The effectiveness of a new generation of computerized drug alerts in reducing the risk of injury from drug side effects: a cluster randomized trial
OPEN ACCESS- Robyn Tamblyn1,2,
- Tewodros Eguale1,
- David L Buckeridge1,2,
- Allen Huang2,
- James Hanley1,2,
- Kristen Reidel1,
- Sherry Shi1,
- Nancy Winslade2
- 1Department of Epidemiology & Biostatistics, McGill University, Montreal, Quebec, Canada
- 2Department of Medicine, McGill University, Montreal, Quebec, Canada
- Correspondence to Dr Robyn Tamblyn, McGill University, Morrice House, 1140 Pine Ave W, Montreal, Quebec H3A 1A3, Canada; robyn.tamblyn{at}mcgill.ca
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Contributors All authors contributed significantly to the conception and design or analysis and interpretation of the data. All authors drafted the article or revised it for important intellectual content, and have given final approval of the version to be published.
- Received 23 September 2011
- Accepted 16 December 2011
- Published Online First 12 January 2012
Abstract
Context Computerized drug alerts for psychotropic drugs are expected to reduce fall-related injuries in older adults. However, physicians over-ride most alerts because they believe the benefit of the drugs exceeds the risk.
Objective To determine whether computerized prescribing decision support with patient-specific risk estimates would increase physician response to psychotropic drug alerts and reduce injury risk in older people.
Design Cluster randomized controlled trial of 81 family physicians and 5628 of their patients aged 65 and older who were prescribed psychotropic medication.
Intervention Intervention physicians received information about patient-specific risk of injury computed at the time of each visit using statistical models of non-modifiable risk factors and psychotropic drug doses. Risk thermometers presented changes in absolute and relative risk with each change in drug treatment. Control physicians received commercial drug alerts.
Main outcome measures Injury risk at the end of follow-up based on psychotropic drug doses and non-modifiable risk factors. Electronic health records and provincial insurance administrative data were used to measure outcomes.
Results Mean patient age was 75.2 years. Baseline risk of injury was 3.94 per 100 patients per year. Intermediate-acting benzodiazepines (56.2%) were the most common psychotropic drug. Intervention physicians reviewed therapy in 83.3% of visits and modified therapy in 24.6%. The intervention reduced the risk of injury by 1.7 injuries per 1000 patients (95% CI 0.2/1000 to 3.2/1000; p=0.02). The effect of the intervention was greater for patients with higher baseline risks of injury (p<0.03).
Conclusion Patient-specific risk estimates provide an effective method of reducing the risk of injury for high-risk older people.
Trial registration number clinicaltrials.gov Identifier: NCT00818285.
Footnotes
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Funding RT is supported by the Canadian Institutes of Health Research and the Canadian Patient Safety Institute. TE is supported by The CIHR Frederick Banting and Charles Best Canada Graduate Scholarship and CIHR Emerging Team Grant. DB is supported by a Canada Research Chair in Public Health Informatics.
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Competing interests None.
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Ethics approval Ethics approval was given by McGill University Institutional Review Board.
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Provenance and peer review Not commissioned; externally peer reviewed.
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