EHR alerts go unread, do not lead to deprescribing of medicines linked
to dementia

Date:
July 8, 2021
Source:
Regenstrief Institute
Summary:
The vast majority of electronic health record (EHR) alerts
attempting to reduce prescribing of high-risk medications linked
to dementia in older adults went unread in a new study.



FULL STORY ==========================================================================
The vast majority of electronic health record (EHR) alerts attempting
to reduce the prescribing of high-risk medications linked to dementia
in older adults went unread in a study led by research scientists
from Regenstrief Institute, Purdue University and Indiana University
School of Medicine. The goal of the intervention was to facilitate the deprescribing of anticholinergics through both provider and patient-based alerts, however, engagement with the alerts was so low, the study team
was unable to conclude if this approach could be an effective method.


========================================================================== Anticholinergics are drugs which affect the brain by blocking
acetylcholine, a nervous system neurotransmitter that influences memory, alertness and planning skills. They are linked to dementia and prescribed
for many conditions common in older adults including depression, urinary incontinence, irritable bowel syndrome and Parkinson's disease. These medications are used by approximately one in four older adults each year,
and nearly half of older adults have used this type of medication at
least once in a five-year period.

Many medical groups have come out in support of deprescribing
anticholinergics, but it is challenging to execute in an already busy
primary care environment.

"Deprescribing is very complex and rarely prioritized over common
medical problems during visits with primary care providers," said
study lead author Noll Campbell, PharmD, M.S., research scientist at
the IU Center for Aging Research at Regenstrief and assistant professor
of pharmacy at Purdue University College of Pharmacy. "In this study,
we used principles of behavioral economics in the design of EHR nudges
directed at both providers and patients to promote the deprescribing of high-risk anticholinergic medications.

However, very few of the alerts were viewed by either recipient, so we
are now evaluating how we can change or improve this approach." In this
study, an alert let the provider know that the patient had high-risk anticholinergic medications prescribed in the medical record and offered alternatives to those medications. Alerts also prompted staff to play a
video providing education about the medicines and modeling a discussion
that led to a change in prescription for patients who were prescribed
one of the target medications.

The research team conducted the cluster randomized trial in Eskenazi
Health clinics and compared the medication records to the previous
year to see if there were any changes. They found there were no
significant differences in deprescribing between the control group and
the intervention group.

During the course of the study, 85 percent of alerts to providers and 95 percent of alerts to medical assistants went unread, so study authors
cannot conclude that priming patients and providers for the discussion
is not a feasible strategy, only that the methods used in this study
were not successful in reaching the target recipients.

"One option going forward is to experiment with different design
approaches in EMR-based nudges," said Dr. Campbell. "Alternatively, a
shift towards human- based interventions that can manage the complexity of deprescribing activities may be more effective at deprescribing high-risk anticholinergic medications.

While we pursue the goal of understanding clinical implications, we are
also cognizant of the scalability of interventions if there is clinical
benefit realized by reducing these high-risk medications." Dr. Campbell
and his colleagues at Regenstrief are currently conducting a clinical
trial designed to determine if stopping anticholinergic medications
results in sustained improvements in cognition. This trial involves
clinical pharmacists working with physicians and patients to switch to
safer medicines.

Another study at the IU Center for Aging Research at Regenstrief
is testing an app called BrainSafe, which provides information on anticholinergics to patients with the goal of leading them to initiate
a deprescribing conversation.

========================================================================== Story Source: Materials provided by Regenstrief_Institute. Note: Content
may be edited for style and length.


========================================================================== Journal Reference:
1. Noll L. Campbell, Richard J. Holden, Qing Tang, Malaz A. Boustani,
Evgenia Teal, Jennifer Hillstrom, Wanzhu Tu, Daniel O. Clark,
Christopher M. Callahan. Multicomponent behavioral intervention
to reduce exposure to anticholinergics in primary care older
adults. Journal of the American Geriatrics Society, 2021; 69 (6):
1490 DOI: 10.1111/jgs.17121 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/07/210708083913.htm

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