Association Between Real-Time Alerts in Electronic Prescribing Systems and Potentially Inappropriate Prescribing...

Area of Science:

• Gerontology
• Pharmacology
• Health Informatics

Background:

• Older adults face increased risks from potentially inappropriate medications (PIMs).
• Evidence on clinical decision support systems (CDSS) for PIM reduction in low- and middle-income countries is scarce.
• This study investigates a national electronic alert system's impact on outpatient PIM prescribing in Iran.

Purpose of the Study:

• To assess the association between a national electronic alert system and PIM prescribing in older adults.
• To evaluate the effectiveness of a real-time, non-interruptive alert system in reducing PIMs.
• To provide evidence for CDSS implementation in resource-constrained healthcare settings.

Main Methods:

• Analysis of 230,719 outpatient prescriptions for adults aged 65+ in Iran.
• Comparison of PIM prescribing rates before (May-Aug 2023) and after (May-Aug 2024) alert system implementation.
• PIMs defined using the 2023 AGS Beers Criteria; subgroup analyses by age, sex, specialty, and drug class.

Main Results:

• The alert system was associated with significant reductions in PIM prescribing among older adults.
• Greatest reductions observed in the 85-100 years age group (-9.85%) and women (-7.89%).
• Significant declines noted for gastrointestinal, pain, CNS, and antihistamine medications, with specific drug examples provided. Reductions varied by physician specialty.

Conclusions:

• A national, real-time, non-interruptive alert system effectively reduced PIM prescribing in older adults.
• Scalable CDSS tools can enhance medication safety, particularly in resource-limited environments.
• The findings support the adoption of electronic alert systems to improve geriatric pharmacotherapy.