Factors Affecting Prescriber Implementation of Computer-Generated Medication Recommendations in the SENATOR Trial: A...

Area of Science:

• Geriatric Medicine
• Clinical Pharmacy
• Health Services Research

Background:

• The SENATOR trial aimed to reduce adverse drug reactions in hospitalized older adults using computer-generated medication recommendations.
• Interim analysis revealed lower-than-expected prescriber implementation rates of STOPP/START recommendations across trial sites.

Purpose of the Study:

• To qualitatively explore factors influencing physician prescriber implementation of medication recommendations within the SENATOR trial.

Main Methods:

• Conducted semi-structured interviews with trial researchers and physician prescribers involved in the SENATOR trial.
• Utilized content analysis and the Theoretical Domains Framework (TDF) to identify barriers and facilitators to recommendation uptake.

Main Results:

• Eight TDF domains were identified as crucial: environmental context, goals, intentions, knowledge, beliefs about consequences, memory/attention/decision processes, role/identity, and social influences.
• Key barriers included timing of recommendations, prescriber inertia, reluctance to change medications outside specialty, and low clinical relevance due to software limitations in assessing full patient context.

Conclusions:

• Clinical relevance of prescribing recommendations is a major determinant of implementation success.
• Future interventions must involve software improvements and multifaceted strategies to address prescriber specialty culture in acute hospital settings.