Intelligent and Practical Geriatric Prescribing Systems

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DESCRIPTION (provided by applicant): Inappropriate prescribing and medication use in the elderly is a major public health issue. At least 85% of senior citizens use one prescription medication, and it is estimated that the prevalence of inappropriate prescriptions in the elderly is between 12-40%. Over 17% of all geriatric hospitalizations are due to Adverse Drug Events (ADEs) and will increase as polypharmacy of chronic health conditions increases. Current Clinical Decision Support (CDS) systems and commercial medication knowledge bases (e.g. Medi-Span), have the potential to dramatically improve prescribing and reduce ADEs. However, these products still lack the sophistication and clinical depth required to assist physicians without inundating them with intrusive and often inappropriate interventions. Additionally, they are not easily incorporated into the physician workflow resulting in physicians often ignoring their recommendations. US CareLink proposes to design and develop an expert prescription software, GerRx, that optimizes geriatric prescribing by ensuring medically- and cost- effective prescriptions. GerRx will use a sophisticated, proven CDS system which references accepted medication guidelines and formularies and leverages relevant patient data for better prescribing. GerRx will have two modes of decision support: Advisory Mode-actively helps the prescriber acquire relevant guideline information augmented by patient data, and Review Mode-runs unobtrusively in the background to review prescriptions as they are entered. For Phase 1, the Aims are to: (1) design and validate an expert prescribing system, (2) develop expert rules for 3 clinically significant geriatric conditions (pain, depression, heart failure), and (3) design a clinical trial in an community-based ambulatory care setting. To do so, we will assemble a panel of geriatric and medication experts to assist in assembling and validating medication rules and knowledge bases. We have recruited a 165-physician independent practice to provide user-acceptance testing. We will collaborate with Dr. Joan Teno, Center for Gerontology and Health Care Research at Brown University, to oversee a Phase 2 clinical trial of system efficacy. While this work will address geriatric populations, our objective is to develop a highly extensible CDS system that can be applied to any medical domain and any EMR. GerRX potentially can improve the quality of life of the elderly through the prevention of ADEs and increasing the correct dosing and use of medications in this frail population.