Use of computer decision support interventions to improve medication prescribing in older adults: A systematic review

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Abstract

Background: Older adults take multiple medications and are at high risk for adverse drug effects.

Objective: This systematic review was conducted to describe the impact of computer decision support (CDS) interventions designed to improve the quality of medication prescribing in older adults.

Methods: PubMed and EMBASE databases were searched from January 1980 through July 2007 (English-language only); studies were eligible if they described a CDS intervention intended to improve medication prescribing in adults aged ≥60 years. Studies were retained if they were observational or experimental in design and reported ≥1 process or clinical outcome measurement related to medication prescribing. In the main analysis, study characteristics and major outcome results were extracted. A combination of searches was performed using relevant medical subject headings: aged; drug therapy, computer-assisted; medication errors; medication errors/prevention and control; decision making, computer-assisted; decision support systems, clinical; and clinical pharmacy information systems.

Results: After review of study abstracts, 10 articles met the eligibility criteria. Of those 10 studies testing CDS interventions, 8 showed at least modest improvements (median number needed to treat, 33) in prescribing, as measured by minimizing drugs to avoid, optimizing drug dosage, or more generally improving prescribing choices in older adults (according to each study's intervention protocols). Findings for the impact of CDS interventions on clinical outcomes were mixed and were reported for only 2 studies.

Conclusions: Various types of CDS interventions may be effective in improving medication prescribing in older adults, but few studies reported clinical outcomes related to changes in medication prescribing. Data from this study should help to guide refinement and testing of future CDS interventions that specifically target older adult populations that are taking multiple medications.

References (45)

  • P Carbonin et al.

    Is age an in-dependent risk factor of adverse drug reactions in hospitalized medical patients?

    J Am Geriatr Soc

    (1991)
  • SL Gray et al.

    Adverse drug events in hospitalized elderly

    J Gerontol A BioI Sci Med Sci

    (1998)
  • MB Gerety et al.

    Adverse events related to drugs and drug withdrawal in nursing home residents

    JAm Geriatr Soc

    (1993)
  • DW Kaufman et al.

    Recent patterns of medication use in the ambulatory adult population of the United States: The Slone survey

    JAMA

    (2002)
  • PA Rochon et al.

    Optimising drug treatment for elderly people: The prescribing cascade

    BMJ

    (1997)
  • PA Rochon et al.

    Use of beta-blocker therapy in older patients after acute myocardial infarction in Ontario

    CMAJ

    (1999)
  • MA Steinman et al.

    Polypharmacy and prescribing quality in older people

    J Am Geriatr Soc

    (2006)
  • SM Fosnight et al.

    A strategy to decrease the use of risky drugs in the elderly

    Cleve Clin J Med

    (2004)
  • PI Kaboli et al.

    Clinical pharmacists and inpatient medical care: A systematic review

    Arch Intern Med

    (2006)
  • A Spinewine et al.

    Eftect of a collaborative approach on the quality of prescribing for geriatric inpatients: A randomized, controlled trial

    J Am Geriatr Soc

    (2007)
  • R Kaushal et al.

    Effects ofcomputerized physician order entry and clinical decision support systems on medication safety: A systematic review

    Arch Intern Med

    (2003)
  • K Kawamoto et al.

    Improving clinical practice using clinical decision support systems: A systematic review of trials to identify features critical to success

    BMJ

    (2005)

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    Copyright © 2008 Published by Elsevier Inc.