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BackgroundPotentially Inappropriate Prescriptions (PIPs) are a common cause of morbidity, particularly in the elderly.ObjectiveWe sought to understand how the Screening Tool of Older People’s Prescriptions (STOPP) prescribing criteria, implemented in a routinely used primary care Electronic Medical Record (EMR), could impact PIP rates in community (non-academic) primary care practices.MethodsWe conducted a mixed-method, pragmatic, cluster, randomized control trial in research naïve primary care practices. Phase 1: In the randomized controlled trial, 40 fully automated STOPP rules were implemented as EMR alerts during a 16-week intervention period. The control group did not receive the 40 STOPP rules (but received other alerts). Participants were recruited through the OSCAR EMR user group mailing list and in person at user group meetings. Results were assessed by querying EMR data PIPs. EMR data quality probes were included. Phase 2: physicians were invited to participate in 1-hour semi-structured interviews to discuss the results.ResultsIn the EMR, 40 STOPP rules were successfully implemented. Phase 1: A total of 28 physicians from 8 practices were recruited (16 in intervention and 12 in control groups). The calculated PIP rate was 2.6% (138/5308) (control) and 4.11% (768/18,668) (intervention) at baseline. No change in PIPs was observed through the intervention (P=.80). Data quality probes generally showed low use of problem list and medication list. Phase 2: A total of 5 physicians participated. All the participants felt that they were aware of the alerts but commented on workflow and presentation challenges.ConclusionsThe calculated PIP rate was markedly less than the expected rate found in literature (2.6% and 4.0% vs 20% in literature). Data quality probes highlighted issues related to completeness of data in areas of the EMR used for PIP reporting and by the decision support such as problem and medication lists. Users also highlighted areas for better integration of STOPP guidelines with prescribing workflows. Many of the STOPP criteria can be implemented in EMRs using simple logic. However, data quality in EMRs continues to be a challenge and was a limiting step in the effectiveness of the decision support in this study. This is important as decision makers continue to fund implementation and adoption of EMRs with the expectation of the use of advanced tools (such as decision support) without ongoing review of data quality and improvement.Trial RegistrationClinicaltrials.gov NCT02130895; https://clinicaltrials.gov/ct2/show/NCT02130895 (Archived by WebCite at http://www.webcitation.org/6qyFigSYT)

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Models of compact radio sources as relativistic jets aligned nearly along the line of sight predict large magnifications of intrinsic jet bends due to projection effects. Several authors have examined the distribution of observed bend angles, for small samples of sources, to provide constraints on the relativistic beaming models. In this study, we examine the alignment of Very Long Baseline Interferometry scale structure with arcsecond scale structure for a much larger sample of core-dominated radio sources and compare the distribution of observed misalignment angles with theoretical distributions calculated from models using a range of intrinsic bend angles, ξ, and Lorentz factors, γ. The theoretical distributions produced by simple relativistic beam models are found to be consistent with the data. However, the values of ξ and γ required to fit the data are highly correlated, with equally good fits produced by γ = 5, ξ = 11° and γ = 10, ξ = 5°, for instance. Either ξ or γ must be known independently for an analysis of the misalignment angle distribution to provide a significant constraint on beam parameters.

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