Trial Outcomes & Findings for An Electronic Clinical Decision Support Tool to Reduce Low-value Antipsychotic Prescriptions (NCT NCT04851691)

Last Updated: 2024-09-19

Results Overview

Cumulative total of new antipsychotic prescription days supplied by clinicians per eligible patient in the 12 months after the intervention rollout date compared to the prior 12-months

Recruitment status

COMPLETED

Study phase

Target enrollment

158 participants

Primary outcome timeframe

12 month time point

Results posted on

2024-09-19

Participant Flow

Patients were enrolled into the study when an eligible provider initiated a new antipsychotic prescription (e.g., Quetiapine, Olanzapine, Risperidone, Aripiprazole, Haloperidol, Clozapine) during a patient visit. Eligible providers were assigned an arm of the study based on their 2019 new antipsychotic orders for this population. Patients were enrolled into each arm based on the providers arm assignment. Healthcare Providers were not enrolled in the study.

Participant milestones

Participant milestones
Measure	EHR CDS Tool Patients with an encounter in which the physician attempts to place an order for a new antipsychotic prescription. Physician has been assigned to the EHR CDS tool. The three-pronged electronic health record clinical decision support tool "pops up": (1) Alerting clinicians that antipsychotic prescriptions increase patient mortality; (2) Offering non-pharmacological behavioral resources for caregivers via a link to the IDEA! strategy resources on how caregivers can best manage a patient's behavioral disturbance non-pharmacologically, which will be available in the EHR to include in the patient's after visit summary; and (3) Defaulting prescriptions to a low supply of pills in to order to minimize harm. In addition, the PI will email all providers randomized to the intervention arm in order to make them aware of the components of this intervention and its motivation.	Control Patients with an encounter in which the physician attempts to place an order for a new antipsychotic prescription. Physician has been assigned to the control. Usual Care: Patients will receive usual care from their physicians.
Overall Study STARTED	67	91
Overall Study COMPLETED	67	91
Overall Study NOT COMPLETED	0	0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

An Electronic Clinical Decision Support Tool to Reduce Low-value Antipsychotic Prescriptions

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	EHR CDS Tool n=67 Participants Patients with an encounter in which the physician attempts to place an order for a new antipsychotic prescription. Physician has been assigned to the EHR CDS tool. Multi-pronged electronic health record (EHR) clinical decision support (CDS) tool intervention to reduce physician prescriptions of new antipsychotic medications among older adults with ADRD EHR CDS: When a clinician initiates a new antipsychotic prescription for a patient with dementia, a three-pronged electronic health record clinical decision support tool "pops up": (1) Alerting clinicians that antipsychotic prescriptions increase patient mortality; (2) Offering non-pharmacological behavioral resources for caregivers via a link to the IDEA! strategy resources on how caregivers can best manage a patient's behavioral disturbance non-pharmacologically, which will be available in the EHR to include in the patient's after visit summary; and (3) Defaulting prescriptions to a low supply of pills in to order to minimize harm. In addition, the PI will email all providers randomized to the intervention arm in order to make them aware of the components of this intervention and its motivation.	Control n=91 Participants Patients with an encounter in which the physician attempts to place an order for a new antipsychotic prescription. Physician has been assigned to the control. Physicians will not receive intervention and perform duties as usual. Usual Care: Patients will receive usual care from their physicians.	Total n=158 Participants Total of all reporting groups
Age, Continuous	81.19 years STANDARD_DEVIATION 15.14 • n=5 Participants	84.78 years STANDARD_DEVIATION 11.77 • n=7 Participants	83.26 years STANDARD_DEVIATION 11.73 • n=5 Participants
Sex: Female, Male Female	41 Participants n=5 Participants	65 Participants n=7 Participants	106 Participants n=5 Participants
Sex: Female, Male Male	26 Participants n=5 Participants	26 Participants n=7 Participants	52 Participants n=5 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	52 Participants n=5 Participants	70 Participants n=7 Participants	122 Participants n=5 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	6 Participants n=5 Participants	10 Participants n=7 Participants	16 Participants n=5 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	9 Participants n=5 Participants	11 Participants n=7 Participants	20 Participants n=5 Participants
Race/Ethnicity, Customized Race Category · Asian	5 Participants n=5 Participants	7 Participants n=7 Participants	12 Participants n=5 Participants
Race/Ethnicity, Customized Race Category · Other Race	3 Participants n=5 Participants	7 Participants n=7 Participants	10 Participants n=5 Participants
Race/Ethnicity, Customized Race Category · White	45 Participants n=5 Participants	63 Participants n=7 Participants	108 Participants n=5 Participants
Race/Ethnicity, Customized Race Category · Unknown or Not Reported	8 Participants n=5 Participants	11 Participants n=7 Participants	19 Participants n=5 Participants
Race/Ethnicity, Customized Race Category · Black or African American	5 Participants n=5 Participants	3 Participants n=7 Participants	8 Participants n=5 Participants
Race/Ethnicity, Customized Race Category · American Indian or Alaska Native	1 Participants n=5 Participants	0 Participants n=7 Participants	1 Participants n=5 Participants

