Simon Steven R, Smith David H, Feldstein Adrianne C, Perrin Nancy, Yang Xiuhai, Zhou Yvonne, Platt Richard, Soumerai Stephen B
HMO Research Network Center for Education and Research in Therapeutics, Harvard Medical School and Harvard Pilgrim Healthcare, Boston, MA 02215, USA.
J Am Geriatr Soc. 2006 Jun;54(6):963-8. doi: 10.1111/j.1532-5415.2006.00734.x.
To examine the effect of replacing drug-specific computerized prescribing alerts with age-specific alerts on rates of dispensing potentially inappropriate medications in older people and to determine whether group academic detailing enhances the effectiveness of these alerts.
Cluster-randomized trial of group academic detailing and interrupted time-series analysis.
Fifteen clinics of a staff-model health maintenance organization.
Seven practices (113 clinicians, 24,119 patients) were randomly assigned to receive age-specific prescribing alerts plus the academic detailing intervention; eight practices (126 clinicians, 26,805 patients) received alerts alone. Prior implementation of drug-specific alerts established a downward trend in use of target medications that served as the baseline trend for the present study.
The computerized age-specific alerts occurred at the time of prescribing a targeted potentially inappropriate medication (e.g., tertiary tricyclic amine antidepressants, long-acting benzodiazepines, propoxyphene) and suggested an alternative medication. Clinicians at seven sites were randomized to group academic detailing, an interactive educational program delivering evidence-based information.
Number of target medications dispensed per 10,000 patients per quarter, 2 years before and 1.5 years after the replacement of drug-specific with age-specific alerts.
Age-specific alerts resulted in a continuation of the effects of the drug-specific alerts without measurable additional effect (P=.75 for level change), but the age-specific alerts led to fewer false-positive alerts for clinicians. Group academic detailing did not enhance the effect of the alerts.
Age-specific alerts sustained the effectiveness of drug-specific alerts to reduce potentially inappropriate prescribing in older people and resulted in a considerably decreased burden of the alerts.
研究用年龄特异性警报取代药物特异性计算机处方警报对老年人潜在不适当药物配药率的影响，并确定团体学术详细指导是否能增强这些警报的有效性。
团体学术详细指导的整群随机试验和中断时间序列分析。
一家员工模式健康维护组织的15家诊所。
7个医疗团队（113名临床医生，24119名患者）被随机分配接受年龄特异性处方警报以及学术详细指导干预；8个医疗团队（126名临床医生，26805名患者）仅接受警报。之前实施的药物特异性警报使目标药物的使用呈下降趋势，为本研究提供了基线趋势。
在开具目标潜在不适当药物（如叔胺类三环抗抑郁药、长效苯二氮䓬类、丙氧芬）时出现计算机化年龄特异性警报，并建议使用替代药物。7个地点的临床医生被随机分配接受团体学术详细指导，这是一个提供循证信息的互动教育项目。
在将药物特异性警报替换为年龄特异性警报之前2年和之后1.5年，每季度每10000名患者中目标药物的配药数量。
年龄特异性警报使药物特异性警报的效果得以延续，且无明显额外效果（水平变化P = 0.75），但年龄特异性警报减少了临床医生收到的假阳性警报。团体学术详细指导并未增强警报的效果。
年龄特异性警报维持了药物特异性警报在减少老年人潜在不适当处方方面的有效性，并显著减轻了警报负担。
