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Physicians' response to guided geriatric dosing: initial results from a randomized trial.
Josh F Peterson1, Benjamin P Rosenbaum, Lemuel R Waitman
1Vanderbilt University School of Medicine, Department of Biomedical Informatics, Nashville, TN, USA. josh.peterson@vanderbilt.edu
Studies in Health Technology and Informatics
|October 4, 2007
Summary
Computerized provider order entry (CPOE) guided dosing improved adherence to geriatric medication recommendations. While physicians did not always select the exact recommended dose, the intervention group
Area of Science:
- Geriatric Medicine
- Health Informatics
- Clinical Pharmacology
Background:
- Computerized provider order entry (CPOE) systems offer potential for optimizing medication management.
- Physician response to guided dosing decision support within CPOE requires further investigation, particularly in geriatric populations.
Purpose of the Study:
- To evaluate the efficacy of guided dosing prompts within a CPOE system on physician prescribing behavior for elderly patients.
- To assess the impact of tailored dosing advice on medication selection and adherence to geriatric guidelines.
Main Methods:
- A randomized trial was conducted involving 778 healthcare providers ordering 9111 study-related medications for 2981 patients over 9 months.
- Physicians received CPOE prompts for 88 drugs, including tailored messages and recommended initial doses/frequencies.
- Prescribing activity was electronically captured, with the primary outcome being the ratio of prescribed dose to recommended dose.
Main Results:
- Physicians utilizing guided dosing orders selected recommended doses more frequently than the control group (28.6% vs. 24.1%, p<0.001).
- The intervention group exhibited significantly lower prescribed doses compared to controls (median ratio 2.5 vs. 3.0, p<0.001).
Conclusions:
- Guided dosing within CPOE modestly improved physician compliance with geriatric medication guidelines.
- Despite suboptimal selection of exact recommended doses, the intervention demonstrated a trend towards safer prescribing practices in the elderly.
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