PRIMARY outcome

Timeframe: 12 month time point

Population: Patients that received a new antipsychotic prescription (e.g., Quetiapine, Olanzapine, Risperidone, Aripiprazole, Haloperidol, Clozapine) from an eligible provider.

Cumulative total of new antipsychotic prescription days supplied by clinicians per eligible patient in the 12 months after the intervention rollout date compared to the prior 12-months

Outcome measures

Outcome measures
Measure	EHR CDS Tool n=67 Participants Patients with an encounter in which the physician attempts to place an order for a new antipsychotic prescription. Physician has been assigned to the EHR CDS tool. Multi-pronged electronic health record (EHR) clinical decision support (CDS) tool intervention to reduce physician prescriptions of new antipsychotic medications among older adults with ADRD EHR CDS: When a clinician initiates a new antipsychotic prescription for a patient with dementia, a three-pronged electronic health record clinical decision support tool "pops up": (1) Alerting clinicians that antipsychotic prescriptions increase patient mortality; (2) Offering non-pharmacological behavioral resources for caregivers via a link to the IDEA! strategy resources on how caregivers can best manage a patient's behavioral disturbance non-pharmacologically, which will be available in the EHR to include in the patient's after visit summary; and (3) Defaulting prescriptions to a low supply of pills in to order to minimize harm. In addition, the PI will email all providers randomized to the intervention arm in order to make them aware of the components of this intervention and its motivation.	Control n=91 Participants Patients with an encounter in which the physician attempts to place an order for a new antipsychotic prescription. Physician has been assigned to the control. Physicians will not receive intervention and perform duties as usual. Usual Care: Patients will receive usual care from their physicians.
Cumulative Total of New Antipsychotic Pill-days Prescribed	12569 New antipsychotic prescription days	25916 New antipsychotic prescription days

SECONDARY outcome

Timeframe: 12 month time point

Population: All participants enrolled in the study were eligible to receive the non-Pharmacologic IDEA Strategy handout

Number of patients who receive the non-Pharmacologic IDEA Strategy handout at 12 month time point comparing the intervention vs. control

Outcome measures

Outcome measures
Measure	EHR CDS Tool n=67 Participants Patients with an encounter in which the physician attempts to place an order for a new antipsychotic prescription. Physician has been assigned to the EHR CDS tool. Multi-pronged electronic health record (EHR) clinical decision support (CDS) tool intervention to reduce physician prescriptions of new antipsychotic medications among older adults with ADRD EHR CDS: When a clinician initiates a new antipsychotic prescription for a patient with dementia, a three-pronged electronic health record clinical decision support tool "pops up": (1) Alerting clinicians that antipsychotic prescriptions increase patient mortality; (2) Offering non-pharmacological behavioral resources for caregivers via a link to the IDEA! strategy resources on how caregivers can best manage a patient's behavioral disturbance non-pharmacologically, which will be available in the EHR to include in the patient's after visit summary; and (3) Defaulting prescriptions to a low supply of pills in to order to minimize harm. In addition, the PI will email all providers randomized to the intervention arm in order to make them aware of the components of this intervention and its motivation.	Control n=91 Participants Patients with an encounter in which the physician attempts to place an order for a new antipsychotic prescription. Physician has been assigned to the control. Physicians will not receive intervention and perform duties as usual. Usual Care: Patients will receive usual care from their physicians.
Number of Patients Who Receive Handout	0 Participants	0 Participants

