N/A
N=201
Optimizing Electronic Health Record Prompts With Behavioral Economics to Improve Prescribing for Older Adults
Aging · Benzodiazepine Sedative Adverse Reaction · Anticholinergic Adverse Reaction · Adverse Drug Event
Bottom Line
View on ClinicalTrials.gov: NCT04284553 ↗Enrolled (actual)
201
Serious AEs
0.0%
Results posted
Oct 2023
Primary outcome: Primary: Change in Inappropriate Prescribing by Study Arm: Descriptive Comparison Across Study Arms — 35.2; 33; 35.6; 40.6 percentage of patients
Study Design & Population
- Study type
- Interventional
- Phase
- N/A
- Interventions
- Order Entry (Other); Open Encounter (Other); Follow-up booster Alert (Other); Cold State outreach (Other); Simplified (Other); Sign-off alert (Other); Pre-commitment (Other); Different Risks (Other); Standard Epic Basic Alert (Other); Enhanced Alert (Other)
- Age
- Adult, Older Adult · 18+ yrs
- Sex
- All
- Sponsor
- Brigham and Women's Hospital
- Primary completion
- Aug 2022
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Change in Inappropriate Prescribing by Study Arm: Descriptive Comparison Across Study Arms |
35.2; 33; 35.6; 40.6; 25.9; 39.2 | — |
| PRIMARY Change in Inappropriate Prescribing by the Seven Behavioral Intervention Factors (Open Encounter Timing, Boostering, Cold-state Priming, Simplification, Sign-off Approval, Pre-commitment, and Risk Framing): Primary Analysis Approach |
33.1; 38.9; 30.8; 40.1; 28.4; 40.4 | — |
| SECONDARY Quantity of Prescribing by Study Arm: Descriptive Comparison Across Study Arms |
64.5; 119.8; 94.4; 104.7; 156.6; 146.3 | — |
| SECONDARY Quantity of Prescribing by the Seven Behavioral Intervention Factors (Open Encounter Timing, Boostering, Cold-state Priming, Simplification, Sign-off Approval, Pre-commitment, and Risk Framing): Primary Analysis Approach |
114.5; 101.3; 152.8; 112.0; 104.7; 115.2 | — |
Summary
Prescribing of potentially unsafe medications for older adults is extremely common; benzodiazepines and sedative hypnotics are, for example, key drug classes frequently implicated in adverse health consequences for vulnerable older adults, such as confusion or sedation, leading to hospitalizations, falls, and fractures. Fortunately, most of these consequences are preventable. Physicians' lack of awareness of alternatives, ambiguous practice guidelines, and perceived pressure from patients or caregivers are among the reasons why these drugs are used more than might be optimal. Reducing inappropriate use of these drugs may be achieved through decision support tools for providers that are embedded in electronic health record (EHR) systems. While EHR strategies are widely used to support the informational needs of providers, these tools have demonstrated only modest effectiveness at improving prescribing. The effectiveness of these tools could be enhanced by leveraging principles of behavioral economics and related sciences.
Eligibility Criteria
Inclusion Criteria
- Primary care provider at Atrius Health
Providers will receive these EHR tools for their patients who meet the following criteria:
- older adults (aged 65 years or more)
- who have been prescribed at least 90 pills of benzodiazepine or sedative hypnotic in the last 180 days.
Exclusion Criteria
- NA
Data sourced from ClinicalTrials.gov (NCT04284553). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.