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Original Investigation
May 22, 2006

The Impact of Prescribing Safety Alerts for Elderly Persons in an Electronic Medical Record: An Interrupted Time Series Evaluation

Author Affiliations

Author Affiliations: Kaiser Permanente Center for Health Research (Drs Smith, Perrin, Feldstein, and Sittig and Messrs Yang and Kuang) and Oregon Health and Sciences University (Dr Perrin), Portland; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (Drs Simon, Platt, and Soumerai).

Arch Intern Med. 2006;166(10):1098-1104. doi:10.1001/archinte.166.10.1098

Background  Considerable effort and attention have focused on medication safety in elderly persons; one approach that has been understudied in the outpatient environment is the use of computerized provider order entry with clinical decision support. The objective of this study was to examine the effects of computerized provider order entry with clinical decision support in reducing the use of potentially contraindicated agents in elderly persons.

Methods  With data from a 39-month period of a natural experiment, we evaluated changes in medication dispensing using interrupted time series analysis to estimate changes, controlling for prealert prescribing trends. The setting was a large health maintenance organization in the Pacific Northwest. All adult enrollees of the health plan participated. The intervention was computerized alerts cautioning against using certain medications in elderly persons. The main outcome measure was dispensing per 10 000 members per month.

Results  Following the implementation of the drug-specific alerts, a large and persistent reduction (5.1 prescriptions per 10 000, P=.004), a 22% relative decrease from the month before alert implementation, in the exposure of elderly patients to nonpreferred medications was observed. We found no evidence of a decrease in use of nonpreferred agents for nonelderly patients. The reduction seen in use of nonpreferred agents for elderly persons was driven primarily by decreases in dispensing for tertiary tricyclic agents.

Conclusions  We found that alerts in an outpatient electronic medical record aimed at decreasing prescribing of medication use in elderly persons may be an effective method of reducing prescribing of contraindicated medications. The effect of the alerts on patient outcomes is less certain and deserves further investigation.