Use of an electronic clinical decision support system (eCDSS) to improve prescribing of medications for older adults was safe but not statistically beneficial in a study conducted in Swiss primary practices. Compared with usual care, improvement in appropriateness of medication or a reduction in prescribing omissions at 12 months was statically similar to usual care.
The cluster randomized clinical trial included older adults (65 years of age or older) with 3 or more chronic conditions and 5 or more long-term medications. General practitioners used eCDSS followed by shared decision making between general practitioners and patients; usual care included a discussion about medications between patients and general practitioners.
Using primary outcomes of improvement in the Medication Appropriateness Index (MAI) and the Assessment of Underutilisation (AOU) at 12 months, the investigators found: “In 43 general practitioner clusters, 323 patients were recruited (median age 77 (interquartile range 73-83) years; 45% (n = 146) women). Twenty one general practitioners with 160 patients were assigned to the intervention group and 22 general practitioners with 163 patients to the control group. On average, one recommendation to stop or start a medication was reported to be implemented per patient. At 12 months, the results of the intention-to-treat analysis of the improvement in appropriateness of medication (odds ratio 1.05, 95% confidence interval 0.59 to 1.87) and the number of prescribing omissions (0.90, 0.41 to 1.96) were inconclusive. The same was the case for the per protocol analysis. No clear evidence was found for a difference in safety outcomes at the 12 month follow-up, but fewer safety events were reported in the intervention group than in the control group at six and 12 months.”