J Am Med Inform Assoc - The effectiveness of a new generation of computerized drug alerts in reducing the risk of injury from drug side effects: a cluster randomized trial.

Tópicos

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Resumo

NTEXT: Computerized drug alerts for psychotropic drugs are expected to reduce fall-related injuries in older adults. However, physicians over-ride most alerts because they believe the benefit of the drugs exceeds the risk.OBJECTIVE: To determine whether computerized prescribing decision support with patient-specific risk estimates would increase physician response to psychotropic drug alerts and reduce injury risk in older people.DESIGN: Cluster randomized controlled trial of 81 family physicians and 5628 of their patients aged 65 and older who were prescribed psychotropic medication.INTERVENTION: Intervention physicians received information about patient-specific risk of injury computed at the time of each visit using statistical models of non-modifiable risk factors and psychotropic drug doses. Risk thermometers presented changes in absolute and relative risk with each change in drug treatment. Control physicians received commercial drug alerts.MAIN OUTCOME MEASURES: Injury risk at the end of follow-up based on psychotropic drug doses and non-modifiable risk factors. Electronic health records and provincial insurance administrative data were used to measure outcomes.RESULTS: Mean patient age was 75.2 years. Baseline risk of injury was 3.94 per 100 patients per year. Intermediate-acting benzodiazepines (56.2%) were the most common psychotropic drug. Intervention physicians reviewed therapy in 83.3% of visits and modified therapy in 24.6%. The intervention reduced the risk of injury by 1.7 injuries per 1000 patients (95% CI 0.2/1000 to 3.2/1000; p=0.02). The effect of the intervention was greater for patients with higher baseline risks of injury (p<0.03).CONCLUSION: Patient-specific risk estimates provide an effective method of reducing the risk of injury for high-risk older people.TRIAL REGISTRATION NUMBER: clinicaltrials.gov Identifier: NCT00818285.

Resumo Limpo

ntext computer drug alert psychotrop drug expect reduc fallrel injuri older adult howev physician overrid alert believ benefit drug exceed riskobject determin whether computer prescrib decis support patientspecif risk estim increas physician respons psychotrop drug alert reduc injuri risk older peopledesign cluster random control trial famili physician patient age older prescrib psychotrop medicationintervent intervent physician receiv inform patientspecif risk injuri comput time visit use statist model nonmodifi risk factor psychotrop drug dose risk thermomet present chang absolut relat risk chang drug treatment control physician receiv commerci drug alertsmain outcom measur injuri risk end followup base psychotrop drug dose nonmodifi risk factor electron health record provinci insur administr data use measur outcomesresult mean patient age year baselin risk injuri per patient per year intermediateact benzodiazepin common psychotrop drug intervent physician review therapi visit modifi therapi intervent reduc risk injuri injuri per patient ci p effect intervent greater patient higher baselin risk injuri pconclus patientspecif risk estim provid effect method reduc risk injuri highrisk older peopletri registr number clinicaltrialsgov identifi nct

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