Quality Improvement Toward Decreasing High-Risk Medications for Older Veteran Outpatients

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Abstract
To examine the effectiveness of a quality improvement program to decrease prescribing of high-risk medications. DESIGN : Single cohort, pre- and postintervention. SETTING : Regional network of Department of Veterans Affairs medical facilities. PARTICIPANTS : Outpatient veterans aged 65 and older who received one or more high-risk medications and the prescribing clinicians. INTERVENTION : A two-stage intervention was implemented. First, a real-time warning message to prescribers appeared whenever one of the high-risk drugs was ordered; second, a personally addressed letter from the Chief Medical Officer asking prescribers to consider discontinuing the high-risk medication along with a copy of the Beers criteria article, a list of suggested alternatives to high-risk medications, and a list of older patients receiving the high-risk medications who had upcoming appointments with these prescribers. MEASUREMENTS : The primary outcome was the absence of prescribed high-risk medications for all patients in the cohort during the postintervention period. For a subgroup of the cohort whose prescribers received the second-stage intervention, an additional outcome was the absence of prescribed high-risk medications within the subgroup. RESULTS : Two thousand seven hundred fifty-three unique patients were identified in the cohort; 1,396 (50.7%) had high-risk medications discontinued, resulting in a significant decrease in the number of patients prescribed high-risk medications from the preintervention period to the postintervention period ( P <.001). Of the 801 patients in the subgroup, 72.0% (n=577) had high-risk medications discontinued ( P <.001). CONCLUSION : This multimethod intervention significantly decreased prescribing of high-risk medications to older patients. Further studies are needed to confirm the findings