A Trial to Reduce Inappropriate Prescribing to Older Adults Visiting the Emergency Department

Yale University

Status: Invitation-only

Conditions: Inappropriate Prescribing

Treatments: Behavioral: Prescribing Feedback

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT07146763

P30AG024968 (U.S. NIH Grant/Contract)

2000036876

Details and patient eligibility

About

Cluster-randomized trial assessing the impact of interventions on guideline-concordant prescribing in Emergency Departments (ED). The study compares the effectiveness of feedback messages about potentially inappropriate medications (PIMs) delivered by peer clinician prescribers or anonymous systems, compared to standard of care. The goal is to reduce PIM prescribing for older adults discharged from emergency departments.

Full description

The goal of this trial is to compare the effectiveness of prescribing feedback delivered by a credible peer messenger and by an anonymous messaging system against standard of care in emergency departments. This intervention to Emergency Department (ED) clinician prescribers is a modification of previous studies that optimizes feedback about Potentially Inappropriate Medications (PIMs) using findings from behavioral science. Clinician prescribers who meet eligibility criteria and provide digital affirmative consent will be enrolled if they have encounters in a participating ED facility. The Joint Data Analytics Team (JDAT) will identify patients aged 65 years and older who were seen in the ED to evaluate prescribing outcomes. The focus of this registration is the randomized trial.

Enrollment: 200 estimated patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Licensed clinicians with prescribing authority (physician, advanced practice registered nurse, or physician assistant)
2. Practicing in one of the participating Yale New Haven Health System emergency departments
3. At least 30 Emergency Department (ED) discharge encounters with patients aged 65 years or older in the 12 months preceding study enrollment
4. Provides digital affirmative consent to participate

Exclusion criteria

• Failure to meet inclusion criteria

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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200 participants in 3 patient groups

Credible Peer Messenger

Experimental group

Description:

Providers receive automated prescribing feedback messages from a credible peer messenger, including aspirational norms and benchmark comparisons based on Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) recommendations, to promote safer prescribing practices.

Treatment:

Behavioral: Prescribing Feedback

Anonymous Messenger

Experimental group

Description:

Providers receive automated prescribing feedback messages from an anonymous messenger system, including aspirational norms and benchmark comparisons based on Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) recommendations, to promote safer prescribing practices.

Treatment:

Behavioral: Prescribing Feedback

Control group

No Intervention group

Description:

Providers continue with standard of care. No feedback messages are sent.