22 Improved medication for the chronically ill with an electronic decision support system
Older adults often live with several chronic diseases and therefore take several medications. The study examined how an electronic clinical decision support system used by general practitioners can contribute to improved medication. At the same time, it points out hurdles in their implementation.
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 clinical decision support system while the control group continued their usual care. GPs decided together with their patients whether or not to accept the prescribing recommendations offered by the decision support system. After six and twelve months, the appropriateness of the medication prescribed, use of healthcare services (e.g. hospitalization, visits to the emergency department), frequency of falls, quality of life and costs were compared between the two groups. Furthermore, the factors that favored or hindered the use of the decision support system into GP practice were investigated.
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 clinical decision support system can help GPs to review medication lists and thus limit undesirable effects.
The study examined the effectiveness of an electronic decision support system for optimizing medication. In addition, the integration of the tool into routine practice and its cost-effectiveness were investigated.
The study showed that 59 per cent of patients in the intervention group had at least one electronic prescribing recommendation implemented. In this group, a reduction in health care costs as well as an increase in quality-adjusted life years could be demonstrated. However, it could not be proven that the implementation of the electronic prescribing recommendations led to improved medication.
Relevance / Application
Significance of the results for research
The study made clear that randomised clinical trials on the topic of medication optimisation in Swiss general practice are possible. It showed that electronic prescribing recommendations were implemented, but not that they led to improved medication. However, the health economic analyses showed a reduction in costs and an increase in quality-adjusted life years in the intervention group.
Significance of the results for practice
In order to promote large-scale and improved use of electronic clinical decision support systems in general practice, the existing implementation hurdles have to be overcome.
Optimising pharmacotherapy In the multimorbid elderly in primary care: a cluster randomised controlled trial (the OPTICA trial)