Computerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: a systematic review and meta-analysis

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dc.contributor.authorDalton, Kieran
dc.contributor.authorO'Brien, Gary L.
dc.contributor.authorO'Mahony, Denis
dc.contributor.authorByrne, Stephen
dc.contributor.funderSeventh Framework Programmeen
dc.contributor.funderIrish Research Councilen
dc.date.accessioned2020-08-12T10:34:43Z
dc.date.available2020-08-12T10:34:43Z
dc.date.issued2018-06-08
dc.date.updated2020-08-12T10:19:42Z
dc.description.abstractBackground: 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.en
dc.description.sponsorshipIrish Research Council (Scholarship Number GOIPG/2016/635)en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationDalton, 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/afy086en
dc.identifier.doi10.1093/ageing/afy086en
dc.identifier.eissn1468-2834
dc.identifier.endpage678en
dc.identifier.issn0002-0729
dc.identifier.issued5en
dc.identifier.journaltitleAge and Ageingen
dc.identifier.startpage670en
dc.identifier.urihttps://hdl.handle.net/10468/10385
dc.identifier.volume47en
dc.language.isoenen
dc.publisherOxford University Pressen
dc.relation.projectinfo:eu-repo/grantAgreement/EC/FP7::SP1::HEALTH/305930/EU/Development and clinical trials of a new Software ENgine for the Assessment & Optimization of drug and non-drug Therapy in Older peRsons/SENATORen
dc.rights© 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/afy086en
dc.subjectInappropriate prescribingen
dc.subjectOlder peopleen
dc.subjectSecondary careen
dc.subjectComputeren
dc.subjectSystematic reviewen
dc.titleComputerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: a systematic review and meta-analysisen
dc.typeArticle (peer-reviewed)en
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