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2022-04-14
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Copyright (c) 2022 Floor van den Hanenberg, Valentina Poetsema, Carolina JPW Keijsers , Jeroen JMA Hendrikx, Jos van Campen, Michiel C Meulendijk , Jelle Tichelaar, Michiel A van Agtmael
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Improving Appropriate Prescribing For Geriatric Patients Using a Clinical Decision Support System
Floor van den Hanenberg
Onze Lieve Vrouwe Gasthuis
Valentina Poetsema
Onze Lieve Vrouwe Gasthuis
Carolina JPW Keijsers
Jeroen Bosch Hospital‘s Hertogenbosch
Jeroen JMA Hendrikx
The Netherlands Cancer Institute
Jos van Campen
Onze Lieve Vrouwe Gasthuis
Michiel C Meulendijk
Leiden
Jelle Tichelaar
VU University Medical Center
Michiel A van Agtmael
VU University Medical Center
DOI: https://doi.org/10.24926/iip.v13i1.4514
Keywords: clinical decision support system, polypharmacy, elderly, geriatric
Abstract
Purpose: Polypharmacy is a known risk factor for potentially inappropriate prescribing. Recently there is an increasing interest in clinical decision support systems (CDSS) to improve prescribing. The objective of this study was to evaluate the impact of a CDSS, with the START-STOPP criteria as main content in the setting of a geriatric ward. Endpoints were 1) appropriateness of prescribing and 2) acceptance rate of recommendations.
Methods: This prospective study comparing the use of a CDSS with usual care involved patients admitted to geriatric wards in two teaching hospitals in the Netherlands. Patients were included from January to May 2017. The medications of 64 patients in the first six weeks was assessed according to the current standard, whereas the medications of 61 patients in the second six weeks were also assessed by using a CDSS. Medication appropriateness was assessed with the Medication Appropriateness Index (MAI).
Results: The medications of 125 patients (median age 83 years) were reviewed. In both the usual care group and the intervention group MAI scores decreased significantly from admission to discharge (within group analyses, p<0.001). This effect was significantly larger in the intervention group (p<0.05). MAI scores at discharge in the usual care group and the intervention group were respectively 9.95±6.70 and 7.26±5.07. The CDSS generated 193 recommendations, of which 71 concerned START criteria, 45 STOPP criteria, and 77 potential interactions. Overall, 31.6% of the recommendations were accepted.
Conclusion: This study shows that a CDSS to improve prescribing has additional value in the setting of a geriatric ward. Almost one third of the software-generated recommendations were interpreted as clinically relevant and accepted, on average one per patient.
