scholarly journals Use of an electronic decision support tool to reduce polypharmacy in elderly people with chronic diseases: cluster randomised controlled trial

BMJ ◽  
2020 ◽  
pp. m1822 ◽  
Author(s):  
Anja Rieckert ◽  
David Reeves ◽  
Attila Altiner ◽  
Eva Drewelow ◽  
Aneez Esmail ◽  
...  
Keyword(s):  
Decision Support ◽  
Confidence Interval ◽  
Hospital Admission ◽  
Elderly People ◽  
Intervention Group ◽  
Decision Support Tool ◽  
Control Group ◽  
Electronic Decision Support ◽  
Support Tool ◽  
Drug Review

Abstract Objective To evaluate the effects of a computerised decision support tool for comprehensive drug review in elderly people with polypharmacy. Design Pragmatic, multicentre, cluster randomised controlled trial. Setting 359 general practices in Austria, Germany, Italy, and the United Kingdom. Participants 3904 adults aged 75 years and older using eight or more drugs on a regular basis, recruited by their general practitioner. Intervention A newly developed electronic decision support tool comprising a comprehensive drug review to support general practitioners in deprescribing potentially inappropriate and non-evidence based drugs. Doctors were randomly allocated to either the electronic decision support tool or to provide treatment as usual. Main outcome measures The primary outcome was the composite of unplanned hospital admission or death by 24 months. The key secondary outcome was reduction in the number of drugs. Results 3904 adults were enrolled between January and October 2015. 181 practices and 1953 participants were assigned to electronic decision support (intervention group) and 178 practices and 1951 participants to treatment as usual (control group). The primary outcome (composite of unplanned hospital admission or death by 24 months) occurred in 871 (44.6%) participants in the intervention group and 944 (48.4%) in the control group. In an intention-to-treat analysis the odds ratio of the composite outcome was 0.88 (95% confidence interval 0.73 to 1.07; P=0.19, 997 of 1953 v 1055 of 1951). In an analysis restricted to participants attending practice according to protocol, a difference was found favouring the intervention (odds ratio 0.82, 95% confidence interval 0.68 to 0.98; 774 of 1682 v 873 of 1712, P=0.03). By 24 months the number of prescribed drugs had decreased in the intervention group compared with control group (uncontrolled mean change −0.42 v 0.06: adjusted mean difference −0.45, 95% confidence interval −0.63 to −0.26; P<0.001). Conclusions In intention-to-treat analysis, a computerised decision support tool for comprehensive drug review of elderly people with polypharmacy showed no conclusive effects on the composite of unplanned hospital admission or death by 24 months. Nonetheless, a reduction in drugs was achieved without detriment to patient outcomes. Trial registration Current Controlled Trials ISRCTN10137559 .

scholarly journals Assessment of the Effectiveness of a Computerised Decision-Support Tool for Health Professionals for the Prevention and Treatment of Childhood Obesity. Results from a Randomised Controlled Trial

Nutrients ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 706 ◽  
Author(s):  
George Moschonis ◽  
Maria Michalopoulou ◽  
Konstantina Tsoutsoulopoulou ◽  
Elpis Vlachopapadopoulou ◽  
Stefanos Michalacos ◽  
...  
Keyword(s):  
Decision Support ◽  
Childhood Obesity ◽  
Randomised Controlled Trial ◽  
Healthcare Professionals ◽  
Controlled Trial ◽  
Intervention Group ◽  
Decision Support Tool ◽  
Control Group ◽  
Support Tool ◽  
Randomised Controlled

We examined the effectiveness of a computerised decision-support tool (DST), designed for paediatric healthcare professionals, as a means to tackle childhood obesity. A randomised controlled trial was conducted with 65 families of 6–12-year old overweight or obese children. Paediatricians, paediatric endocrinologists and a dietitian in two children’s hospitals implemented the intervention. The intervention group (IG) received personalised meal plans and lifestyle optimisation recommendations via the DST, while families in the control group (CG) received general recommendations. After three months of intervention, the IG had a significant change in dietary fibre and sucrose intake by 4.1 and −4.6 g/day, respectively. In addition, the IG significantly reduced consumption of sweets (i.e., chocolates and cakes) and salty snacks (i.e., potato chips) by −0.1 and −0.3 portions/day, respectively. Furthermore, the CG had a significant increase of body weight and waist circumference by 1.4 kg and 2.1 cm, respectively, while Body Mass Index (BMI) decreased only in the IG by −0.4 kg/m2. However, the aforementioned findings did not differ significantly between study groups. In conclusion, these findings indicate the dynamics of the DST in supporting paediatric healthcare professionals to improve the effectiveness of care in modifying obesity-related behaviours. Further research is needed to confirm these findings.

