ArticleDrugs & aging2020
Reducing Inappropriate Drug Use in Older Patients by Use of Clinical Decision Support in Community Pharmacy: A Mixed-Methods Evaluation.
Article in Drugs & aging, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Pooled it
- Development and evaluation of an e-learning program on drug-related problems for community pharmacists.International journal of clinical pharmacy · 2026Article
- First-Generation Antihistamine Use in Geriatric Emergency Department Patients: Retrospective Review.The western journal of emergency medicine · 2025Article
- A model for identifying potentially inappropriate medication used in older people with dementia: a machine learning study.International journal of clinical pharmacy · 2024Article
- Clinical decision support system supported interventions in hospitalized older patients: a matter of natural course and adequate timing.BMC geriatrics · 2024Article
- Potentially inappropriate medication prescribing based on 2019 Beers criteria and the impact of pharmacist intervention in elderly patients with kidney diseases: A report from Iran.Health science reports · 2024Article
- Development and implementation of medication-related clinical rules for obstetrics, gynaecology, and paediatric outpatients.European journal of hospital pharmacy : science and practice · 2024Article
- A quality improvement study of the implementation and initial results of a pragmatic clinical decision support system in the community pharmacy setting.International journal of clinical pharmacy · 2024Observational
- Clinical decision support systems in community pharmacies: a scoping review.Journal of the American Medical Informatics Association : JAMIA · 2023Article
- Clinical Decision Support Systems in Hospitalized Older Patients: An Exploratory Analysis in a Real-Life Clinical Setting.Drugs - real world outcomes · 2023Article
- Prescriber Uncertainty as Opportunity to Improve Care of Type 2 Diabetes with Chronic Kidney Disease: Mixed Methods Study.Journal of general internal medicine · 2023Article
- Developing a Warning Model of Potentially Inappropriate Medications in Older Chinese Outpatients in Tertiary Hospitals: A Machine-Learning Study.Journal of clinical medicine · 2023Article
- Development and Validation of Comprehensive Healthcare Providers' Opinions, Preferences, and Attitudes towards Deprescribing (CHOPPED Questionnaire).Pharmacy (Basel, Switzerland) · 2022Article
- A user-centered evaluation of medication therapy management alerts for community pharmacists: Recommendations to improve usability and usefulness.Research in social & administrative pharmacy : RSAP · 2021Observational
- The Use of a Decision Support System in Swedish Pharmacies to Identify Potential Drug-Related Problems-Effects of a National Intervention Focused on Reviewing Elderly Patients' Prescriptions.Pharmacy (Basel, Switzerland) · 2020Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionOlder people are prone to drug-related harm. Clinical decision support systems (CDSSs) in community pharmacies may improve appropriate prescribing in this population.
objectiveThis study investigated (persistent) drug therapy changes and its determinants to reduce potentially inappropriate medication (PIM) in older patients based on CDSS alerts and to investigate barriers and facilitators for implementation of drug therapy changes based on these CDSS alerts.
methodsFive clinical decision rules based on national guidelines for inappropriate drugs in older patients were incorporated in a web-based CDSS in 31 community pharmacies between February and April 2017. The CDSS generated alerts for patients aged > 70 years who had prescriptions for one of the following drugs: alprazolam, amitriptyline, barnidipine, duloxetine, fluoxetine, trazodone, quetiapine and olanzapine. The registered alert management data and medication dispensing histories were analysed to find potential determinants of persistent drug therapy changes. Ten pharmacists were interviewed about the barriers and facilitators for implementing drug therapy changes based on CDSS alerts. An inductive thematic analysis of the transcripts was performed.
resultsThe pharmacists recorded the management of 1810 of the 2589 generated alerts, and 158 (8.7%) alerts were associated with a persistent drug therapy change. A logistic regression analysis found that the drug triggering the alert and the type of prescription [first dispensing vs. repeat; odds ratio 2.1 (95% confidence interval 1.4-3.2)] were significantly associated with persistent drug therapy changes. No association was found between persistent changes and age, sex, number of medicines in use, or recent clinical medication review. Analysis of the interviews revealed nine barriers and facilitators associated with drug therapy change.
conclusionWhen community pharmacists implemented CDSS alerts to reduce inappropriate drug use in older patients, they registered a persistent drug therapy change in 8.7% of the cases. Alerts triggered by a first prescription were two times more likely to be associated with a persistent drug therapy change than alerts triggered by repeat prescriptions. This study found that clinical rules can be used to detect inappropriate drug use in older patients and that drug therapy can change based on the alerts. This suggests that CDSS alerts are a useful tool for implementing guidelines on PIM in older patients in daily practice.
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