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J Gen Intern Med. 2008 Apr;23(4):399-404. doi: 10.1007/s11606-007-0482-z.

An electronic medical record (EMR)-based intervention to reduce polypharmacy and falls in an ambulatory rural elderly population.

Author information

  • 1Department of General Internal Medicine and Geriatrics, Geisinger Health System, Danville, PA 17822-1401, USA. vdweber@geisinger.edu

Abstract

BACKGROUND:

Falls are the leading cause of injury-related deaths in the aging population. Electronic medical record (EMR) systems can identify at-risk patients and enable interventions to decrease risk factors for falls.

OBJECTIVE:

The objectives of this study were to evaluate an EMR-based intervention to reduce overall medication use, psychoactive medication use, and occurrence of falls in an ambulatory elderly population at risk for falls.

DESIGN:

Prospective, randomized by clinic site.

PATIENTS/PARTICIPANTS:

Six-hundred twenty community-dwelling patients over 70 at risk for falls based on age and medication use.

INTERVENTIONS:

A standardized medication review was conducted and recommendations made to the primary physician via the EMR.

MEASUREMENTS AND MAIN RESULTS:

Patients were contacted to obtain self reports of falls at 3-month intervals over the 15-month period of study. Fall-related diagnoses and medication data were collected through the EMR. A combination of descriptive analyses and multivariate regression models were used to evaluate differences between the 2 groups, adjusting for baseline medication patterns and comorbidities. Although the intervention did not reduce the total number of medications, there was a significant negative relationship between the intervention and the total number of medications started during the intervention period (p < .01, regression estimate -0.199) and the total number of psychoactive medications (p < .05, regression estimate -0.204.) The impact on falls was mixed; with the intervention group 0.38 times as likely to have had 1 or more fall-related diagnosis (p < .01); when data on self-reported falls was included, a nonsignificant reduction in fall risk was seen.

CONCLUSIONS:

The current study suggests that using an EMR to assess medication use in the elderly may reduce the use of psychoactive medications and falls in a community-dwelling elderly population.

PMID:
18373136
[PubMed - indexed for MEDLINE]
PMCID:
PMC2359523
Free PMC Article
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