Development of the Tool to Reduce Inappropriate Medications (TRIM): A Clinical Decision Support System to Improve Medication Prescribing for Older Adults
Development of the Tool to Reduce Inappropriate Medications (TRIM): A Clinical Decision Support System to Improve Medication Prescribing for Older Adults
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DOI：
10.1002/phar.1751
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发表时间：
2016-06-01
期刊：
影响因子：
4.1
通讯作者：
Fried, Terri R.
中科院分区：
文献类型：
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作者：
Niehoff, Kristina M.;Rajeevan, Nallakkandi;Fried, Terri R.
研究目的建立一个临床决策支持系统（CDSS），用于根据广泛的标准评估老年门诊患者的用药问题。研究对象：40名65岁及以上的退伍军人，接受7种或7种以上的药物治疗，包括糖尿病和高血压的治疗。减少不当用药工具（TRIM）使用一个程序从电子健康记录中提取年龄、药物和慢性病，以识别高风险患者，并作为评估药物方案的输入。通过图表审查和直接患者评估获得的其他健康变量输入到基于Web的程序中。基于一系列算法，TRIM为临床医生生成反馈报告。TRIM在98%（39/40）的退伍军人中发现了药物协调差异，在58%（23/40）的退伍军人中发现了潜在的不适当药物，（基于依从性差和/或认知障碍），50%（20/40）的潜在过度治疗高血压，43%（17/40）的潜在过度治疗糖尿病，5%（2/40）的肾排泄药物剂量不当，患者报告的不良反应5%（2/40）。结论TRIM的评价表明，数据元素可以从电子健康记录中提取，以确定老年初级保健患者的潜在问题的药物治疗方案的风险。辅以图表审查和直接患者评估，这些数据可以通过临床算法进行处理，以识别潜在问题并生成患者特定的反馈报告。有必要开展更多的工作，以评估TRIM对药物处方的影响。
STUDY OBJECTIVE To create a clinical decision support system (CDSS) for evaluating problems with medications among older outpatients based on a broad set of criteria.DESIGN Web-based CDSS development.SETTING Primary care clinics at a Veterans Affairs medical center.PARTICIPANTS Forty veterans 65 years and older who were prescribed seven or more medications that included those for treatment of diabetes mellitus and hypertension.MEASUREMENTS AND MAIN RESULTS The Tool to Reduce Inappropriate Medications (TRIM) uses a program to extract age, medications, and chronic conditions from the electronic health record to identify high-risk patients and as input for evaluating the medication regimen. Additional health variables obtained through chart review and direct patient assessment are entered into a Web-based program. Based on a series of algorithms, TRIM generates feedback reports for clinicians. TRIM identified medication reconciliation discrepancies in 98% (39/40) of veterans, potentially inappropriate medications in 58% (23/40), potential problems with feasibility (based on poor adherence and/or cognitive impairment) in 25% (10/40), potential overtreatment of hypertension in 50% (20/40), potential overtreatment of diabetes in 43% (17/40), inappropriate dosing of renally excreted medications in 5% (2/40), and patient-reported adverse reactions in 5% (2/40).CONCLUSION This evaluation of TRIM demonstrated that data elements can be extracted from the electronic health record to identify older primary care patients at risk for potentially problematic medication regimens. Supplemented with chart review and direct patient assessment, these data can be processed through clinical algorithms that identify potential problems and generate patient-specific feedback reports. Additional work is necessary to assess the effects of TRIM on medication deprescribing.