Use of an Electronic Decision Support Tool to Reduce Polypharmacy in Elderly People with Chronic Diseases: Cluster Randomised Controlled Trial

Overview

Journal BMJ

Specialty General Medicine

Date 2020 Jun 20

PMID 32554566

Citations 45

Authors

Anja Rieckert

David Reeves

Attila Altiner

Eva Drewelow

Aneez Esmail

Maria Flamm

Mark Hann

Tim Johansson

Renate Klaassen-Mielke

Ilkka Kunnamo

Christin Loffler

Giuliano Piccoliori

Christina Sommerauer

Ulrike S Trampisch

Anna Vogele

Adrine Woodham

Andreas Sonnichsen

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the effects of a computerised decision support tool for comprehensive drug review in elderly people with polypharmacy.

Design: Pragmatic, multicentre, cluster randomised controlled trial.

Setting: 359 general practices in Austria, Germany, Italy, and the United Kingdom.

Participants: 3904 adults aged 75 years and older using eight or more drugs on a regular basis, recruited by their general practitioner.

Intervention: A newly developed electronic decision support tool comprising a comprehensive drug review to support general practitioners in deprescribing potentially inappropriate and non-evidence based drugs. Doctors were randomly allocated to either the electronic decision support tool or to provide treatment as usual.

Main Outcome Measures: The primary outcome was the composite of unplanned hospital admission or death by 24 months. The key secondary outcome was reduction in the number of drugs.

Results: 3904 adults were enrolled between January and October 2015. 181 practices and 1953 participants were assigned to electronic decision support (intervention group) and 178 practices and 1951 participants to treatment as usual (control group). The primary outcome (composite of unplanned hospital admission or death by 24 months) occurred in 871 (44.6%) participants in the intervention group and 944 (48.4%) in the control group. In an intention-to-treat analysis the odds ratio of the composite outcome was 0.88 (95% confidence interval 0.73 to 1.07; P=0.19, 997 of 1953 1055 of 1951). In an analysis restricted to participants attending practice according to protocol, a difference was found favouring the intervention (odds ratio 0.82, 95% confidence interval 0.68 to 0.98; 774 of 1682 873 of 1712, P=0.03). By 24 months the number of prescribed drugs had decreased in the intervention group compared with control group (uncontrolled mean change -0.42 0.06: adjusted mean difference -0.45, 95% confidence interval -0.63 to -0.26; P<0.001).

Conclusions: In intention-to-treat analysis, a computerised decision support tool for comprehensive drug review of elderly people with polypharmacy showed no conclusive effects on the composite of unplanned hospital admission or death by 24 months. Nonetheless, a reduction in drugs was achieved without detriment to patient outcomes.

Trial Registration: Current Controlled Trials ISRCTN10137559.

Citing Articles

Benefits of Clinical Decision Support Systems for the Management of Noncommunicable Chronic Diseases: Targeted Literature Review.

Grechuta K, Shokouh P, Alhussein A, Muller-Wieland D, Meyerhoff J, Gilbert J Interact J Med Res. 2024; 13:e58036.

PMID: 39602213 PMC: 11635333. DOI: 10.2196/58036.

Drug prescriptions in elderly hospitalized patients with cognitive impairment in the Italian Dementia Friendly Hospital project.

Govoni S, Rosi A, Preda S, Lanni C, Cappa S, Allegri N Front Pharmacol. 2024; 15:1474986.

PMID: 39600363 PMC: 11588458. DOI: 10.3389/fphar.2024.1474986.

Potentially Inappropriate Medications Involved in Drug-Drug Interactions in a Polish Population over 80 Years Old: An Observational, Cross-Sectional Study.

Bleszynska-Marunowska E, Jagiello K, Wierucki L, Renke M, Grodzicki T, Kalarus Z Pharmaceuticals (Basel). 2024; 17(8).

PMID: 39204131 PMC: 11357612. DOI: 10.3390/ph17081026.

Medication Optimization Protocol Efficacy for Geriatric Inpatients: A Randomized Clinical Trial.

Ie K, Hirose M, Sakai T, Motohashi I, Aihara M, Otsuki T JAMA Netw Open. 2024; 7(7):e2423544.

PMID: 39078632 PMC: 11289701. DOI: 10.1001/jamanetworkopen.2024.23544.

A Preliminary Scoping Review of the Impact of e-Prescribing on Pharmacists in Community Pharmacies.

Farghali A, Borycki E Healthcare (Basel). 2024; 12(13).

PMID: 38998815 PMC: 11241554. DOI: 10.3390/healthcare12131280.

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