Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme

Area of Science:

• Geriatric Medicine
• Health Services Research
• Pharmacology

Background:

• Potentially inappropriate medications (PIMs) pose risks for older adults discharged from emergency departments.
• The Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED) program targets reducing PIMs in this population.
• Previous success of the EQUIPPED model within the Veterans Health Administration (VA) prompted its adaptation and implementation in other health systems.

Purpose of the Study:

• To describe the prescribing outcomes of three academic health systems implementing the EQUIPPED medication safety program.
• To assess the feasibility and impact of adapting and sequentially implementing the EQUIPPED program outside the VA system.
• To evaluate the reduction in monthly PIMs prescribed to older adults (≥65 years) discharged from the emergency department.

Main Methods:

• The EQUIPPED program was adapted from a VA model and implemented sequentially over 3 years in three academic health systems using the Epic electronic medical record.
• Local modifications to order sets and provider prescribing reports were generated by local champions.
• A generalized linear time series model with a Poisson distribution analyzed monthly PIM proportions (defined by 2015 Beers Criteria) for 6 months pre-implementation and 12 months post-implementation.

Main Results:

• Baseline PIM proportions ranged from 5.6% to 7.3% across the three sites.
• Significant reduction in PIMs was observed at one of the three implementing sites.
• Exploratory analysis indicated a decrease in benzodiazepine prescriptions from ~17% to 9.5%-12% of PIMs across all sites, though not all reached statistical significance.

Conclusions:

• The EQUIPPED program is feasible for implementation in health systems outside the VA.
• While program impact may vary, significant reduction in specific high-risk drug classes like benzodiazepines is a potential target for improvement.
• Sites with lower baseline PIM prescribing rates may benefit from targeted interventions within the EQUIPPED framework.