Reduction of inappropriate medication in older populations by electronic decision support (the PRIMA-eDS study): a qualitative study of practical implementation in primary care

Anja Rieckert, Christina Sommerauer, Anja Krumeich, Andreas Sönnichsen, Anja Rieckert, Christina Sommerauer, Anja Krumeich, Andreas Sönnichsen

Abstract

Background: Within the EU-funded project PRIMA-eDS (Polypharmacy in chronic diseases: Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support) an electronic decision support tool (the "PRIMA-eDS-tool") was developed for general practitioners (GPs) to reduce inappropriate medication in their older polypharmacy patients. After entering patient data relevant to prescribing in an electronic case report form the physician received a comprehensive medication review (CMR) on his/her screen displaying recommendations regarding missing indications, necessary laboratory tests, evidence-base of current medication, dose adjustments for renal malfunction, potentially harmful drug-drug interactions, contra-indications, and possible adverse drug events. We set out to explore the usage of the PRIMA-eDS tool and the adoption of the recommendations provided by the CMR to optimise the tool and prepare it for its future implementation.

Methods: In a qualitative study carried out in North Rhine-Westphalia, Germany, 21 GPs using the PRIMA-eDS tool within the PRIMA-eDS study were interviewed. Interviews encompassed the GPs' attitudes regarding use of the electronic case report form and the CMR, their response to the recommendations, and the implementation of the tool into daily practice routine. The collected data were analysed applying thematic qualitative text analysis.

Results: GPs found the patient data entry into the electronic case report form to be inconvenient and time-consuming. The CMR was conducted often outside practice hours and without the patient present. GPs found that the PRIMA-eDS CMR provided relevant information for and had several positive effects on the caring process. However, they encountered several barriers when wanting to change medication.

Conclusions: It is unlikely that the PRIMA-eDS CMR will be used in the future as it is now as patient data entry is too time-consuming. Several barriers towards deprescribing medications were found which are common in deprescribing studies. Given the positive attitude towards the CMR, a new way of entering patient data into the PRIMA-eDS tool to create the CMR needs to be developed.

Keywords: Aged; Computerized clinical decision support system; Deprescribing; Evidence-based medicine; General practitioner; Perceptions.

Conflict of interest statement

Ethics approval and consent to participate

The study has been approved by the ethics committee of Witten/ Herdecke University in July 2015 [no: 92/2015]. Written informed consent was obtained from the participants before the start of each interview.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Components of the PRIMA-eDS tool [–49]
Fig. 2
Fig. 2
Screenshot from the Comprehensive Medication Review tool by Duodecim Medical Publications Ltd. showing recommendations about amending current medications and recommendations regarding dosing in renal malfunction
Fig. 3
Fig. 3
Screenshot from the Comprehensive Medication Review tool by Duodecim Medical Publications Ltd. showing the RISKBASE® table (former PHARAO®)
Fig. 4
Fig. 4
Course of the PRIMA-eDS study

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