Clinicians who received alerts via electronic health records systems were less likely to provide unnecessary care to older adult patients, according to a study published in the Annals of Internal Medicine.
Over-testing and over-treatment of older adults is common, said Stephen Persell, MD, MPH, professor of Medicine in the Division of General Internal Medicine, who was senior author of the study.
“From a behavioral science perspective, we think the reason clinicians may not follow published evidence is because they’re worried about something. They’re perceiving something that the patient wants or they’re perceiving how they’ll feel if they miss something,” said Persell, also director of the Center for Primary Care Innovation of the Institute for Public Health and Medicine (IPHAM). “When in fact, you can actually cause harm by giving unnecessary antibiotics or treatments that expose patients to risks, such as adverse drug events or infections.”
In the study, more than 350 clinicians at 60 primary care practices throughout Chicago received online education about the dangers of overuse of care, specifically prostate cancer screening in men aged 76 years or older without a history of prostate cancer; urine testing in women aged 65 years or older for nonspecific reasons; and prescribing insulin or other drugs that cause low blood sugar to patients with diabetes aged 75 years or older who had a hemoglobin A1c level less than 7 percent.
Then, half of the clinicians received electronic health records alerts about the dangers of care overuse during patient visits, while the other half did not. During these 18 months, rates of care overuse were lower in the group that received health records alerts, according to the study.
Finally, the study tracked all clinicians over an additional year, during which they did not receive further electronic health records alerts. Rates of care overuse were similar in both groups of clinicians, with a slightly lower percentage of patients receiving unnecessary urinary testing in the group that had previously received alerts.
“We targeted three really different types of care in our intervention study, and we clearly show that when you take away the pressure of that electronic nudge, people start screening more elderly patients for prostate cancer,” Persell said. “The effect dissipates quickly over time.”
The results suggest that different interventions are needed to prevent care overuse in older adults, Persell said.
Currently, Persell and his collaborators are utilizing similar tactics to try to reduce over-medication, in which older adults are prescribed multiple drugs which could potentially interact and lead to falls or other side effects.
“There’s always a fine balance between using the computer to put recommendations in front of doctors and disrupting their workflow,” Persell said. “We know that’s a cost and we don’t want to do that indiscriminately. But we also haven’t seen a scalable, affordable intervention that can actually bend the curve away from low-value, potentially harmful care. This is a potential tool for that.”
Lucia Petito, PhD, assistant professor of Preventive Medicine in the Division of Biostatistics, was the first and corresponding author of the study.
The study was supported by National Institute on Aging grant R33AG057383.
