Prevention of inappropriate prescribing in hospitalized older patients using a computerized prescription support system (intercheck®)

Simona Ghibelli, Alessandra Marengoni, Codjo D. Djade, Alessandro Nobili, Mauro Tettamanti, Carlotta Franchi, Silvio Caccia, Flavio Giovarruscio, Andrea Remuzzi, Luca Pasina

Research output: Contribution to journalArticle

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Abstract

Background: Polypharmacy is very common among older adults and can lead to inappropriate prescribing, poor adherence to treatment, adverse drug events and the prevalence of potential drug-drug interactions (DDIs). Electronic prescription database software may help to prevent inappropriate prescribing and minimize the occurrence of adverse drug reactions. INTERcheck® is a Computerized Prescription Support System (CPSS) developed in order to optimize drug prescription for elderly people with multimorbidity. Objectives: The objectives of this study were (i) to evaluate the applicability of INTERcheck® as a means of reviewing the pharmacological profiles of elderly patients hospitalized in an acute geriatric ward in Northern Italy; and (ii) to evaluate the effectiveness of INTERcheck® in reducing potentially inappropriate medications (PIMs), potentially severe DDIs and the anticholinergic burden in daily practice. Methods: Two samples of elderly patients (aged 65+ years) hospitalized in a geriatric ward in Italy were enrolled throughout 2012. During the first (observation) phase, medications prescribed to 74 patients at admission and discharge were analyzed with INTERCheck® without any kind of interference based on information obtained from the software. During the second (intervention) phase, the treatment of 60 patients was reviewed and changed at discharge according to INTERCheck® suggestions. Results: In the observational period, the number of patients exposed to at least one PIM remained unchanged on both admission (n = 29; 39.1 %) and discharge (n = 28; 37.8 %). In the intervention phase, 25 patients (41.7 %) were exposed to at least one PIM at admission and 7 (11.6 %) at discharge (p <0.001). The number of patients exposed to at least one potentially severe DDI decreased from 27 (45.0 %) to 20 (33.3 %), although the difference was not statistically significant (p = 0.703), while the number of new-onset potentially severe DDIs decreased from 37 (59.0 %) to 9 (33.0 %) [p <0.001]. Conclusions: The use of INTERCheck® was associated with a significant reduction in PIMs and new-onset potentially severe DDIs. CPSSs combining different prescribing quality measures should be considered as an important strategy for optimizing medication prescription for elderly patients.

Original languageEnglish
Pages (from-to)821-828
Number of pages8
JournalDrugs and Aging
Volume30
Issue number10
DOIs
Publication statusPublished - Oct 2013

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Inappropriate Prescribing
Prescriptions
Drug Interactions
Pharmaceutical Preparations
Drug-Related Side Effects and Adverse Reactions
Geriatrics
Italy
Software
Electronic Prescribing
Drug Prescriptions
Polypharmacy
Patient Discharge
Patient Admission
Cholinergic Antagonists
Comorbidity
Observation
Databases
Pharmacology
Potentially Inappropriate Medication List
Therapeutics

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Geriatrics and Gerontology

Cite this

Prevention of inappropriate prescribing in hospitalized older patients using a computerized prescription support system (intercheck®). / Ghibelli, Simona; Marengoni, Alessandra; Djade, Codjo D.; Nobili, Alessandro; Tettamanti, Mauro; Franchi, Carlotta; Caccia, Silvio; Giovarruscio, Flavio; Remuzzi, Andrea; Pasina, Luca.

In: Drugs and Aging, Vol. 30, No. 10, 10.2013, p. 821-828.

