This study demonstrated that replacing drug-specific alerts with age-specific ones sustained (but did not enhance) previously noted decreases in inappropriate prescribing with drug-specific alerts alone. Investigators conducted a cluster-randomized trial of seven practices that received age-specific alerts in addition to academic detailing with eight practices that received only the alerts. The academic detailing process involved an interactive educational program to assist with alternative and evidence-based medication choices. Findings suggested that clinical decision support can be effective using alert systems, but improvements in tools such as academic detailing are needed, as the process had no benefit in this study. Shifting to age-specific alerts did decrease the alert burden overall to providers. A past review discussed the issue of inappropriate prescribing in the elderly while other studies evaluated its prevalence in outpatient settings and elderly veterans.

Implementation of electronic health record systems continues to grow. This study aimed to evaluate the impact of such a system on the use and quality of ambulatory care. Using two regions of Kaiser Permanente’s patient population, investigators collected data on utilization of office visits, lab, and radiology services, as well as quality measures from the Health Plan Employer Data and Information Set (HEDIS). Findings include a decrease in utilization of office visits, an increase in telephone contacts, and largely unaffected measures of quality. Authors conclude that introducing electronic health records may increase appropriate use of health care services and lead to noted changes in physician workflow.