Alternatives to potentially inappropriate medications for use in e-prescribing software: triggers and treatment algorithms

OBJECTIVE: To describe the development of evidence-based electronic prescribing (e-prescribing) triggers and treatment algorithms for potentially inappropriate medications (PIMs) for older adults. DESIGN: Literature review, expert panel and focus group. SETTING: Primary care with access to e-prescribing systems. PARTICIPANTS: Primary care physicians using e-prescribing systems receiving medication history. INTERVENTIONS: Standardised treatment algorithms for clinicians attempting to prescribe PIMs for older patients. MAIN OUTCOME MEASURE: Development of 15 treatment algorithms suggesting alternative therapies. RESULTS: Evidence-based treatment algorithms were well received by primary care physicians. Providing alternatives to PIMs would make it easier for physicians to change decisions at the point of prescribing. CONCLUSION: Prospectively identifying older persons receiving PIMs or with adherence issues and providing feasible interventions may prevent adverse drug events.