Impact of Computerized Physician Order Entry Alerts on Prescribing in Older Patients

Abstract

The data suggest that prescribing rates for drugs with the least efficacy and potential for harm and with alternative agents (i.e., diphenhydramine and metoclopramide) can be modified by CPOE alerts for older patients.

Effects of pharmacist intervention on polypharmacy in patients with type 2 diabetes in Japan

“…By comparing the number of drugs and PP rate at the time of hospitalization and discharge, it was possible to observe that both the number of drugs (hospitalization vs. discharge: 9 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] vs. 7 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16], P < 0.001) and PP rate (hospitalization vs. discharge: 75.4% vs. 61.1%, P < 0.001) were significantly lower at discharge (Fig. 1).…”

“…After a patient's admission at the hospital, a clinical ward pharmacist evaluates inappropriate medications using a pharmaceutical approach and checks for PP. The clinical ward pharmacy service is effective in eliminating PP, as reported in the United States of America and in Europe [11][12][13][14]. But so far, no similar studies have been carried out in Japan.…”

Reducing Potentially Inappropriate Prescriptions for Older Patients Using Computerized Decision Support Tools: Systematic Review

“…Six studies were conducted exclusively in secondary health care institutions [35,37,38,40,44,45]. In two studies, only emergency department participants were included [33,39].…”

“…In total, six studies were performed exclusively in primary health care institutions [30-32,41-43], one study took place in a health maintenance organization [34], and one study included participants from both secondary and primary health care institutions [36]. Six studies took place at teaching hospitals [36-38,40,44,45].…”

“…PIM was defined in some papers using internationally recognized criteria, such as the Beers Criteria (n=5) [32,34,39,40,45], the Screening Tool of Older People’s Prescriptions (STOPP) criteria (n=3) [31,32,40], and the Anticholinergic Cognitive Burden Scale (n=1) [45]. In other studies (n=4), some group medications were specifically the target, such as benzodiazepines, opiates, and neuroleptics [35]; glyburide [36]; nonsteroidal anti-inflammatory drugs (NSAIDs), beta blockers, angiotensin-converting enzyme (ACE) inhibitors, or loop diuretics [41]; and diphenhydramine, metoclopramide, and antipsychotics [38].…”