Computer systems tools and potentially inappropriate medications ordered at discharge for adults 65 years of age and older: a systematic review.

Abstract

Review question/objective The overall objective of this systematic review is to determine the best available evidence related to the effectiveness of computer systems tools that assist in clinical decision making regarding reduction in frequency of potentially inappropriate medications (PIMs) ordered at discharge and PIMs-related unplanned emergency room (ER) visits or hospital readmissions in community dwelling patients > 65 years of age. More specifically, the focused systematic review question is: what is the effectiveness of computer systems tools that assist in clinical decision making on reduction in frequency of PIMs ordered at discharge and PIMs-related unplanned ER visits or hospital readmissions in community dwelling patients > 65 years of age? Inclusion Criteria Types of Participants This review will consider studies that include community based adults > 65 years of age (regardless of diagnosis, gender, ethnicity, stage of disease co-morbidities, and previous treatment received) who were admitted to the hospital from the community and then discharged back into the community and prescribed potentially inappropriate medications. For the purposes of this review, community-based adults will include those living at home or with family members. Adults living in nursing homes or assisted living facilities will be excluded. Types of Intervention This review will include studies that evaluate any intervention described as an electronic or computer based clinical decision making supplement or support related to prescribing of potentially inappropriate medications PIMs. Comparator This review will include studies in which the comparator is absence of computer systems support tools (ex., before-and-after studies) and either no other intervention or an intervention which does not include electronic or computer based support. Types of Outcomes This review will consider studies that include any of the following outcome measures: frequency of ordering potentially inappropriate medications PIMs for patients at discharge, unexpected hospital readmission rate of patients who were discharged on PIMs, and unexpected visits to the ED of patients who were discharged on PIMs. Frequency of ordering potentially inappropriate medications (PIMs) is measured as a proportion or percentage.TRUNCATED AT 350 WORDS