evaluating the evidence of computerized decision support in reducing potentially inappropriate medication use in older adults

Open Access
- Author:
- Licatovich, Jaron Matthew
- Area of Honors:
- Nursing
- Degree:
- Bachelor of Science
- Document Type:
- Thesis
- Thesis Supervisors:
- Donna Marie Fick, Thesis Supervisor
Harleah Graham Buck, Thesis Honors Advisor - Keywords:
- computerized decision support
inappropriate prescribing
older adult - Abstract:
- Background: Approximately 44,000 to 98,000 patients die annually in the United States as a result of medication errors. Older adults are at increased risk of suffering a drug related problem due to age related changes in their pharmacokintetic and pharmacodynamics metabolism of drugs, co-morbidities, and polypharmacy. Purpose: Evaluate the efficacy of computerized decision support (CDS) in reducing inappropriate prescribing, reducing adverse drug events (ADEs), and improving patient health outcomes. Data Sources: Pubmed (Medline), CINHAL, and Cochrane databases were searched for studies that evaluated the impact of CDS on inappropriate prescribing, ADEs, and health outcomes. Methods: 409 studies were reviewed and 13 were chosen for inclusion in the review. Selection criteria includes: focus on adults aged 65 or older, published within last ten years, evaluation of provider prescribing with CDS assistance compared to care without CDS assistance, focus on potentially inappropriate medications, ADEs, and health outcomes, and written in English. Data Synthesis/Results: A review of the evidence found that the majority of studies used an interruptive alert design as opposed to a non-interruptive design. Seven studies had a primary outcome evaluating CDS efficacy in reducing prescription of potentially inappropriate medications (PIMs). Evidence supports that CDS has a statistically significant effect on decreasing PIMs, however overall acceptance of alerts is modest. Interesting factors related to CDS success include alert design, provider acceptance of alerts, burden on providers, reasons for overriding alerts, and setting in which the CDS is used. Further research is needed to support the effect of CDS on decreasing ADEs and improving patient health outcomes. Conclusion: CDS improves prescribing, but effects on patient outcomes remain understudied.