scholarly journals THE PRIMA-EDS ELECTRONIC DECISION SUPPORT TOOL FOR POLYPHARMACY: A MULTINATIONAL EUROPEAN PROJECT

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 1048-1048
Author(s):  
A. Renom Guiteras ◽  
I. Kunnamo ◽  
D. Reeves ◽  
J. Hoeck ◽  
G. Piccoliori ◽  
...  
Keyword(s):  
Decision Support ◽  
Decision Support Tool ◽  
Electronic Decision Support ◽  
Support Tool ◽  
European Project

Decision Support Tool Identifies Ulcerative Colitis Patients Most Likely to Achieve Remission With Vedolizumab vs Adalimumab

2021 ◽  
Author(s):  
Parambir S Dulai ◽  
Emily C L Wong ◽  
Walter Reinisch ◽  
Jean-Frederic Colombel ◽  
John K Marshall ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Decision Support ◽  
Confidence Interval ◽  
Drug Exposure ◽  
Area Under The Curve ◽  
Decision Support Tool ◽  
Support Tool ◽  
Predicted Probability ◽  
Baseline Probability ◽  
Probability Of Response

Abstract Background & Aims We have previously validated a clinical decision support tool (CDST) (vedolizumab CDST [VDZ-CDST]) for clinical and endoscopic remission with VDZ in ulcerative colitis (UC). We aim to expand the validation for predicting histoendoscopic mucosal improvement (HEMI) with VDZ vs adalimumab (ADA). Methods In a post hoc analysis of a clinical trial for VDZ vs ADA in moderate to severe UC (VARSITY trial; NCT02497469), comparative accuracy was evaluated for the VDZ-CDST among an external validation cohort of VDZ- and ADA-treated patients for week 52 HEMI (Mayo endoscopic subscore 0-1 and Geboes score &lt;3.2). Comparative effectiveness of VDZ and ADA was assessed after stratifying the cohort by baseline probability of response to VDZ using the VDZ-CDST. Results A total of 419 patients were included. The majority of patients enrolled in the VARSITY trial had a high (61%) or intermediate (29%) baseline predicted probability of response to VDZ. The baseline VDZ-CDST score was significantly more likely to predict week 52 HEMI for VDZ (area under the curve , 0.712; 95% confidence interval, 0.636-0.787) relative to ADA-treated patients (area under the curve, 0.538; 95% confidence interval, 0.377-0.700; P &lt; .001 for AUC comparison). A significant (P &lt; .001) association was observed between the VDZ-CDST and measured VDZ drug exposure over 52 weeks. Superiority of VDZ to ADA was only observed in patients with a high baseline predicted probability of response to VDZ. Conclusions Superiority of VDZ to ADA is dependent on baseline probability of response, and a VDZ-CDST is capable of identifying UC patients most appropriate for VDZ vs ADA.

scholarly journals Reduction of the long-term use of proton pump inhibitors by a patient-oriented electronic decision support tool (arriba-PPI): study protocol for a randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Anja Rieckert ◽  
Annette Becker ◽  
Norbert Donner-Banzhof ◽  
Annika Viniol ◽  
Bettina Bücker ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Decision Support ◽  
Controlled Trial ◽  
Decision Support Tool ◽  
Routine Care ◽  
Electronic Decision Support ◽  
Support Tool ◽  
Randomized Controlled ◽  
Cluster Randomized

