An electronic medical record (EMR)-based intervention to reduce polypharmacy and falls in an ambulatory rural elderly population.
J Gen Intern Med
; 23(4): 399-404, 2008 Apr.
Article
em En
| MEDLINE
| ID: mdl-18373136
ABSTRACT
BACKGROUND:
Falls are the leading cause of injury-related deaths in the aging population. Electronic medical record (EMR) systems can identify at-risk patients and enable interventions to decrease risk factors for falls.OBJECTIVE:
The objectives of this study were to evaluate an EMR-based intervention to reduce overall medication use, psychoactive medication use, and occurrence of falls in an ambulatory elderly population at risk for falls.DESIGN:
Prospective, randomized by clinic site. PATIENTS/PARTICIPANTS:
Six-hundred twenty community-dwelling patients over 70 at risk for falls based on age and medication use.INTERVENTIONS:
A standardized medication review was conducted and recommendations made to the primary physician via the EMR. MEASUREMENTS AND MAINRESULTS:
Patients were contacted to obtain self reports of falls at 3-month intervals over the 15-month period of study. Fall-related diagnoses and medication data were collected through the EMR. A combination of descriptive analyses and multivariate regression models were used to evaluate differences between the 2 groups, adjusting for baseline medication patterns and comorbidities. Although the intervention did not reduce the total number of medications, there was a significant negative relationship between the intervention and the total number of medications started during the intervention period (p < .01, regression estimate -0.199) and the total number of psychoactive medications (p < .05, regression estimate -0.204.) The impact on falls was mixed; with the intervention group 0.38 times as likely to have had 1 or more fall-related diagnosis (p < .01); when data on self-reported falls was included, a nonsignificant reduction in fall risk was seen.CONCLUSIONS:
The current study suggests that using an EMR to assess medication use in the elderly may reduce the use of psychoactive medications and falls in a community-dwelling elderly population.
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Base de dados:
MEDLINE
Assunto principal:
Psicotrópicos
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Acidentes por Quedas
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Sistemas Computadorizados de Registros Médicos
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Sistemas de Alerta
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Polimedicação
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Sistemas de Apoio a Decisões Clínicas
Idioma:
En
Ano de publicação:
2008
Tipo de documento:
Article