Reducing Potentially Inappropriate Medication Prescribing for Older Patients in the ED

Not Applicable

Active, not recruiting

• Conditions: Aging
• Interventions: Other: EQUIPPED with Active Feedback; Other: EQUIPPED with Passive Feedback

• Registration Number: NCT04004936
• Lead Sponsor: VA Office of Research and Development

Brief Summary

This research is being conducted to learn which implementation strategy of EQUIPPED is most effective to improve prescribing practices of ED providers toward older Veterans and determine the factors influencing implementation of this program to reduce the prescribing of PIMs to older adults upon discharge from the ED. The study has three research aims. The procedures for these research aims are described below:

* Aim 1 - Examining the Impact of Passive Provider Feedback vs. Active Provider Feedback Through a Randomized Trial

* Aim 2 - Determination of Factors Affecting Organizational Adoption of EQUIPPED

* Aim 3 - Micro-Costing the Active and Passive Feedback Versions of the EQUIPPED Intervention

Detailed Description

Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. In order to inform a Veterans Affairs (VA) system-wide approach to improve prescribing safety for older Veterans, the investigators will conduct a study to determine best practices for influencing provider prescribing behavior in order to decrease PIMs prescribed for older Veterans at the time of ED discharge. The overall goal of this project is to determine which EQUIPPED implementation strategy (active or passive feedback) is most effective to reduce prescribing of PIMs for older Veterans discharged from the ED.

Study Timeline

• Study First Submitted: 2019-06-28
• Study First Submitted QC: 2019-06-28
• Study First Posted: 2019-07-02
• Study Start: 2019-10-01
• Primary Completion: 2022-12-31
• Results First Submitted: 2023-12-26
• Status Verified: 2024-08
• Results First Submitted QC: 2024-08-02
• Last Update Submitted: 2024-08-02
• Results First Posted: 2024-08-06
• Last Update Posted: 2024-08-06
• Study Completion: 2024-12-31

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 74

Inclusion Criteria

• Prescribers at VA Medical Centers that are implementing EQUIPPED
• Members of the EQUIPPED implementation team at enrolled sites

Exclusion Criteria

• Providers at VA Medical Centers that are not part of the upcoming EQUIPPED implementation trial.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Active Feedback	EQUIPPED with Active Feedback	EQUIPPED with active provider feedback, implementing one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise.
Passive Feedback	EQUIPPED with Passive Feedback	EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking.

Primary Outcome Measures

Name	Time	Method
Percentage of PIMs Prescribed	12-Months Post Implementation of EQUIPPED	Percentage of prescriptions that are PIMS (potentially inappropriate medications) as defined according to the Beers criteria prescribed to adults aged 65 and older and discharged from the ED.

Secondary Outcome Measures

Name	Time	Method
Impact of EQUIPPED on Behavior Change and Factors Impacting Implementation	12-Months After the Delivery of the First EQUIPPED Report	Prescribers at participating EDs will be asked to complete a brief survey at baseline, 6, and 12 months to assess key components of the social cognitive factors that we expect to be impacted by the intervention. Interviews will be conducted with EQUIPPED implementation team members to assess implementation facilitators and barriers.
Micro-Costing the Active and Passive Feedback Versions of the EQUIPPED Intervention	12-Months Post Implementation of EQUIPPED	Micro-costing of the intervention will be done to learn details of specific factors that may impact the cost of the intervention to the organization.

Trial Locations

Locations (4)

Durham VA Medical Center, Durham, NC; 🇺🇸 Durham, North Carolina, United States

Birmingham VA Medical Center, Birmingham, AL; 🇺🇸 Birmingham, Alabama, United States

VA Salt Lake City Health Care System, Salt Lake City, UT; 🇺🇸 Salt Lake City, Utah, United States

Atlanta VA Medical and Rehab Center, Decatur, GA; 🇺🇸 Decatur, Georgia, United States