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Computerized Alerts Can Influence Drug Prescribing

After computer prodding, physicians ordered fewer prescriptions for potentially inappropriate drugs and heavily advertised drugs.

Computerized decision support is one way to influence drug prescribing. In two new studies, researchers addressed this topic.

One study was conducted in an Indianapolis emergency department (ED) with a computerized order-entry system for all prescriptions. Researchers tracked prescribing patterns for older patients (age, 65) after 63 ED physicians were randomized to a decision-support prescribing intervention or to a control group. In the intervention group, orders for nine drugs that were deemed to be potentially inappropriate for older adults (e.g., promethazine, diazepam, propoxyphene, diphenhydramine) generated computerized alerts that suggested alternatives. During the 2-year study, the proportion of older ED patients who received prescriptions for potentially inappropriate medications was significantly lower in the intervention group than in the control group (2.6% vs. 3.9%).

Researchers at a large Boston group practice focused on four heavily advertised hypnotic drugs (Ambien CR, Sonata, Lunesta, and Rozerem). Fourteen practice sites were randomized to usual care, to computerized prescribing alerts (advising clinicians who ordered the 4 advertised drugs to consider generic zolpidem or trazodone), or to computerized alerts plus an educational session on managing insomnia. During the 1-year study, prescribing rates for the four advertised drugs were significantly higher in the control group than in the intervention groups; prescribing was similar in the alert group and the alert-plus-education group.

Comment: These studies indicate that computerized alerts can influence drug prescribing. In the hypnotic drug study, the goal clearly was to limit prescribing of expensive branded drugs. The ED study, however, raises interesting conceptual questions about what should be considered "inappropriate" in geriatric prescribing. That question is addressed in another recently published study (JW Gen Med Sep 3 2009).

— Allan S. Brett, MD

Published in Journal Watch General Medicine September 3, 2009

Citation(s):

Terrell KM et al. Computerized decision support to reduce potentially inappropriate prescribing to older emergency department patients: A randomized, controlled trial. J Am Geriatr Soc 2009 Aug; 57:1388.

• Medline abstract (Free)

Fortuna RJ et al. Reducing the prescribing of heavily marketed medications: A randomized controlled trial. J Gen Intern Med 2009 Aug; 24:897.

• Medline abstract (Free)

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• Computerized Alerts Can Influence Drug Prescribing
  f fallahian, 8 Sep 2009 12:49 PM EST
  Hi, in this way, it seems it would be possible in future to have a pharmacopy software for drug registration... [more]

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