An Electronic Medical Record (EMR)-Based Intervention to Reduce Polypharmacy and Falls in an Ambulatory Rural Elderly Population

Abstract

BACKGROUND: Falls are the leading cause of injuryrelated deaths in the aging population. Electronic medical record (EMR) systems can identify at-risk patients and enable interventions to decrease risk factors for falls. OBJECTIVE:The objectives of this study were to evaluate an EMR-based intervention to reduce overall medication use, psychoactive medication use, and occurrence of falls in an ambulatory elderly population at risk for falls. DESIGN:Prospective, randomized by clinic site. PATIENTS/PARTICIPANTS:Six-hundred twenty community-dwelling patients over 70 at risk for falls based on age and medication use. INTERVENTIONS:A standardized medication review was conducted and recommendations made to the primary physician via the EMR. MEASUREMENTS AND MAIN RESULTS:Patients were contacted to obtain self reports of falls at 3-month intervals over the 15-month period of study. Fall-related diagnoses and medication data were collected through the EMR. A combination of descriptive analyses and multivariate regression models were used to evaluate differences between the 2 groups, adjusting for baseline medication patterns and comorbidities. Although the intervention did not reduce the total number of medications, there was a significant negative relationship between the intervention and the total number of medications started during the intervention period (p <.01, regression estimate −0.199) and the total number of psychoactive medications (p<.05, regression estimate −0.204.) The impact on falls was mixed; with the intervention group 0.38 times as likely to have had 1 or more fall-related diagnosis (p<.01); when data on self-reported falls was included, a nonsignificant reduction in fall risk was seen. CONCLUSIONS:The current study suggests that using an EMR to assess medication use in the elderly may reduce the use of psychoactive medications and falls in a community-dwelling elderly population.

Gradual Electronic Health Record Implementation: New Insights on Physician and Patient Adaptation

“…The electronic health record (EHR) may improve health care delivery [1][2][3][4][5][6] by facilitating physician communication about medications, 3,7 enhancing documentation, 4,8,9 increasing effi ciency, [8][9][10][11][12] and fostering information sharing and responsibility with patients. 10,11 Implementation is often costly, 13 takes time and computer expertise, 14 and has unanticipated consequences.…”

Maintaining independence after a fall

“…51 Trials aiming to reduce overall medication among community-dwelling elderly patients have reported significant reductions in the number of total falls and fall-related injuries. [52][53][54] However, it has been concluded that patient compliance with permanent withdrawal may be difficult to achieve. 54 This is largely due to the negative effects experienced by individuals stopping medications that have previously been relied upon for relief of psychosomatic symptoms including insomnia and anxiety.…”

Uso de medicamentos asociados al riesgo de caídas en ancianos no institucionalizados

“…A greater number of prescribed drugs has been shown to substantially increase the possibility of adverse effects; however, an exact number has not been determined (11)(12) . In the scientific literature, the use of four or more drugs per day has been considered a risk factor for falls among the older adult population (13) . Some studies have examined the incidence of falls among older adults taking certain types of medications, but few authors have correlated the number of drugs with the risk of falls, and even fewer have targeted populations with a history of falls (14)(15) .…”