Abstract Background Proton pump inhibitors (PPIs) are increasingly being prescribed, although long-term use is associated with multiple side effects. Therefore, an electronic decision support tool with the aim of reducing the long-term use of PPIs in a shared decision-making process between general practitioners (GPs) and their patients has been developed. The developed tool is a module that can be added to the so-called arriba decision support tool, which is already used by GPs in Germany in routine care. In this large-scale cluster-randomized controlled trial we evaluate the effectiveness of this arriba-PPI tool. Methods The arriba-PPI tool is an electronic decision support system that supports shared decision-making and evidence-based decisions around the long-term use of PPIs at the point of care. The tool will be evaluated in a cluster-randomized controlled trial involving 210 GP practices and 3150 patients in Germany. GP practices will be asked to recruit 20 patients aged ≥ 18 years regularly taking PPIs for ≥ 6 months. After completion of patient recruitment, each GP practice with enrolled patients will be cluster-randomized. Intervention GP practices will get access to the software arriba-PPI, whereas control GPs will treat their patients as usual. After an observation period of six months, GP practices will be compared regarding the reduction of cumulated defined daily doses of PPI prescriptions per patient. Discussion Our principal hypothesis is that the application of the arriba-PPI tool can reduce PPI prescribing in primary care by at least 15% compared to conventional strategies used by GPs. A positive result implies the implementation of the arriba-PPI tool in routine care. Trial registration German Clinical Trials Register, DRKS00016364. Registered on 31 January 2019.

scholarly journals Using an Electronic Decision Support Tool to Reduce Inappropriate Polypharmacy and Optimize Medicines: Rationale and Methods

2016 ◽  
Vol 5 (2) ◽  
pp. e105 ◽  
Author(s):  
Amber Young ◽  
June Tordoff ◽  
Susan Dovey ◽  
David Reith ◽  
Hywel Lloyd ◽  
...  
Keyword(s):  
Decision Support ◽  
Decision Support Tool ◽  
Electronic Decision Support ◽  
Support Tool

scholarly journals Shared Decision-Making in Chronic Patients with Polypharmacy: An Interventional Study for Assessing Medication Appropriateness

2019 ◽  
Vol 8 (6) ◽  
pp. 904
Author(s):  
Valle Coronado-Vázquez ◽  
Juan Gómez-Salgado ◽  
Javier Cerezo-Espinosa de los Monteros ◽  
Diego Ayuso-Murillo ◽  
Carlos Ruiz-Frutos
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Intervention Group ◽  
Decision Support Tool ◽  
Control Group ◽  
Potentially Inappropriate Medications ◽  
Shared Decision ◽  
Support Tool ◽  
Inappropriate Medications ◽  
Medication Appropriateness

Potentially inappropriate medications are associated with polypharmacy and polypathology. Some interventions such as pharmacotherapy reviews have been designed to reduce the prescribing of inappropriate medications. The objective of this study is to evaluate how effective a decision-making support tool is for determining medication appropriateness in patients with one or more chronic diseases (hypertension, dyslipidaemia, and/or diabetes) and polypharmacy in the primary care setting. For this, a quasi-experimental study (randomised, controlled and multicentre) has been developed. The study compares an intervention group, which assesses medication appropriateness by applying a decision support tool, with a control group that follows the usual clinical practice. The intervention included a decision support tool in paper format, where participants were informed about polypharmacy, inappropriate medications, associated problems and available alternatives, as well as shared decision-making. This is an informative guide aimed at helping patients with decision-making by providing them with information about the secondary risks associated with inappropriate medications in their treatment, according to the Beers and START/STOPP criteria. The outcome measure was the proportion of medication appropriateness. The proportion of patients who confirmed medication appropriateness after six months of follow-up is greater in the intervention group (32.5%) than in the control group (27.9%) p = 0.008. The probability of medication appropriateness, which was calculated by the proportion of drugs withdrawn or replaced according to the STOPP/Beers criteria and those initiated according to the START criteria, was 2.8 times higher in the intervention group than in the control group (OR = 2.8; 95% CI 1.3–6.1) p = 0.008. In patients with good adherence to the treatment, the percentage of appropriateness was 62.1% in the shared decision-making group versus 37.9% in the control group (p = 0.005). The use of a decision-making support tool in patients with potentially inappropriate medications increases the percentage of medication appropriateness when compared to the usual clinical practice.

