Clinician Decision Support Initiative to Decrease Outpatient High-Risk Medicine Prescriptions in the Elderly

  • Corinne RhodesEmail author
  • Jeffrey Tokazewski
  • Kristin Christensen
  • Maureen Holman
  • Ami Eimers
  • Maryanne Peifer
Concise Research Report


Reduction of high-risk medications (HRM) in the elderly (age 65+) was identified as an opportunity for improvement in a clinic-based quality improvement (QI) program at one academic suburban outpatient clinic when assessing electronic clinical quality measures within a Medicare demonstration grant Comprehensive Primary Care Plus (CPC+).

Previous studies have shown HRM in elderly, as defined by the American Geriatrics Society BEERS list in the USA,1 lead to increased odds of adverse drug reactions (OR 1.44 95% CI 1.33–1.56) and hospitalizations (1.27 95% CL 1.2–1.35).2 Strategies to reduce risk of adverse drug events include discontinuing medications and prescribing new medications sparingly.3

QI work at initial site supported by our institution’s process improvement in action program included a mixed intervention: brief peer education, monthly peer comparison report cards, patient-targeted informational posters, and low-technical refill clinical decision support from a...


Compliance with Ethical Standards

Conflict of Interest

The authors declare that there is no conflict of interest.


  1. 1.
    2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019 ;67(4):674-694.CrossRefGoogle Scholar
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    Xing XX, Zhu C, Liang HY, Wang K, Chu YQ, Zhao LB, Jiang C, Wang YQ, Yan SY. Associations Between Potentially Inappropriate Medications and Adverse Health Outcomes in the Elderly: A Systematic Review and Meta-analysis. Ann Pharmacother. 2019;53(10):1005-1019. doi: Scholar
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    PRETORIUS, RW, Gataric, G, Swedlund S, and Millier, J. Reducing the Risk of Adverse Drug Events in Older Adults. Am Fam Physician. 2013;87(5):331-336.PubMedGoogle Scholar
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    Healthy Aging: BEERS list and alternatives. Accessed July 15, 2019

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.University of Pennsylvania Health System PhiladelphiaUSA
  2. 2.TMF Health Quality Institute AustinUSA

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