Skip to main content
Log in

Prevention of Inappropriate Prescribing in Hospitalized Older Patients Using a Computerized Prescription Support System (INTERcheck®)

  • Short Communication
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Background

Polypharmacy is very common among older adults and can lead to inappropriate prescribing, poor adherence to treatment, adverse drug events and the prevalence of potential drug–drug interactions (DDIs). Electronic prescription database software may help to prevent inappropriate prescribing and minimize the occurrence of adverse drug reactions. INTERcheck® is a Computerized Prescription Support System (CPSS) developed in order to optimize drug prescription for elderly people with multimorbidity.

Objectives

The objectives of this study were (i) to evaluate the applicability of INTERcheck® as a means of reviewing the pharmacological profiles of elderly patients hospitalized in an acute geriatric ward in Northern Italy; and (ii) to evaluate the effectiveness of INTERcheck® in reducing potentially inappropriate medications (PIMs), potentially severe DDIs and the anticholinergic burden in daily practice.

Methods

Two samples of elderly patients (aged 65+ years) hospitalized in a geriatric ward in Italy were enrolled throughout 2012. During the first (observation) phase, medications prescribed to 74 patients at admission and discharge were analyzed with INTERCheck® without any kind of interference based on information obtained from the software. During the second (intervention) phase, the treatment of 60 patients was reviewed and changed at discharge according to INTERCheck® suggestions.

Results

In the observational period, the number of patients exposed to at least one PIM remained unchanged on both admission (n = 29; 39.1 %) and discharge (n = 28; 37.8 %). In the intervention phase, 25 patients (41.7 %) were exposed to at least one PIM at admission and 7 (11.6 %) at discharge (p < 0.001). The number of patients exposed to at least one potentially severe DDI decreased from 27 (45.0 %) to 20 (33.3 %), although the difference was not statistically significant (p = 0.703), while the number of new-onset potentially severe DDIs decreased from 37 (59.0 %) to 9 (33.0 %) [p < 0.001].

Conclusions

The use of INTERCheck® was associated with a significant reduction in PIMs and new-onset potentially severe DDIs. CPSSs combining different prescribing quality measures should be considered as an important strategy for optimizing medication prescription for elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Veehof LJG, Stewart RE, Haaijer-Raskamp FM, et al. The development of polypharmacy. A longitudinal study. Fam Pract. 2000;17:261–7.

    Article  PubMed  CAS  Google Scholar 

  2. Gurwitz JH. Polypharmacy. A new paradigm for quality drug therapy in the elderly? Arch Intern Med. 2004;164:1957–9.

    Article  PubMed  Google Scholar 

  3. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5:345–51.

    Article  PubMed  Google Scholar 

  4. Lin CF, Wang CY, Bai CH. Polypharmacy, aging and potential drug–drug interactions in outpatients in Taiwan. Drugs Aging. 2011;28(3):219–25.

    Article  PubMed  CAS  Google Scholar 

  5. Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults. Clin Pharmacol Ther. 2009;85:86–98.

    Article  PubMed  CAS  Google Scholar 

  6. Steinman MA, Landefeld CS, Rosenthal GE, et al. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006;54:1516–23.

    Article  PubMed  Google Scholar 

  7. Koh Y, Kutty FBM, Li SC. Drug-related problems in hospitalized patients on polypharmacy: the influence of age and gender. Ther Clin Risk Manag. 2005;1:39–48.

    Article  PubMed  Google Scholar 

  8. Lund BC, Camahan RM, Egge JA, et al. Inappropriate prescribing predicts adverse drug events in older adults. Ann Pharmacother. 2010. doi:10.1345/aph.1M657.

  9. Nobili A, Garattini S, Mannucci PM. Multiple diseases and polypharmacy in the elderly: challenges for the internist of the third millennium. J Comorbidity. 2011;1:28–44.

    Google Scholar 

  10. Cruciol-Souza JM, Thomson JC. Prevalence of potential drug–drug interactions and its associated factors in a Brazilian teaching hospital. J Pharm Pharm Sci. 2006;9:427–33.

    PubMed  CAS  Google Scholar 

  11. Radosevic N, Gantumur M, Vlahovic-Palcevski V. Potentially inappropriate prescribing to hospitalised patients. Pharmacoepidemiol Drug Saf. 2008;17:733–7.

    Article  PubMed  Google Scholar 

  12. O’Connor MN, Gallagher P, O’Mahony D. Inappropriate prescribing: criteria, detection and prevention. Drugs Aging. 2012;29(6):437–52.

    Article  PubMed  Google Scholar 

  13. Chang CB, Chan DC. Comparison of published explicit criteria for potentially inappropriate medications in older adults. Drugs Aging. 2010;27(12):947–57.

    Article  PubMed  Google Scholar 

  14. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716–24.

