Computerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: a systematic review and meta-analysis
Loading...
Files
Accepted Version
Supplementary Data
Date
2018-06-08
Authors
Dalton, Kieran
O'Brien, Gary L.
O'Mahony, Denis
Byrne, Stephen
Journal Title
Journal ISSN
Volume Title
Publisher
Oxford University Press
Published Version
Abstract
Background: computerised interventions have been suggested as an effective strategy to reduce potentially inappropriate prescribing (PIP) for hospitalised older adults. This systematic review and meta-analysis examined the evidence for efficacy of computerised interventions designed to reduce PIP in this patient group. Methods: an electronic literature search was conducted using eight databases up to October 2017. Included studies were controlled trials of computerised interventions aiming to reduce PIP in hospitalised older adults (≥65 years). Risk of bias was assessed using Cochrane’s Effective Practice and Organisation of Care criteria. Results: of 653 records identified, eight studies were included—two randomised controlled trials, two interrupted time series analysis studies and four controlled before–after studies. Included studies were mostly at a low risk of bias. Overall, seven studies showed either a statistically significant reduction in the proportion of patients prescribed a potentially inappropriate medicine (PIM) (absolute risk reduction {ARR} 1.3–30.1%), or in PIMs ordered (ARR 2–5.9%). However, there is insufficient evidence thus far to suggest that these interventions can routinely improve patient-related outcomes. It was only possible to include three studies in the meta-analysis—which demonstrated that intervention patients were less likely to be prescribed a PIM (odds ratio 0.6; 95% CI 0.38, 0.93). No computerised intervention targeting potential prescribing omissions (PPOs) was identified. Conclusions: this systematic review concludes that computerised interventions are capable of statistically significantly reducing PIMs in hospitalised older adults. Future interventions should strive to target both PIMs and PPOs, ideally demonstrating both cost-effectiveness data and clinically significant improvements in patient-related outcomes.
Description
Keywords
Inappropriate prescribing , Older people , Secondary care , Computer , Systematic review
Citation
Dalton, K., O'Brien, G., O'Mahony, D. and Byrne, S. (2018) 'Computerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: a systematic review and meta-analysis', Age and Ageing, 47(5), pp. 670-678. doi: 10.1093/ageing/afy086
Link to publisher’s version
Copyright
© 2018, the Authors. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. This is a pre-copyedited, author-produced version of an article accepted for publication in Age and Ageing following peer review. The version of record [Dalton, K., O'Brien, G., O'Mahony, D. and Byrne, S. (2018) 'Computerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: a systematic review and meta-analysis', Age and Ageing, 47(5), pp. 670-678. doi: 10.1093/ageing/afy086] is available online at: https://doi.org/10.1093/ageing/afy086