Geriatric Prescribing Context Proves Effective Among Older Adults

In July of 2017 after a medication-related death of a hospitalized older adult (OA) was linked to inappropriateness of medication default doses, the Geriatric Prescribing Context (GPC) was developed and implemented. GPC is an electronic health record (EHR) based set of age-specific dose and frequency defaults for patients aged 75 years and older, which has proven to be effective among OAs.

According to researchers, significant dose decreases after 1 year were observed for 9 of 10 most commonly used medications and GPC defaults and inpatient medication orders were aligned. A follow-up investigation was conducted to examine the GPC alignment of frequency and dose over the 42-month period preceding implementation.

From July 2016 through December 2020, order data for the 10 most commonly used medications were retrospectively collected from Oregon Health & Science University Hospital, Portland, OR. To assess the proportion of medication orders that aligned with GPC’s recommendations, researchers utilized statistical process control charts.

Researchers assessed special cause signals in an effort to identify periods where process averages likely occurred and then assessed suspected shifts via binomial proportion tests. Per the results, no special causes were observed during the preimplementation phase of all medications.

The control charts demonstrated 3 different patterns of performance after significant initial improvement in 2017. The initial improvement was maintained by 8 medications and 1 medication showed a second significant improvement at a later date. A subsequent decline in performance was observed for 2 medications, but not statistically diverse from baseline.

More age-friendly doses and frequencies were observed for 8 of 10 medications after 42 months compared to baseline.

“The GPC is an effective method to support safer prescribing for hospitalized older patients, but long-term impacts may be medication-specific,” concluded study authors. “Further investigation is needed to ensure appropriate prescribing across drug classes and understand the GPC's impact on patient outcomes like adverse drug events.”

Reference:
De Lima B, DeVane K, Drago K. Long-term impact of a geriatric prescribing context. J Am Geriatr Soc. Published online April 14, 2022. doi:10.1111/jgs.17799