Background: Falls are the leading cause of injury-related mortality and hospitalization among adults aged ≥ 65 years. An important modifiable fall-risk factor is use of fall-risk increasing drugs (FRIDs). However, deprescribing is not always attempted or performed successfully. The ADFICE_IT trial evaluates the combined use of a clinical decision support system (CDSS) and a patient portal for optimizing the deprescribing of FRIDs in older fallers. The intervention aims to optimize and enhance shared decision making (SDM) and consequently prevent injurious falls and reduce healthcare-related costs. Methods: A multicenter, cluster-randomized controlled trial with process evaluation will be conducted among hospitals in the Netherlands. We aim to include 856 individuals aged ≥ 65 years that visit the falls clinic due to a fall. The intervention comprises the combined use of a CDSS and a patient portal. The CDSS provides guideline-based advice with regard to deprescribing and an individual fall-risk estimation, as calculated by an embedded prediction model. The patient portal provides educational information and a summary of the patient’s consultation. Hospitals in the control arm will provide care-as-usual. Fall-calendars will be used for measuring the time to first injurious fall (primary outcome) and secondary fall outcomes during one year. Other measurements will be conducted at baseline, 3, 6, and 12 months and include quality of life, cost-effectiveness, feasibility, and shared decision-making measures. Data will be analyzed according to the intention-to-treat principle. Difference in time to injurious fall between the intervention and control group will be analyzed using multilevel Cox regression. Discussion: The findings of this study will add valuable insights about how digital health informatics tools that target physicians and older adults can optimize deprescribing and support SDM. We expect the CDSS and patient portal to aid in deprescribing of FRIDs, resulting in a reduction in falls and related injuries.
Health informatics (also referred to as medical informatics or biomedical informatics) is an interdisciplinary field that deals with health‐related data in healthcare and with the technologies that are used to support healthcare services. While the goal of some health informatics systems is to automate processes, the more common goal is to help clinicians, patients, policymakers, and others to manage health information, and to communicate that information efficiently and effectively to end users. Thus, there is considerable overlap between the fields of health informatics and health communication, and this intriguing intersection between the two fields opens many opportunities for innovation. Health communication is often visible in health informatics in the area of patient communication. Examples of this include patient self‐management tools that support behavior change. Correspondingly, health informatics is often visible in health communication in the use of computational methods and “big data” to build on communication theory. Future research in health communication will likely involve more and more intensive use of information technology. This can bring exciting new possibilities for both interventions and analytical techniques, yet researchers should ensure that information technology interventions respect participants' privacy and guarantee their safety. Investigating the effect of information technology on communications between healthcare professionals and with patients also offers interesting opportunities for collaborative research.
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