The paper under review is ‘Use of Computer Decision Support Interventions to Improve Medication Prescribing in Older Adults: A Systematic Review’. The authors describe the scale of the problem with between 6 and 15% of elderly inpatients experiencing adverse drug events. In order to minimise this, various techniques have been used. One particular technique is the use of computer decision support (CDS) used in conjunction with electronic prescribing. The authors describe a number of variations on this ranging from looking at drug interactions through to the specifics of oral anticoagulant scheduling.
The researchers have adopted a rigorous approach in selecting papers. Firstly they used a variety of terms in their search of Embase and PubMed. They backed this up with a hand search of the papers they had identified in the references section of the relevant papers. Within the articles they looked for clinical and prescribing outcome measures and ensured that the papers were relevant to the elderly population. After doing this, the researchers had narrowed down from 7345 articles identifed on the databse to 285 screened articles and finally 10 selected articles.
The majority of studies involved outpatient prescribing. The authors found that 80% of the selected studies identified improvements in the prescribing of medications. For instance they quote one paper which found that with the intervention of the computer warning system, there was a 22% decrease in the ‘non-preferred’ medications mainly attributable to a reduction in prescribing of older tricyclic antidepressants.
A number of the studies looked at generic prescribing in the elderly which is still important in Old Age Psychiatry. However, one of the studies, a time-series of 3718 patients, looked specifically at psychotropic medication. Interestingly the paper reported a reduction in supra-threshold prescribing together with a reduction in falls. Nevertheless there wasn’t any significant reduction in length of stay for inpatients or in change in mental status (on clinical outcome measures). Most of the studies however didn’t have clinical outcome measures.
However in terms of prescribing measures, a number of studies showed significant benefits for computer-assisted prescribing. One of the difficulties in interpretation however, is that different packages were used and the final number of studies (10) was relatively small although having a large sample size. The heterogeneity both of sample clinical populations and prescribing packages mean that it wasn’t possible to integrate the results of the studies. The included studies are neatly summarised and this paper would provide a useful starting point for those interested in looking at computer-assisted prescribing.
Given the encouraging results there is obviously a need for further studies which include not just prescribing patterns but also clinical outcome measures. There is enough evidence here to support the consideration of computer-assisted prescribing and it would be useful for the findings on reduction in falls to b replicated.
Yourman L, Concato J and Agostini J. Use of Computer Decision Support Interventions to Improve Medication Prescribing in Older Adults: A Systematic Review. The American Journal of Geriatric Pharmacotherapy. Vol 6. Number 2. 2008.
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