The effectiveness of a new generation of computerized drug alerts in reducing the risk of injury from drug side effects: a cluster randomized trial.
J Am Med Inform Assoc
; 19(4): 635-43, 2012.
Article
em En
| MEDLINE
| ID: mdl-22246963
ABSTRACT
CONTEXT Computerized drug alerts for psychotropic drugs are expected to reduce fall-related injuries in older adults. However, physicians over-ride most alerts because they believe the benefit of the drugs exceeds the risk. OBJECTIVE:
To determine whether computerized prescribing decision support with patient-specific risk estimates would increase physician response to psychotropic drug alerts and reduce injury risk in older people.DESIGN:
Cluster randomized controlled trial of 81 family physicians and 5628 of their patients aged 65 and older who were prescribed psychotropic medication. INTERVENTION Intervention physicians received information about patient-specific risk of injury computed at the time of each visit using statistical models of non-modifiable risk factors and psychotropic drug doses. Risk thermometers presented changes in absolute and relative risk with each change in drug treatment. Control physicians received commercial drug alerts. MAIN OUTCOMEMEASURES:
Injury risk at the end of follow-up based on psychotropic drug doses and non-modifiable risk factors. Electronic health records and provincial insurance administrative data were used to measure outcomes.RESULTS:
Mean patient age was 75.2 years. Baseline risk of injury was 3.94 per 100 patients per year. Intermediate-acting benzodiazepines (56.2%) were the most common psychotropic drug. Intervention physicians reviewed therapy in 83.3% of visits and modified therapy in 24.6%. The intervention reduced the risk of injury by 1.7 injuries per 1000 patients (95% CI 0.2/1000 to 3.2/1000; p=0.02). The effect of the intervention was greater for patients with higher baseline risks of injury (p<0.03).CONCLUSION:
Patient-specific risk estimates provide an effective method of reducing the risk of injury for high-risk older people. TRIAL REGISTRATION NUMBER clinicaltrials.gov Identifier NCT00818285.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Psicotrópicos
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Acidentes por Quedas
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Padrões de Prática Médica
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Sistemas de Registro de Ordens Médicas
Tipo de estudo:
Clinical_trials
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Etiology_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2012
Tipo de documento:
Article