An Interdisciplinary Academic Detailing Approach to Decrease Inappropriate Medication Prescribing by Physician Residents for Older Veterans Treated in the Emergency Department

• Authors: Jason M. Moss, Durham VA Medical Center; William E. Bryan, III, Durham VA Medical Center; Loren M. Wilkerson, Duke University; Heather A. King, Durham VA Medical Center; George L. Jackson, Durham VA Medical Center; Ryan K. Owenby, Durham VA Medical Center; Courtney H. Van Houtven, Durham VA Medical Center; Melissa Stevens, Emory University; James Powers, Nashville VA Medical Center; Camille Vaughan, Emory University; William W. Hung, Bronx VA Medical Center; Ula Hwang, Bronx VA Medical Center; Alayne D. Markland, University of Alabama; Richard Sloane, Durham VA Medical Center; William Knaack, Durham VA Medical Center; Susan Nicole Hastings, Durham VA Medical Center
• Journal Title: Journal of Pharmacy Practice
• Volume: Volume 32, Number 2
• Publisher: SAGE Publications (UK and US) | 2019-04-01, Pages 167-174
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1177/0897190017747424
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Pharmacy
• Keywords: academic detailing; elderly; potentially inappropriate medications

Abstract

Objective: To evaluate the impact of an academic detailing intervention delivered as part of a quality improvement project by a physician–pharmacist pair on (1) self-reported confidence in prescribing for older adults and (2) rates of potentially inappropriate medications (PIMs) prescribed to older adults by physician residents in a Veteran Affairs emergency department (ED). Methods: This quality improvement project at a single site utilized a questionnaire that assessed knowledge of Beers Criteria, self-perceived barriers to appropriate prescribing in older adults, and self-rated confidence in ability to prescribe in older adults which was administered to physician residents before and after academic detailing delivered during their emergency medicine rotation. PIM rates in the resident cohort who received the academic detailing were compared to residents who did not receive the intervention. Results: Sixty-three residents received the intervention between February 2013 and December 2014. At baseline, approximately 50% of the residents surveyed reported never hearing about nor using the Beers Criteria. A significantly greater proportion of residents agreed or strongly agreed in their abilities to identify drug–disease interactions and to prescribe the appropriate medication for the older adult after receiving the intervention. The resident cohort who received the educational intervention was less likely to prescribe a PIM when compared to the untrained resident cohort with a rate ratio of 0.73 (P <.0001). Conclusion: Academic detailing led by a physician–pharmacist pair resulted in improved confidence in physician residents’ ability to prescribe safely in an older adult ED population and was associated with a statistically significant decrease in PIM rates.