. A., Woodbridge, P. and Reeves, P. (2008), Quality Improvement Toward Decreasing High-Risk Medications for Older Veteran Outpatients. Journal of the American Geriatrics Society, 56: 1299–1305. doi: 10.1111/j.1532-5415.2008.01772.x
- Issue online: 7 AUG 2008
- Version of Record online: 4 JUN 2008
- Beers criteria;
- medication prescribing;
- medication safety
OBJECTIVES: To examine the effectiveness of a quality improvement program to decrease prescribing of high-risk medications.
DESIGN: Single cohort, pre- and postintervention.
SETTING: Regional network of Department of Veterans Affairs medical facilities.
PARTICIPANTS: Outpatient veterans aged 65 and older who received one or more high-risk medications and the prescribing clinicians.
INTERVENTION: A two-stage intervention was implemented. First, a real-time warning message to prescribers appeared whenever one of the high-risk drugs was ordered; second, a personally addressed letter from the Chief Medical Officer asking prescribers to consider discontinuing the high-risk medication along with a copy of the Beers criteria article, a list of suggested alternatives to high-risk medications, and a list of older patients receiving the high-risk medications who had upcoming appointments with these prescribers.
MEASUREMENTS: The primary outcome was the absence of prescribed high-risk medications for all patients in the cohort during the postintervention period. For a subgroup of the cohort whose prescribers received the second-stage intervention, an additional outcome was the absence of prescribed high-risk medications within the subgroup.
RESULTS: Two thousand seven hundred fifty-three unique patients were identified in the cohort; 1,396 (50.7%) had high-risk medications discontinued, resulting in a significant decrease in the number of patients prescribed high-risk medications from the preintervention period to the postintervention period (P<.001). Of the 801 patients in the subgroup, 72.0% (n=577) had high-risk medications discontinued (P<.001).
CONCLUSION: This multimethod intervention significantly decreased prescribing of high-risk medications to older patients. Further studies are needed to confirm the findings.