Computerized prescribing alerts and group academic detailing to reduce the use of potentially inappropriate medications in older people

J Am Geriatr Soc. 2006 Jun;54(6):963-8. doi: 10.1111/j.1532-5415.2006.00734.x.


Objectives: To examine the effect of replacing drug-specific computerized prescribing alerts with age-specific alerts on rates of dispensing potentially inappropriate medications in older people and to determine whether group academic detailing enhances the effectiveness of these alerts.

Design: Cluster-randomized trial of group academic detailing and interrupted time-series analysis.

Setting: Fifteen clinics of a staff-model health maintenance organization.

Participants: Seven practices (113 clinicians, 24,119 patients) were randomly assigned to receive age-specific prescribing alerts plus the academic detailing intervention; eight practices (126 clinicians, 26,805 patients) received alerts alone. Prior implementation of drug-specific alerts established a downward trend in use of target medications that served as the baseline trend for the present study.

Intervention: The computerized age-specific alerts occurred at the time of prescribing a targeted potentially inappropriate medication (e.g., tertiary tricyclic amine antidepressants, long-acting benzodiazepines, propoxyphene) and suggested an alternative medication. Clinicians at seven sites were randomized to group academic detailing, an interactive educational program delivering evidence-based information.

Measurements: Number of target medications dispensed per 10,000 patients per quarter, 2 years before and 1.5 years after the replacement of drug-specific with age-specific alerts.

Results: Age-specific alerts resulted in a continuation of the effects of the drug-specific alerts without measurable additional effect (P=.75 for level change), but the age-specific alerts led to fewer false-positive alerts for clinicians. Group academic detailing did not enhance the effect of the alerts.

Conclusion: Age-specific alerts sustained the effectiveness of drug-specific alerts to reduce potentially inappropriate prescribing in older people and resulted in a considerably decreased burden of the alerts.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Clinical Pharmacy Information Systems*
  • Decision Support Systems, Clinical / standards*
  • Drug Prescriptions / standards*
  • Drug Utilization Review / organization & administration*
  • Female
  • Humans
  • Male
  • Medication Errors*
  • Practice Patterns, Physicians' / standards*
  • Practice Patterns, Physicians' / trends
  • Quality Assurance, Health Care*