scholarly journals Reduction of inappropriate medication in older populations by electronic decision support (the PRIMA-eDS project): a survey of general practitioners’ experiences

2019 ◽  
Vol 26 (11) ◽  
pp. 1323-1332 ◽  
Author(s):  
Anja Rieckert ◽  
Anne-Lisa Teichmann ◽  
Eva Drewelow ◽  
Celine Kriechmayr ◽  
Giuliano Piccoliori ◽  
...  
Keyword(s):  
Decision Support ◽  
Electronic Health Record ◽  
General Practitioners ◽  
Inappropriate Medication ◽  
Decision Support Tool ◽  
Health Record ◽  
Electronic Decision Support ◽  
Support Tool ◽  
Electronic Health ◽  
Older Populations

Abstract Objective We sought to investigate the experiences of general practitioners (GPs) with an electronic decision support tool to reduce inappropriate polypharmacy in older patients (the PRIMA-eDS [Polypharmacy in chronic diseases: Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support] tool) in a multinational sample of GPs and to quantify the findings from a prior qualitative study on the PRIMA-eDS-tool. Materials and Methods Alongside the cluster randomized controlled PRIMA-eDS trial, a survey was conducted in all 5 participating study centers (Bolzano, Italy; Manchester, United Kingdom; Salzburg, Austria; Rostock, Germany; and Witten, Germany) between October 2016 and July 2017. Data were analyzed using descriptive statistics and chi-square tests. Results Ninety-one (n = 160) percent of the 176 questionnaires were returned. Thirty-two percent of the respondents reported that they did not cease drugs because of the medication check. The 68% who had discontinued drugs comprise 57% who had stopped on average 1 drug and 11% who had stopped 2 drugs or more per patient. The PRIMA-eDS tool was found to be useful (69%) and the recommendations were found to help to increase awareness (86%). The greatest barrier to implementing deprescribing recommendations was the perceived necessity of the medication (69%). The majority of respondents (65%) would use the electronic medication check in routine practice if it was part of the electronic health record. Conclusions GPs generally viewed the PRIMA-eDS medication check as useful and as informative. Recommendations were not always followed due to various reasons. Many GPs would use the medication check if integrated into the electronic health record.

Abstract WP290: Impact of TIA Training for General Practitioners on 90-Day Stroke Outcomes Following TIA

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Annemarei Ranta ◽  
Susan Dovey ◽  
John Gommans ◽  
Mark Weatherall
Keyword(s):  
Decision Support ◽  
General Practitioners ◽  
Controlled Trial ◽  
Decision Support Tool ◽  
Minor Stroke ◽  
Education Session ◽  
Vascular Events ◽  
Electronic Decision Support ◽  
Support Tool ◽  
Significant Difference

Introduction: The FASTEST trial demonstrated benefit of a TIA/stroke electronic decision support tool for the management of patients with TIA or minor stroke in primary. As part of the trial general practitioners (GPs) were offered an educational session on TIA and stroke prior to trial begin. Hypothesis: GP TIA/stroke education has a beneficial effect on patient outcomes especially if combined with the use of electronic decision support. Methods: The FASTEST trial was a multi-centre, single blind, parallel group, cluster randomised controlled trial comparing TIA/stroke electronic decisions support guided primary care management with usual care. A one-hour pre-trial TIA education session was offered to all participating GPs. Results: Of 181 participating GPs 79 (43.7%) attended a pre-trial education session and 140/291 (48.1%) trial patients were managed by GPs who attended education. Overall, there was no significant difference in 90-day stroke events in patients treated by GPs who attended (2/140 (1.4%)) versus those who did not attend the education session (5/151 (3.3%)); cluster adjusted OR 0.42, 95% CI 0.08-2.21; p=0.30). GP education that was reinforced by subsequent access to the electronic decision support tool during the trial did result in fewer 90-day strokes (0/71; 0%) when compared with patients treated by GPs who neither accessed education nor the TIA/stroke tool (3/50; 6.0%); p=0.033. Similarly there were fewer 90-day vascular events or deaths when education was combined with access to the tool (1/71 (1.4%) versus 8/50 (16%); cluster adjusted OR 0.075, 95%CI 0.02-0.62; p=0.016). When either only the tool or only training were accessed results fell between the extremes with the tool alone performing better than training alone (90-day vascular event or death rate 6/101; 5.9% versus 9/69 13%). Conclusion: GP training alone does not significantly reduce 90-day stroke events following TIA, however, education in combination with access to TIA/stroke electronic decision can enhance the reduction of 90-day stroke and vascular events.

