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Clinical-decision tool improves communication, documentation in older veterans

The Tool to Reduce Inappropriate Medications improved communication about medication and documentation accuracy in veterans aged 65 years and older, according to findings recently published in the Journal of the American Geriatrics Society.

However, the researchers reported no association with prescribing.

“Although the data are mixed, the majority of studies examining polypharmacy have demonstrated associations with a range of undesirable outcomes, including adverse drug events, falls, hospitalization, physical and cognitive disability, and hospitalization,” Terri R. Fried, MD, of the Veterans Affairs Connecticut Healthcare System, West Haven, and colleagues wrote. “The greater the number of total prescribed medications, the greater was the likelihood of prescription of a medication individually associated with risk of harm.”

According to study background, the Tool to Reduce Inappropriate Medication (TRIM) gathers data on chronic conditions and medications from electronic health records, and uses information gleaned from charts and assessments to determine medication reconciliation discrepancies, as well as potentially inappropriate medications and regimens. Furthermore, TRIM uses clinician feedback to summarize discrepancies and provide deprescribing recommendations, and patient feedback to summarize discrepancies and self-reported medication problems.

For the study, researchers randomly assigned 128 veterans to receive either TRIM or usual care. Primary outcomes were subscales of the Patient Assessment of Care for Chronic Conditions (PACIC) regarding shared decision-making, and patient and clinician communication. The secondary outcomes were changes in medications.

Overall, 29.7% of TRIM participants and 15.6% of control participants had the highest PACIC ratings; however, the difference was not significant.

After adjustment for covariates and clustering of patients within clinicians, TRIM yielded significantly more-active patient communication and facilitative clinician communication and more medication-related communication among patients and clinicians. The tool was also significantly associated with correction of medication discrepancies, but had no effect on medication number or reduction in potentially inappropriate medications.

“The use of TRIM ... improved shared decision-making and reduced medication reconciliation errors but did not change prescribing,” Fried and colleagues concluded. “The challenges of deprescribing may require more-intensive interactions with clinicians.” – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.