Inappropriate Prescribing
Conditions
Keywords
Older Adults, Emergency Department, Inappropriate Prescribing
Brief summary
Cluster-randomized trial assessing the impact of interventions on guideline-concordant prescribing in Emergency Departments (ED). The study compares the effectiveness of feedback messages about potentially inappropriate medications (PIMs) delivered by peer clinician prescribers or anonymous systems, compared to standard of care. The goal is to reduce PIM prescribing for older adults discharged from emergency departments.
Detailed description
The goal of this trial is to compare the effectiveness of prescribing feedback delivered by a credible peer messenger and by an anonymous messaging system against standard of care in emergency departments. This intervention to Emergency Department (ED) clinician prescribers is a modification of previous studies that optimizes feedback about Potentially Inappropriate Medications (PIMs) using findings from behavioral science. Clinician prescribers who meet eligibility criteria and provide digital affirmative consent will be enrolled if they have encounters in a participating ED facility. The Joint Data Analytics Team (JDAT) will identify patients aged 65 years and older who were seen in the ED to evaluate prescribing outcomes. The focus of this registration is the randomized trial.
Interventions
BEHAVIORALPrescribing Feedback
Automated prescribing feedback messages are delivered to clinician prescribers in participating emergency departments. Messages are based on Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) recommendations and include aspirational norms and benchmark comparisons. Depending on study arm, feedback is sent either from a credible peer messenger or through an anonymous messenger system.
Sponsors
Yale University
National Institute on Aging (NIA)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Intervention model description
The study population are Emergency Medicine prescribers practicing in the Yale New Haven Health System with at least 30 visits with patients over age 65. Patients are not target subjects but that their data will be utilized from the medical record, pre- and post-intervention.
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
1. Licensed clinicians with prescribing authority (physician, advanced practice registered nurse, or physician assistant) 2. Practicing in one of the participating Yale New Haven Health System emergency departments 3. At least 30 Emergency Department (ED) discharge encounters with patients aged 65 years or older in the 12 months preceding study enrollment 4. Provides digital affirmative consent to participate
Exclusion criteria
* Failure to meet inclusion criteria
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change PIM prescribing rate | At ED discharge, calculated monthly, using rolling 90-day prescribing data, over the 12-month intervention period and 6-month follow-up | Change in potentially inappropriate medication (PIM) prescribing rate based on the Geriatric Emergency Medication Safety Recommendations (GEMS-Rx). Outcome is measured as the percentage of Emergency Department (ED) discharge prescriptions for PIMs among patients aged 65 years or older. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes in prescribing by medication class | At ED discharge, calculated monthly, using rolling 90-day prescribing data, over the 12-month intervention period and 6-month follow-up | Changes in prescribing rates for high-risk medication classes identified in the GEMS-Rx based on percentage of ED discharge prescriptions for each targeted medication class among patients aged 65 years or older. |
| Adoption of alternative recommendations | Monthly during the 12-month intervention period and 6-month follow-up | Percentage of ED discharge encounters in which a recommended alternative medication was prescribed in place of a PIM based on percentage of eligible encounters. |
| Access to Epic workbench reports | Monthly during the 12-month intervention period and 6-month follow-up | Access to Epic workbench prescribing reports and message links (including Frequently Asked Questions, FAQs) based on number of accesses per clinician per month. |
| Mean overall readmission rate | Measured at 30 days post-discharge for all eligible ED visits during the 12-month intervention period and 6-month follow-up | All-cause readmission rates will be monitored to assess safety based on percentage of ED discharge encounters followed by any hospital readmission within 30 days. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORDaniella Meeker, PhD
Yale University
Outcome results
None listed