scholarly journals Transient ischaemic attack and stroke risk: pilot of a primary care electronic decision support tool

2013 ◽  
Vol 5 (2) ◽  
pp. 138 ◽  
Author(s):  
Annemarei Ranta
Keyword(s):  
Decision Support ◽  
User Satisfaction ◽  
Transient Ischaemic Attack ◽  
Decision Support Tool ◽  
Adverse Outcomes ◽  
Electronic Decision Support ◽  
Support Tool ◽  
Transient Ischaemic Attacks ◽  
Ischaemic Attack ◽  
Record Review

INTRODUCTION: Transient ischaemic attacks (TIAs) indicate high risk for stroke and rapid management reduces stroke burden. Rapid specialist access to initiate timely management is often challenging to achieve. AIM: To assess the feasibility of implementing a TIA/Stroke electronic decision support (EDS) tool intended to aid general practitioners (GPs) in the timely management of TIAs. METHODS: An eight-week pilot provided access to the TIA/Stroke EDS to selected GPs in the MidCentral district, with subsequent patient record review and a post-pilot user satisfaction survey. RESULTS: Eleven patients from eight practices were entered into the tool and when EDS-rendered advice was followed, diagnosis was accurate and management was in accordance with New Zealand TIA guidelines. No adverse outcomes resulted and user feedback was positive. DISCUSSION: Results indicate that wider implementation of the TIA/Stroke EDS tool is feasible. KEYWORDS: Decision support systems; primary health care; software; stroke; transient ischaemic attack

scholarly journals Effect of a Cognitive Aid on Adherence to Perioperative Assessment and Management Guidelines for the Cardiac Evaluation of Noncardiac Surgical Patients

2014 ◽  
Vol 120 (6) ◽  
pp. 1339-1353 ◽  
Author(s):  
William R. Hand ◽  
Kathryn H. Bridges ◽  
Marjorie P. Stiegler ◽  
Randall M. Schell ◽  
Amy N. DiLorenzo ◽  
...  
Keyword(s):  
Decision Support ◽  
Heart Association ◽  
Decision Support Tool ◽  
Electronic Decision Support ◽  
Support Tool ◽  
Tool Performance ◽  
Clinical Scenarios ◽  
Cardiac Evaluation ◽  
Time Required ◽  
With Memory

Abstract Background: The 2007 American College of Cardiologists/American Heart Association Guidelines on Perioperative Cardiac Evaluation and Care for Noncardiac Surgery is the standard for perioperative cardiac evaluation. Recent work has shown that residents and anesthesiologists do not apply these guidelines when tested. This research hypothesized that a decision support tool would improve adherence to this consensus guideline. Methods: Anesthesiology residents at four training programs participated in an unblinded, prospective, randomized, cross-over trial in which they completed two tests covering clinical scenarios. One quiz was completed from memory and one with the aid of an electronic decision support tool. Performance was evaluated by overall score (% correct), number of incorrect answers with possibly increased cost or risk of care, and the amount of time required to complete the quizzes both with and without the cognitive aid. The primary outcome was the proportion of correct responses attributable to the use of the decision support tool. Results: All anesthesiology residents at four institutions were recruited and 111 residents participated. Use of the decision support tool resulted in a 25% improvement in adherence to guidelines compared with memory alone (P &lt; 0.0001), and participants made 77% fewer incorrect responses that would have resulted in increased costs. Use of the tool was associated with a 3.4-min increase in time to complete the test (P &lt; 0.001). Conclusions: Use of an electronic decision support tool significantly improved adherence to the guidelines as compared with memory alone. The decision support tool also prevented inappropriate management steps possibly associated with increased healthcare costs.

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