    Article  PubMed  Google Scholar 

  15. Flacker JM, Cummings V, Mach JR Jr, et al. The association of serum anticholinergic activity with delirium in elderly medical patients. Am J Geriatr Psychiatry. 1998;6(1):31–41.

    PubMed  CAS  Google Scholar 

  16. Tune LE. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry. 2001;62(suppl 21):11–4.

    PubMed  CAS  Google Scholar 

  17. Hanlon JT, Schamder KE, Boult C, et al. Use of inappropriate prescription drugs by older people. J Am Geriatr Soc. 2002;50:26–34.

    Article  PubMed  Google Scholar 

  18. Campbell NL, Boustani MA, Lane KA, et al. Use of anticholinergics and the risk of cognitive impairment in an African American population. Neurology. 2010;75:152–9.

    Article  PubMed  CAS  Google Scholar 

  19. Carriere I, Fourrier-Reglat A, Dartigues JF, et al. Drugs with anticholinergic properties, cognitive decline, dementia in an elderly general population-the 3-City study. Arch Intern Med. 2009;169:1317–24.

    Article  PubMed  CAS  Google Scholar 

  20. Lechevallier-Michel N, Molimard M, Dartigues JF, et al. Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PAQUID study. Br J Clin Pharmacol. 2005;59(2):143–51.

    Article  PubMed  Google Scholar 

  21. Roe CM, Anderson MJ, Spivack B. Use of anticholinergic medications by older adults with dementia. J Am Geriatr Soc. 2002;50(5):836–42.

    Article  PubMed  Google Scholar 

  22. Han L, McCusker J, Cole M, et al. Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med. 2001;161(8):1099–105.

    Article  PubMed  CAS  Google Scholar 

  23. Moore AR, O’Keeffe ST. Drug-induced cognitive impairment in the elderly. Drugs Aging. 1999;15(1):15–28.

    Article  PubMed  CAS  Google Scholar 

  24. Aizenberg D, Sigler M, Weizman A, et al. Anticholinergic burden and the risk of falls among elderly psychiatric inpatients: a 4-year case–control study. Int Psychogeriatr. 2002;14(3):307–10.

    Article  PubMed  Google Scholar 

  25. Ancelin ML, Artero S, Portet F, et al. Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. BMJ. 2006;332(7539):455–9.

    Article  PubMed  Google Scholar 

  26. Landi F, Russo A, Liperoti R, et al. Anticholinergic drugs and physical function among frail elderly population. Clin Pharmacol Ther. 2007;81(2):235–41.

    Article  PubMed  CAS  Google Scholar 

  27. Atkin PA, Veitch PC, Veitch EM, et al. The epidemiology of serious adverse drug reactions among the elderly. Drugs Aging. 1999;14(2):141–52.

    Article  PubMed  CAS  Google Scholar 

  28. Hutchinson TA, Flegel KM, Kramer MS, et al. Frequency, severity and risk factors for adverse drug reactions in adult out-patients: a prospective study. J Chron Dis. 1986;39(7):533–42.

    Article  PubMed  CAS  Google Scholar 

  29. Pasina L, Djade CD, Lucca U, et al. Association of anticholinergic burden with cognitive and functional status in a cohort of hospitalized elderly: comparison of the anticholinergic cognitive burden scale and anticholinergic risk scale. Drugs Aging. 2012. doi:10.1007/s40266-012-0044-x.

  30. Hines LE, Murphy JE. Potentially harmful drug–drug interactions in the elderly: a review. Am J Geriatr Pharmacother. 2011;9(6):364–77.

    Article  PubMed  CAS  Google Scholar 

  31. Bowie MW, Slattum PW. Pharmacodynamics in older adults: a review. Am J Geriatr Pharmacother. 2007;5:263–303.

    Article  PubMed  CAS  Google Scholar 

  32. Mallet L, Spinewine A, Huang A. The challenge of managing drug interactions in elderly people. Lancet. 2007;370:185–91.

    Article  PubMed  CAS  Google Scholar 

  33. Bjorkman IK, Fastbom J, Schmidt IK, et al. Drug–drug interactions in the elderly. Ann Pharmacother. 2002;36:1675–81.

    Article  PubMed  CAS  Google Scholar 

  34. Becker ML, Kallewaard M, Caspers PW, et al. Hospitalisations and emergency department visits due to drug–drug interactions: a literature review. Pharmacoepidemiol Drug Saf. 2007;16:641–51.

    Article  PubMed  Google Scholar 

  35. Petrovic M, van der Cammen T, Onder G. Adverse drug reactions in older people: detection and prevention. Drugs Aging. 2012;29(6):453–62.

    Article  PubMed  Google Scholar 

  36. Somers A, Petrovic M, Robays H, et al. Reporting adverse drug reactions on a geriatric ward: a pilot project. Eur J Clin Pharmacol. 2003;58:707–14.

