A Trial to Reduce Inappropriate Prescribing to Older Adults Visiting the Emergency Department

A Randomized Trial to Reduce Inappropriate Prescribing to Older Adults Visiting the Emergency Department

Cluster-randomized trial assessing the impact of interventions on guideline-concordant prescribing in Emergency Departments (ED). The study compares the effectiveness of feedback messages about potentially inappropriate medications (PIMs) delivered by peer clinician prescribers or anonymous systems, compared to standard of care. The goal is to reduce PIM prescribing for older adults discharged from emergency departments.

The goal of this trial is to compare the effectiveness of prescribing feedback delivered by a credible peer messenger and by an anonymous messaging system against standard of care in emergency departments. This intervention to Emergency Department (ED) clinician prescribers is a modification of previous studies that optimizes feedback about Potentially Inappropriate Medications (PIMs) using findings from behavioral science. Clinician prescribers who meet eligibility criteria and provide digital affirmative consent will be enrolled if they have encounters in a participating ED facility. The Joint Data Analytics Team (JDAT) will identify patients aged 65 years and older who were seen in the ED to evaluate prescribing outcomes. The focus of this registration is the randomized trial.

Inclusion Criteria:

1. Licensed clinicians with prescribing authority (physician, advanced practice registered nurse, or physician assistant)
2. Practicing in one of the participating Yale New Haven Health System emergency departments
3. At least 30 Emergency Department (ED) discharge encounters with patients aged 65 years or older in the 12 months preceding study enrollment
4. Provides digital affirmative consent to participate

Exclusion Criteria:

• Failure to meet inclusion criteria