Study Finds Simple EHR Alerts Help Doctors Safely Reduce Risky Medications for Older Adults
Behavioral science-based reminders built into electronic health records can help primary care doctors safely stop or taper potentially harmful medications.
Many older adults take medications that can increase their risk of falls, confusion, and hospitalization, yet stopping or reducing these drugs — known as deprescribing — can be challenging in busy primary care settings. New research suggests that small changes inside electronic health records may make a meaningful difference.
Published in JAMA, the study, “Electronic Health Record Intervention and Deprescribing for Older Adults: A Randomized Clinical Trial,” assessed the effectiveness of two EHR interventions grounded in behavioral science in deprescribing potentially inappropriate medications, compared with “usual care.” The researchers found that the EHR notifications significantly increased deprescribing of potentially inappropriate medications among adults aged 65 and older.
The trial included 1,146 older patients and 201 primary care physicians. Compared with usual care, physicians who received “pre-commitment” EHR prompts — messages to physicians during the first patient visit asking the PCP to discuss medication risks and a second reminder to deprescribe — were 40% more likely to deprescribe at least one risky medication. A second approach, called “boostering,” which reinforced deprescribing intentions with follow-up reminders, also significantly increased deprescribing rates.
The medications targeted in the study included benzodiazepines, non-benzodiazepine sleep medications, and strongly anticholinergic drugs, which are commonly prescribed to older adults but are associated with a higher risks of falls, cognitive impairment, and hospitalizations. Importantly, no increase in serious adverse events was observed.
“Many older adults remain on medications long past the point where the risks outweigh the benefits,” said Dae Hyun Kim, MD, MPH, ScD, associate director and senior scientist at Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research. “This study shows that thoughtfully designed electronic health record tools can support better conversations between clinicians and patients and help make deprescribing a more routine, achievable part of primary care — without adding burden to visits.”
Researchers note that because these interventions are embedded directly into existing EHR workflows, they could be scaled across health systems to improve medication safety for millions of older adults.
In addition to Dr. Kim, researchers were Julie C. Lauffenburger, PharmD, PhD, associate professor of medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital and Harvard Medical School; Meekang Sung, PharmD, MS, research specialist, Center for Healthcare Delivery Sciences, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital; Robert J. Glynn, ScD, PhD, professor of medicine, Harvard Medical School, senior biostatistician, Brigham and Women’s Hospital; Punam Keller, PhD, Charles Henry Jones Third Century Professor of Management, Tuck School of Business, Dartmouth College; Ted Robertson, MPA, executive director, Center for Healthcare Marketplace Innovation, UC Berkeley; Gauri Bhatkhande, MPH, Center for Healthcare Delivery Sciences, Brigham and Women’s Hospital; Katharina Tabea Jungo, PhD, research fellow in medicine, Division of Pharmacoepidemiology and Pharmacoeconomics and the Center for Healthcare Delivery Sciences, Brigham and Women’s Hospital; Nancy Haff, MD, MPH, assistant professor of medicine, Harvard Medical School, associate epidemiologist, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital; Kaitlin E. Hanken, MPH, program manager, Center for Healthcare Delivery Sciences, Brigham and Women’s Hospital; Thomas Isaac, MD, MBA, MPH, Institute of Primary Health Care, University of Bern; and Niteesh K. Choudhry, MD, PhD, executive director, Center for Healthcare Delivery Sciences, Brigham and Women’s Hospital.
About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 4,500 seniors a day across seven campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; Jack Satter House, Revere; and Leyland Community, Dorchester. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $87 million, making it one of the largest gerontological research facilities in the U.S. in a clinical setting. It also trains more than 500 geriatric care providers each year. For more information about Hebrew SeniorLife, follow us on our blog, Facebook, Instagram, and LinkedIn.
About the Hinda and Arthur Marcus Institute for Aging Research
Scientists at the Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity, and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment, and cure of disease; advance the standard of care for older people; and inform public decision-making.
