电子健康记录干预和老年人的处方:一个随机临床试验
Julie C Lauffenburger1,2, Meekang Sung1,2, Robert J Glynn1
1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
JAMA
|January 29, 2026
概括
使用行为科学的电子健康记录 (EHR) 工具增加了老年人可能不适合药物的处方. 与通常的护理相比,承诺前干预显示了40%的增加.
科学领域:
- 老年病的医生 老年病的医生
- 医疗信息学 医疗信息学
- 行为科学 行为科学
背景情况:
- 潜在不合适的药物 (PIMs) 经常被过度处方给老年人.
- 基于电子健康记录 (EHR) 的工具可以促进基于证据的处方,但它们对减少PIM的影响尚不清楚.
研究的目的:
- 评估两种EHR干预措施的有效性,结合行为科学,与通常护理相比,在老年患者中减轻PIM.
主要方法:
- 一个3组并行随机临床试验,涉及201名初级保健医生 (PCP).
- 干预措施包括一个预承诺策略 (连续的EHR信息) 和一个增强策略 (通知和提醒).
- 主要结局是药物降低处方,定义为由医生指导的停药或逐渐减少,通过EHR数据评估.
主要成果:
- 在预承诺组的36.8%,在增强组的34.3%,在常规护理组的26.8%发生了停止处方.
- 与常规护理相比,预承诺组的抑郁率高出40% (RR,1.40),而增强组的抑郁率高出26% (RR,1.26).
- 没有报告严重的不良事件;死亡率在不同组之间有所不同.
结论:
- 根据行为科学原则设计的EHR工具可以显著提高老年人PIM的抑郁症.
- 这些发现支持实施这种有针对性的干预措施,以提高老年人群的药物安全性.
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