SECONDARY outcome

Timeframe: 90 days

Other events: 6 other events

Deaths: 2 deaths

Serious adverse events

Serious adverse events
Measure	EHR CDS Tool n=67 participants at risk Patients with an encounter in which the physician attempts to place an order for a new antipsychotic prescription. Physician has been assigned to the EHR CDS tool. Multi-pronged electronic health record (EHR) clinical decision support (CDS) tool intervention to reduce physician prescriptions of new antipsychotic medications among older adults with ADRD EHR CDS: When a clinician initiates a new antipsychotic prescription for a patient with dementia, a three-pronged electronic health record clinical decision support tool "pops up": (1) Alerting clinicians that antipsychotic prescriptions increase patient mortality; (2) Offering non-pharmacological behavioral resources for caregivers via a link to the IDEA! strategy resources on how caregivers can best manage a patient's behavioral disturbance non-pharmacologically, which will be available in the EHR to include in the patient's after visit summary; and (3) Defaulting prescriptions to a low supply of pills in to order to minimize harm. In addition, the PI will email all providers randomized to the intervention arm in order to make them aware of the components of this intervention and its motivation.	Control n=91 participants at risk Patients with an encounter in which the physician attempts to place an order for a new antipsychotic prescription. Physician has been assigned to the control. Physicians will not receive intervention and perform duties as usual. Usual Care: Patients will receive usual care from their physicians.
General disorders Inpatient Admission	3.0% 2/67 • Participants were tracked for adverse events 3 months after their first encounter with a randomized physician during which a new antipsychotic medication order is initiated. An adverse event is defined as an Emergency Department visit that did not require hospitalization. Serious adverse events include hospitalization or death. Providers were not assessed for adverse events	13.2% 12/91 • Participants were tracked for adverse events 3 months after their first encounter with a randomized physician during which a new antipsychotic medication order is initiated. An adverse event is defined as an Emergency Department visit that did not require hospitalization. Serious adverse events include hospitalization or death. Providers were not assessed for adverse events

Other adverse events

Other adverse events
Measure	EHR CDS Tool n=67 participants at risk Patients with an encounter in which the physician attempts to place an order for a new antipsychotic prescription. Physician has been assigned to the EHR CDS tool. Multi-pronged electronic health record (EHR) clinical decision support (CDS) tool intervention to reduce physician prescriptions of new antipsychotic medications among older adults with ADRD EHR CDS: When a clinician initiates a new antipsychotic prescription for a patient with dementia, a three-pronged electronic health record clinical decision support tool "pops up": (1) Alerting clinicians that antipsychotic prescriptions increase patient mortality; (2) Offering non-pharmacological behavioral resources for caregivers via a link to the IDEA! strategy resources on how caregivers can best manage a patient's behavioral disturbance non-pharmacologically, which will be available in the EHR to include in the patient's after visit summary; and (3) Defaulting prescriptions to a low supply of pills in to order to minimize harm. In addition, the PI will email all providers randomized to the intervention arm in order to make them aware of the components of this intervention and its motivation.	Control n=91 participants at risk Patients with an encounter in which the physician attempts to place an order for a new antipsychotic prescription. Physician has been assigned to the control. Physicians will not receive intervention and perform duties as usual. Usual Care: Patients will receive usual care from their physicians.
General disorders Emergency Department visits that did not require admissions	6.0% 4/67 • Participants were tracked for adverse events 3 months after their first encounter with a randomized physician during which a new antipsychotic medication order is initiated. An adverse event is defined as an Emergency Department visit that did not require hospitalization. Serious adverse events include hospitalization or death. Providers were not assessed for adverse events	6.6% 6/91 • Participants were tracked for adverse events 3 months after their first encounter with a randomized physician during which a new antipsychotic medication order is initiated. An adverse event is defined as an Emergency Department visit that did not require hospitalization. Serious adverse events include hospitalization or death. Providers were not assessed for adverse events

Additional Information

Project Manager

University of California Los Angeles, Division of General Internal Medicine and Health Services Research

Phone: 310-825-8253

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee
Publication restrictions are in place