22 Improved medication for the chronically ill with an electronic decision support system
Patients with multiple chronic illnesses often use potentially inappropriate medications. This study examined how an electronic decision support system designed for general practitioners (GPs) can improve prescribing appropriateness and patient quality of life.
Project description (completed research project)
43 GPs participated in the study and were divided between an intervention group and a control group. The study included patients who were at least 65 years old, had at least three chronic diseases and were taking at least five medications. The GPs of the intervention group were supported by the electronic decision support system while the control group continued their usual care. GPs decided in agreement with their patients whether or not to accept the prescribing recommendations offered by the decision support system to optimize prescribing. After six and twelf months, the appropriateness of the medication prescribed, use of healthcare services (e.g. hospitalisation, visits to the emergency department), frequency of falls, quality of life and costs were compared between the two groups. Furthermore, the factors that favoured or hindered the use of this tool into GP practice were investigated.
Many older adults have multiple chronic illnesses and therefore take different medications, which is associated with multimorbidity. GPs often have insufficient time to systematically examine their patients’ medication lists. However, inappropriate prescribing and errors in medication use increase health risks and costs. An electronic decision support system can help GPs to review medication and thus limit undesirable effects.
The study examined the effectiveness of an electronic support system for optimising medication. In addition, the integration of the tool into routine practice and its cost-effectiveness was investigated.
Whether an electronic decision support system contributes to improved medication appropriateness and quality of life and reduce healthcare costs of chronically ill patients can only be answered at the beginning of 2023, when the study results are available. However, the study makes it clear that the use of an electronic decision support system in general practice for optimizing prescribing is possible, even if there are some implementation hurdles to overcome.
Relevance / Application
Significance of the results for research and practice
If it can be proven that the electronic decision support system contributes to optimised prescribing and a better quality of life and lower costs, it could be introduced nationwide in all medical practices. The prerequisite is that the implementation hurdles are overcome. With regard to further research, the study was able to show that it is possible to conduct clinical studies in Swiss GP practices on the topic of optimzing prescribing in older adults with several chronic conditions and medications.
Optimising pharmacotherapy In the multimorbid elderly in primary care: a cluster randomised controlled trial (the OPTICA trial)