Impact of a Counselling System Coupled With a Computer Prescribing System to Optimize the Use of the Drugs for Old Subjects Having Renal Function Impairment

Context: The incidence of drug side effects increases with patient age, and the frail old subjects hospitalized in geriatric units are particularly exposed to this risk. Optimizing drug prescription is an important issue to prevent the side effects. Among the various possible actions, it is important to pay attention to impaired renal function which requires careful dose adjustment for drugs eliminated by renal way.

Objective: To evaluate the quality of orders for target drugs in old patients with impaired renal function, hospitalized or living in long stay units, and to improve these practices by means of counselling system coupled to a computer prescribing system. The computer prescribing system allow (a) to detect in real-time the order of drugs contraindicated in case of renal failure or prescribed in excessive amount taking into account the creatinine clearance (ClCr), and (b) to counsel the physician in these situations.

Participants: A coordinating centre (team of geriatrics 1, hospital Charles Foix, Ivry-sur-Seine, France), and 12 hospital investigator centres (hospital services of geriatrics working already in network, including the co-ordinating centre), and the department of Biostatistics (hospital Pitié-Salpétrière, Paris)

Type of study: Intervention study, cluster randomised, open, parallel.

General design: The investigator centres will be equipped with the electronic prescribing system (EPS) developed for the project. For each patient, the software requires the seizure of weight and plasma creatinine and calculates ClCr using Cockcroft formula, from which the result is accessible to the physician. After a phase of training of the EPS, the quality of the orders given to old subjects having renal failure (defined by ClCr<60 ml/mn) will be studied for 3 months under natural conditions of prescribing, without use of the counselling system (sequence A). After this phase, the counselling system will be activated for 6 months (sequence B) in 6 investigatory centres chosen by a cluster randomisation process. The centres were paired by the numbers of orders during the sequence A. For each pair, the centres were allocated to either intervention or control group by a randomisation table.