Reduction in targeted potentially inappropriate medication use in elderly inpatients: a pragmatic randomized controlled trial

Abstract

Purpose

The use of potentially inappropriate medications (PIMs) in hospitalized older adults is a complex problem, but the use of computerized alert systems (CAS) has shown some potential. The study’s objective is to assess the change in PIM use with a CAS-based pharmacist-physician intervention model compared to usual clinical care.

Methods

Pragmatic single-site randomized controlled trial was conducted at a university teaching hospital. Hospitalizations identified with selected Beers or STOPP criteria were randomized to usual clinical care or to the CAS-based pharmacist-physician intervention. The primary outcome was PIM drug cessation or dosage decrease. Clinical relevance of the CAS alerts was assessed.

Results

Analyses included 231 patients who had 128 and 126 hospitalizations in the control and intervention groups, respectively. Patients had a mean age of 81, and 60% were female. In the intervention compared to the control group, drug cessation or dosage decrease were more frequent at 48 h post-alert (45.8 vs 15.9%; absolute difference 30.0%; 95%CI 13.8 to 46.1%) and at discharge from the hospital (48.1 vs 27.3%; absolute difference 20.8%; 95%CI 4.6 to 37.0%). In a post hoc analysis of all alerts, regardless of their clinical relevance, the absolute difference in drug cessation or dosage decrease between the intervention and control groups was 16.2% (95%CI 2.9 to 29.6%) at 48 h and 8.0% (95%CI −4.0 to 20.0%) at discharge from the hospital.

Conclusions

In hospitalized older adults, a CAS-based pharmacist-physician intervention, compared to usual clinical care, resulted in significant higher number of drug cessation and dosage reductions for targeted PIMs.

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Acknowledgments

The authors are grateful to Guillaume Joly for his help in developing and structuring the CAS, and to Jean-Michel Gagnon, Philippe Nault, and Philip-André Fillion for their informatics support. The interventions were conducted by four pharmacists: Sabrina Bergeron-Wolff, Nora Bernier-Fillion, Martine Grondin, and Claudia Pelletier-Mayette.

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Authors

Contributions

Benoit Cossette, Jean-François Éthier, Thomas Joly-Mischlich, Josée Bergeron, Geneviève Ricard, Serge Brazeau, Janusz Kaczorowski, and Mitchell Levine designed the study; Benoit Cossette, Jean-François Éthier, Thomas Joly-Mischlich, Mathieu Caron, and Olivier Germain acquired and analyzed the data; Benoit Cossette, Jean-François Éthier, Thomas Joly-Mischlich, Josée Bergeron, Geneviève Ricard, Serge Brazeau, Mathieu Caron, Hélène Payette, Janusz Kaczorowski, and Mitchell Levine interpreted the data; Benoit Cossette drafted the manuscript; Jean-François Éthier, Thomas Joly-Mischlich, Josée Bergeron, Geneviève Ricard, Serge Brazeau, Mathieu Caron, Olivier Germain, Hélène Payette, Janusz Kaczorowski, and Mitchell Levine critically revised the manuscript.

Corresponding author

Correspondence to Benoit Cossette.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was approved by the CHUS ethics committee. The committee did not request patient consent before randomization but required that each patient be contacted after the hospitalization to determine if their relevant hospitalization information could be included in the analysis.

Funding

This study was funded through a grant received from the Merck funds of the Faculty of Medicine and Health Sciences of the University of Sherbrooke. The funding source had no involvement in the study design, data collection, analysis, or interpretation, the writing of the report, or the decision to submit the report for publication.

Additional information

ClinicalTrials.gov Identifier: NCT02570945

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Cossette, B., Éthier, J., Joly-Mischlich, T. et al. Reduction in targeted potentially inappropriate medication use in elderly inpatients: a pragmatic randomized controlled trial. Eur J Clin Pharmacol 73, 1237–1245 (2017). https://doi.org/10.1007/s00228-017-2293-4

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Keywords

  • Older adults
  • Computerized alert system
  • Potentially inappropriate medications
  • Hospital
  • Knowledge translation