An electronic medical record (EMR)-based intervention to reduce polypharmacy and falls in an ambulatory rural elderly population

J Gen Intern Med. 2008 Apr;23(4):399-404. doi: 10.1007/s11606-007-0482-z.


Background: Falls are the leading cause of injury-related deaths in the aging population. Electronic medical record (EMR) systems can identify at-risk patients and enable interventions to decrease risk factors for falls.

Objective: The objectives of this study were to evaluate an EMR-based intervention to reduce overall medication use, psychoactive medication use, and occurrence of falls in an ambulatory elderly population at risk for falls.

Design: Prospective, randomized by clinic site.

Patients/participants: Six-hundred twenty community-dwelling patients over 70 at risk for falls based on age and medication use.

Interventions: A standardized medication review was conducted and recommendations made to the primary physician via the EMR.

Measurements and main results: Patients were contacted to obtain self reports of falls at 3-month intervals over the 15-month period of study. Fall-related diagnoses and medication data were collected through the EMR. A combination of descriptive analyses and multivariate regression models were used to evaluate differences between the 2 groups, adjusting for baseline medication patterns and comorbidities. Although the intervention did not reduce the total number of medications, there was a significant negative relationship between the intervention and the total number of medications started during the intervention period (p < .01, regression estimate -0.199) and the total number of psychoactive medications (p < .05, regression estimate -0.204.) The impact on falls was mixed; with the intervention group 0.38 times as likely to have had 1 or more fall-related diagnosis (p < .01); when data on self-reported falls was included, a nonsignificant reduction in fall risk was seen.

Conclusions: The current study suggests that using an EMR to assess medication use in the elderly may reduce the use of psychoactive medications and falls in a community-dwelling elderly population.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Accidental Falls / prevention & control*
  • Aged
  • Attitude to Computers
  • Case-Control Studies
  • Cohort Studies
  • Decision Support Systems, Clinical*
  • Female
  • Health Services for the Aged
  • Humans
  • Male
  • Medical Audit
  • Medical Records Systems, Computerized*
  • Outpatient Clinics, Hospital
  • Pennsylvania
  • Physicians, Family
  • Polypharmacy*
  • Practice Patterns, Physicians'
  • Psychotropic Drugs / adverse effects*
  • Reminder Systems*
  • Risk Factors
  • Rural Population


  • Psychotropic Drugs