Study: EHR Alerts Intended to Reduce Medications Linked to Dementia Largely Go Unread

Electronic health record (EHR) alerts intended to reduce the prescribing of high-risk medications linked to dementia in older adults largely went unread by health care providers and patients, according to a study published in the Journal of the American Geriatrics Society. Engagement with these alerts was low enough to make it impossible for the investigators to determine whether this intervention, intended to facilitate the deprescribing of anticholinergics through alerts to both patients and providers, was a potentially effective approach.

“Deprescribing is very complex and rarely prioritized over common medical problems during visits with primary care providers,” said Noll Campbell, PharmD, MS, research scientist at the Indiana University Center for Aging Research at Regenstrief and assistant professor of pharmacy at Purdue University College of Pharmacy, in a press release. “In this study, we used principles of behavioral economics in the design of EHR nudges directed at both providers and patients to promote the deprescribing of high-risk anticholinergic medications. However, very few of the alerts were viewed by either recipient, so we are now evaluating how we can change or improve this approach.”

Anticholinergics—drugs which block acetylcholine, a nervous system neurotransmitter that influences memory, alertness and planning skills—are linked to dementia, and are prescribed for a number of conditions in older adults. These include depression, urinary incontinence, irritable bowel syndrome, and Parkinson disease. Nearly 50% of older adults have used this category of medication once in a 5-year period, and they are used by approximately 25% of older adults each year.

The investigators conducted the study in Eskenazi Health clinics, comparing the medication records to the previous year to see if there were any changes in the prescribing habits around anticholinergics. The study involved sending alerts to providers informing them that a patient had been prescribed high-risk anticholinergic medications and offered alternatives to these medications. These alerts also requested that staff watch a video providing education on the medicines in question and modeling a conversation between patient and provider that would lead to a change in prescription.

According to the results of the study, no significant differences were observed between the control group and the intervention group in terms of the rate of prescription for anticholinergics. Further, 85% of the alerts sent to providers were ignored, and 95% of alerts to medical assistants went unread. The investigators could not conclude whether or not priming providers and patients for discussing a change in medication was effective, only that their methods of priming were unsuccessful in reaching their target populations.

“One option going forward is to experiment with different design approaches in EMR-based nudges,” Campbell said in the release. "Alternatively, a shift towards human-based interventions that can manage the complexity of deprescribing activities may be more effective at deprescribing high-risk anticholinergic medications. While we pursue the goal of understanding clinical implications, we are also cognizant of the scalability of interventions if there is clinical benefit realized by reducing these high-risk medications.”

REFERENCE

EHR alerts go unread, do not lead to deprescribing of medicines linked to dementia [news release]. EurekAlert; July 8, 2021. Accessed July 8, 2021. https://www.eurekalert.org/pub_releases/2021-07/ri-eag070721.php