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Ehr Interventions for Beers Criteria Prescribing (Paperback)
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Ehr Interventions for Beers Criteria Prescribing (Paperback)
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For over a decade, there has been a high prevalence of potentially
inappropriate medication (PIM) use as defined by the "Beers
criteria" in the outpatient elderly population. Using CPOE
medication lists, the measured prevalence of PIMs as of April 1,
2006 was 23.3% (8,693/37,247) of patients at Intermountain
Healthcare and 23.0% (5,528/24,004) at the Cleveland Clinic.
Patient characteristics associated with PIMs were polypharmacy,
female, and multiple primary care visits. A decision support system
of geriatric precaution screening alerts for 86 PIMs was integrated
into Intermountain Healthcare's CPOE system. A 9-month prospective,
randomized controlled trial of the system was conducted in 52
outpatient primary care and specialty clinics. Intervention clinics
received the alerts, while control clinics received usual care. No
significant difference in canceled PIM prescriptions was found
between intervention clinics at 4.7% (187/3977) and control clinics
at 4.8% (113/2364). None of the individual 86 PIM alerts showed
significant differences. Positive physician feedback suggest the
alerts have some clinical value.
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