E-learning in order to improve drug prescription for hospitalized older patients: A cluster-randomized controlled study

Carlotta Franchi, Mauro Tettamanti, Codjo Dgnefa Djade, Luca Pasina, Pier Mannuccio Mannucci, Graziano Onder, Gualberto Gussoni, Dario Manfellotto, Stefano Bonassi, Francesco Salerno, Alessandro Nobili

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Aims: The aim of the study was to evaluate the effect of an e-learning educational program meant to foster the quality of drug prescription in hospitalized elderly patients. Methods: Twenty geriatric and internal medicine wards were randomized to intervention (e-learning educational program) or control (basic geriatric pharmacology notions). Logistic regression analysis was used in order to assess the effect of the intervention on the use of potentially inappropriate medication (PIM, primary outcome) at hospital discharge. Secondary outcomes were a reduced prevalence of at least one potential drug-drug interaction (DDI) and potentially severe DDI at discharge. Mortality rate and incidence of re-hospitalizations were other secondary outcomes assessed at the 12-month follow-up. Results: A total of 697 patients (347 in the intervention and 350 in the control arms) were enrolled. No difference in the prevalence of PIM at discharge was found between arms (OR 1.29 95%CI 0.87-1.91). We also found no decrease in the prevalence of DDI (OR 0.67 95%CI 0.34-1.28) and potentially severe DDI (OR 0.86 95%CI 0.63-1.15) at discharge, nor in mortality rates and incidence of re-hospitalization at 12-month follow-up. Conclusions: This e-learning educational program had no clear effect on the quality of drug prescription and clinical outcomes in hospitalized elderly patients. Given the high prevalence of PIMs and potential DDIs recorded in the frame of this study, other approaches should be developed in order to improve the quality of drug prescription in this population.

Original languageEnglish
JournalBritish Journal of Clinical Pharmacology
DOIs
Publication statusAccepted/In press - 2016

Fingerprint

Drug Prescriptions
Drug Interactions
Learning
Geriatrics
Pharmaceutical Preparations
Hospitalization
Mortality
Incidence
Internal Medicine
Logistic Models
Regression Analysis
Pharmacology
Population

Keywords

  • Comprehensive geriatric assessment
  • Drug prescription
  • Drug-drug interaction
  • E-learning
  • Elderly people
  • Potentially inappropriate medication

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology

Cite this

E-learning in order to improve drug prescription for hospitalized older patients : A cluster-randomized controlled study. / Franchi, Carlotta; Tettamanti, Mauro; Djade, Codjo Dgnefa; Pasina, Luca; Mannucci, Pier Mannuccio; Onder, Graziano; Gussoni, Gualberto; Manfellotto, Dario; Bonassi, Stefano; Salerno, Francesco; Nobili, Alessandro.

In: British Journal of Clinical Pharmacology, 2016.

Research output: Contribution to journalArticle

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abstract = "Aims: The aim of the study was to evaluate the effect of an e-learning educational program meant to foster the quality of drug prescription in hospitalized elderly patients. Methods: Twenty geriatric and internal medicine wards were randomized to intervention (e-learning educational program) or control (basic geriatric pharmacology notions). Logistic regression analysis was used in order to assess the effect of the intervention on the use of potentially inappropriate medication (PIM, primary outcome) at hospital discharge. Secondary outcomes were a reduced prevalence of at least one potential drug-drug interaction (DDI) and potentially severe DDI at discharge. Mortality rate and incidence of re-hospitalizations were other secondary outcomes assessed at the 12-month follow-up. Results: A total of 697 patients (347 in the intervention and 350 in the control arms) were enrolled. No difference in the prevalence of PIM at discharge was found between arms (OR 1.29 95{\%}CI 0.87-1.91). We also found no decrease in the prevalence of DDI (OR 0.67 95{\%}CI 0.34-1.28) and potentially severe DDI (OR 0.86 95{\%}CI 0.63-1.15) at discharge, nor in mortality rates and incidence of re-hospitalization at 12-month follow-up. Conclusions: This e-learning educational program had no clear effect on the quality of drug prescription and clinical outcomes in hospitalized elderly patients. Given the high prevalence of PIMs and potential DDIs recorded in the frame of this study, other approaches should be developed in order to improve the quality of drug prescription in this population.",
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T2 - A cluster-randomized controlled study

AU - Franchi, Carlotta

AU - Tettamanti, Mauro

AU - Djade, Codjo Dgnefa

AU - Pasina, Luca

AU - Mannucci, Pier Mannuccio

AU - Onder, Graziano

AU - Gussoni, Gualberto

AU - Manfellotto, Dario

AU - Bonassi, Stefano

AU - Salerno, Francesco

AU - Nobili, Alessandro

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N2 - Aims: The aim of the study was to evaluate the effect of an e-learning educational program meant to foster the quality of drug prescription in hospitalized elderly patients. Methods: Twenty geriatric and internal medicine wards were randomized to intervention (e-learning educational program) or control (basic geriatric pharmacology notions). Logistic regression analysis was used in order to assess the effect of the intervention on the use of potentially inappropriate medication (PIM, primary outcome) at hospital discharge. Secondary outcomes were a reduced prevalence of at least one potential drug-drug interaction (DDI) and potentially severe DDI at discharge. Mortality rate and incidence of re-hospitalizations were other secondary outcomes assessed at the 12-month follow-up. Results: A total of 697 patients (347 in the intervention and 350 in the control arms) were enrolled. No difference in the prevalence of PIM at discharge was found between arms (OR 1.29 95%CI 0.87-1.91). We also found no decrease in the prevalence of DDI (OR 0.67 95%CI 0.34-1.28) and potentially severe DDI (OR 0.86 95%CI 0.63-1.15) at discharge, nor in mortality rates and incidence of re-hospitalization at 12-month follow-up. Conclusions: This e-learning educational program had no clear effect on the quality of drug prescription and clinical outcomes in hospitalized elderly patients. Given the high prevalence of PIMs and potential DDIs recorded in the frame of this study, other approaches should be developed in order to improve the quality of drug prescription in this population.

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KW - Drug-drug interaction

KW - E-learning

KW - Elderly people

KW - Potentially inappropriate medication

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