    PubMed  Google Scholar 

  37. Gillespie U, Alassaad A, Henrohn D, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med. 2009;169:894–900.

    Article  PubMed  Google Scholar 

  38. Onder G, Petrovic M, Tangiisuran B, et al. Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years or older: the GerontoNet ADR risk score. Arch Intern Med. 2010;170(13):1142–8.

    Article  PubMed  Google Scholar 

  39. World Health Organization. Sweden 1990. Guidelines for ATC Classification. World Health Organization. Collaborating Centre for Drug Statistics Methodology, Norway and Nordic Councils on Medicines.

  40. Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc. 1968;16(5):622–6.

    PubMed  CAS  Google Scholar 

  41. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J. 1965;14:61–5.

    PubMed  CAS  Google Scholar 

  42. Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.

    Article  PubMed  CAS  Google Scholar 

  43. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.

    Article  Google Scholar 

  44. Rudolph JL, Salow MJ, Angelini MC, et al. The anticholinergic risk scale and anticholinergic adverse effects in older person. Arch Intern Med. 2008;168(5):508–13.

    Article  PubMed  Google Scholar 

  45. Carnahan RM, et al. The anticholinergic drug scale as a measure of drug-related anticholinergic burden: association with serum anticholinergic activity. J Clin Pharmacol. 2006;46:1481–6.

    Article  PubMed  CAS  Google Scholar 

  46. Buostani M, et al. Impact of anticholinergics on the aging brain: a review and practical application. Aging Health. 2008;4(3):311–20.

    Article  Google Scholar 

  47. Nobili A, Pasina L, Tettamanti M, et al. Potentially severe drug interactions in elderly outpatients: results of an observational study of an administrative prescription database. J Clin Pharm Ther. 2009;34(4):377–86.

    Article  PubMed  CAS  Google Scholar 

  48. Garattini S, Nobili A (2001) Interazioni tra farmaci: una valutazione della loro rilevanza clinica. Selecta Medica Eds, Pavia.

  49. Kuperman GJ, Gibson RF. Computer physician order entry: benefits, costs and issues. Arch Intern Med. 2003;139:31–9.

    Article  Google Scholar 

  50. Kaushal R, Shojania KG, Bates DW. Benefits of computerized physician order entry and clinical decision support systems on medication safety. Arch Intern Med. 2003;163:1409–16.

    Article  PubMed  Google Scholar 

  51. Mattison ML, Afonso KA, Ngo LH, et al. Preventing potentially inappropriate medication use in hospitalized older patients with a computerized provider order entry warning system. Arch Intern Med. 2010;170(15):1331–6.

    Article  PubMed  Google Scholar 

  52. Tamblyn R, Huang A, Perreault R. The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ. 2003;169:549–56.

    PubMed  Google Scholar 

  53. Laroche ML, Charmes JP, Nouaille Y, et al. Is inappropriate medication use a major cause of adverse drug reactions in the elderly? Br J Clin Pharmacol. 2007;63(2):177–86.

    Article  PubMed  Google Scholar 

  54. Onder G, Landi F, Cesari M, et al. Inappropriate medication use among hospitalized older adults in Italy: results from the Italian Group of Pharmacoepidemiology in the Elderly. Eur J Clin Pharmacol. 2003;59(2):157–62.

    PubMed  Google Scholar 

  55. Corsonello A, Pedone C, Lattanzio F, et al. Potentially inappropriate medications and functional decline in elderly hospitalized patients. J Am Geriatr Soc. 2009;57(6):1007–14.

    Article  PubMed  Google Scholar 

  56. Egger SS, Ratz AE, Bravo AE, et al. Age-related differences in the prevalence of potential drug–drug interactions in ambulatory dyslipidaemic patients treated with statins. Drugs Aging. 2007;24:429–40.

    Article  PubMed  CAS  Google Scholar 

  57. Vonbach P, Dubied A, Krahenbuhl S, et al. Prevalence of drug–drug interactions at hospital entry and during hospital stay of patients in internal medicine. Eur J Intern Med. 2008;19:413–20.

    Article  PubMed  Google Scholar 

  58. Egger SS, Drewe J, Schlienger RG. Potential drug–drug interactions in the medication of medical patients at hospital discharge. Eur J Clin Pharmacol. 2003;58(11):773–8.

    PubMed  Google Scholar 

  59. Pasina L, Djade CD, Nobili A. Potentially severe drug–drug interactions in a cohort of hospitalized elderly patients. Pharmacoepidemiol Drug Saf (in press).

Download references

Acknowledgments

No sources of funding were used to assist in the conduct of this study or the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Luca Pasina.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material (DOCX 11 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ghibelli, S., Marengoni, A., Djade, C.D. et al. Prevention of Inappropriate Prescribing in Hospitalized Older Patients Using a Computerized Prescription Support System (INTERcheck®). Drugs Aging 30, 821–828 (2013). https://doi.org/10.1007/s40266-013-0109-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-013-0109-5

Keywords

Navigation