The use of an electronic clinical decision support system to reduce polypharmacy in the elderly patients

Aim

To evaluate the efficacy of the electronic clinical decision support system (DSS) for optimizing drug therapy in the elderly patients with polypharmacy.

Material and methods

We developed DSS that allowed to study STOPP/START criteria, anticholinergic burden scale, potential drug interaction and intake of medications associated with a higher risk of falls. This system was tested in the elderly patients admitted to the internal medicine and neurological departments.

Results

We evaluated drug therapy prior to and after implementation of DSS in 162 patients in the retrospective group (68.5% females, average age 77.8±8.3 years) and 99 patients in the prospective group (69.7% females, average age 75.9±7.5 years), respectively. The use of DSS resulted in a statistically significant decrease in the number of drugs per person (10.02 and 8.28, respectively, p<0.001), the number of STOPP criteria (0.82 and 0.08, h<0.001) and START criteria (2.67 and 0.55, p<0.001), total score on the anticholinergic burden scale (1.45 and 1.03, p<0.001), the number of potential interactions of high clinical significance (0.74 and 0.28, p<0.001) and of moderate clinical significance (8.08 and 6.25, p<0.001), the number of drugs associated with high (1.45 and 1.17, p<0.001) or moderate risk of falls (1.53 and 1.35, p<0.001).

Conclusion

Our findings suggest that DSS is an effective tool to optimize drug therapy and to reduce polypharmacy in the elderly patients.

Key words

elderly, STOPP/START criteria, DSS, polypharmacy, anticholinergic burden scale.