Impoving sedative-hypnotic prescribing in older hospitalized patients; provider-perceived benefits and barriers of a computer-based reminder
Authors: Agostoni JV, Concato J, Inouye SK
Although sedative-hypnotic medication can have harmful effects in the elderly at least one third of older patients are prescribed a sedative-hypnotic during hospitalization.
The authors conducted a qualitative study to determine prescriber’s attitudes toward a computerized reminder system that had been found previously to be successful in reducing inappropriate prescribing of sedative-hypnotic drugs.
RESULTS
36 providers prescribed a sedative-hypnotic; 29 (81%) of where interns and 23 (64%) were providing cross-coverage. All the participants had read the reminder alert. The participants were by and large satisfied with the reminder alert. Three main benefits of the computer reminder system were identified; awareness of safety risks associated with sedative-hypnotics; value of computer technology; and educational value of the computer reminder system content. The main barriers to the computer reminder system identified were; time constraint involved in reading the alerts; the loss of clinician authority; and the information content of the alert itself.
DISCUSSION
The authors opined that given there was a general high satisfaction rate with the computer reminder system this augured well for designing future systems. The study also replicated earlier studies showing that directed messages at the point of order entry worked best. Per the authors major strengths of the study included the open-ended interview and the reduction in recall bias. Also, the authors interviewed house staff, who by virtue of the fact they wrote the majority of the orders in the hospital, were the people most familiar with the computerized order system. The authors identified a significant limitation of the study; the use of a nonrandom sampling (“convenience sample.”) Hence one cannot infer from the study participants to all physicians.
L Bernard-Pantin Category: OHSU-BMI-512-SP08