Research output: Contribution to journalArticle

Ghibelli, Simona ; Marengoni, Alessandra ; Djade, Codjo D. ; Nobili, Alessandro ; Tettamanti, Mauro ; Franchi, Carlotta ; Caccia, Silvio ; Giovarruscio, Flavio ; Remuzzi, Andrea ; Pasina, Luca. / Prevention of inappropriate prescribing in hospitalized older patients using a computerized prescription support system (intercheck®). In: Drugs and Aging. 2013 ; Vol. 30, No. 10. pp. 821-828.
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abstract = "Background: Polypharmacy is very common among older adults and can lead to inappropriate prescribing, poor adherence to treatment, adverse drug events and the prevalence of potential drug-drug interactions (DDIs). Electronic prescription database software may help to prevent inappropriate prescribing and minimize the occurrence of adverse drug reactions. INTERcheck{\circledR} is a Computerized Prescription Support System (CPSS) developed in order to optimize drug prescription for elderly people with multimorbidity. Objectives: The objectives of this study were (i) to evaluate the applicability of INTERcheck{\circledR} as a means of reviewing the pharmacological profiles of elderly patients hospitalized in an acute geriatric ward in Northern Italy; and (ii) to evaluate the effectiveness of INTERcheck{\circledR} in reducing potentially inappropriate medications (PIMs), potentially severe DDIs and the anticholinergic burden in daily practice. Methods: Two samples of elderly patients (aged 65+ years) hospitalized in a geriatric ward in Italy were enrolled throughout 2012. During the first (observation) phase, medications prescribed to 74 patients at admission and discharge were analyzed with INTERCheck{\circledR} without any kind of interference based on information obtained from the software. During the second (intervention) phase, the treatment of 60 patients was reviewed and changed at discharge according to INTERCheck{\circledR} suggestions. Results: In the observational period, the number of patients exposed to at least one PIM remained unchanged on both admission (n = 29; 39.1 {\%}) and discharge (n = 28; 37.8 {\%}). In the intervention phase, 25 patients (41.7 {\%}) were exposed to at least one PIM at admission and 7 (11.6 {\%}) at discharge (p <0.001). The number of patients exposed to at least one potentially severe DDI decreased from 27 (45.0 {\%}) to 20 (33.3 {\%}), although the difference was not statistically significant (p = 0.703), while the number of new-onset potentially severe DDIs decreased from 37 (59.0 {\%}) to 9 (33.0 {\%}) [p <0.001]. Conclusions: The use of INTERCheck{\circledR} was associated with a significant reduction in PIMs and new-onset potentially severe DDIs. CPSSs combining different prescribing quality measures should be considered as an important strategy for optimizing medication prescription for elderly patients.",
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AU - Marengoni, Alessandra

AU - Djade, Codjo D.

AU - Nobili, Alessandro

AU - Tettamanti, Mauro

AU - Franchi, Carlotta

AU - Caccia, Silvio

AU - Giovarruscio, Flavio

AU - Remuzzi, Andrea

AU - Pasina, Luca

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N2 - Background: Polypharmacy is very common among older adults and can lead to inappropriate prescribing, poor adherence to treatment, adverse drug events and the prevalence of potential drug-drug interactions (DDIs). Electronic prescription database software may help to prevent inappropriate prescribing and minimize the occurrence of adverse drug reactions. INTERcheck® is a Computerized Prescription Support System (CPSS) developed in order to optimize drug prescription for elderly people with multimorbidity. Objectives: The objectives of this study were (i) to evaluate the applicability of INTERcheck® as a means of reviewing the pharmacological profiles of elderly patients hospitalized in an acute geriatric ward in Northern Italy; and (ii) to evaluate the effectiveness of INTERcheck® in reducing potentially inappropriate medications (PIMs), potentially severe DDIs and the anticholinergic burden in daily practice. Methods: Two samples of elderly patients (aged 65+ years) hospitalized in a geriatric ward in Italy were enrolled throughout 2012. During the first (observation) phase, medications prescribed to 74 patients at admission and discharge were analyzed with INTERCheck® without any kind of interference based on information obtained from the software. During the second (intervention) phase, the treatment of 60 patients was reviewed and changed at discharge according to INTERCheck® suggestions. Results: In the observational period, the number of patients exposed to at least one PIM remained unchanged on both admission (n = 29; 39.1 %) and discharge (n = 28; 37.8 %). In the intervention phase, 25 patients (41.7 %) were exposed to at least one PIM at admission and 7 (11.6 %) at discharge (p <0.001). The number of patients exposed to at least one potentially severe DDI decreased from 27 (45.0 %) to 20 (33.3 %), although the difference was not statistically significant (p = 0.703), while the number of new-onset potentially severe DDIs decreased from 37 (59.0 %) to 9 (33.0 %) [p <0.001]. Conclusions: The use of INTERCheck® was associated with a significant reduction in PIMs and new-onset potentially severe DDIs. CPSSs combining different prescribing quality measures should be considered as an important strategy for optimizing medication prescription for elderly patients.

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