A Trial to Reduce Inappropriate Prescribing to Older Adults Visiting the Emergency Department

NCT07146763 | Active Not Recruiting

• 2 other identifiers: 2000036876P30AG024968
• Study Type: interventional
• Target: 200
• Locations: 1 country
• Sites: 1

Brief Summary

Cluster-randomized trial assessing the impact of interventions on guideline-concordant prescribing in Emergency Departments (ED). The study compares the effectiveness of feedback messages about potentially inappropriate medications (PIMs) delivered by peer clinician prescribers or anonymous systems, compared to standard of care. The goal is to reduce PIM prescribing for older adults discharged from emergency departments.

Conditions

Inappropriate Prescribing

Keywords

Older Adults; Emergency Department; Inappropriate Prescribing

Outcome Measures

Primary Outcomes (1)

• Change PIM prescribing rate

  Change in potentially inappropriate medication (PIM) prescribing rate based on the Geriatric Emergency Medication Safety Recommendations (GEMS-Rx). Outcome is measured as the percentage of Emergency Department (ED) discharge prescriptions for PIMs among patients aged 65 years or older.

  At ED discharge, calculated monthly, using rolling 90-day prescribing data, over the 12-month intervention period and 6-month follow-up

Secondary Outcomes (4)

• Changes in prescribing by medication class

  At ED discharge, calculated monthly, using rolling 90-day prescribing data, over the 12-month intervention period and 6-month follow-up

• Adoption of alternative recommendations

  Monthly during the 12-month intervention period and 6-month follow-up

• Access to Epic workbench reports

  Monthly during the 12-month intervention period and 6-month follow-up

• Mean overall readmission rate

  Measured at 30 days post-discharge for all eligible ED visits during the 12-month intervention period and 6-month follow-up

Study Arms (3)

Credible Peer Messenger

EXPERIMENTAL

Providers receive automated prescribing feedback messages from a credible peer messenger, including aspirational norms and benchmark comparisons based on Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) recommendations, to promote safer prescribing practices.

Behavioral: Prescribing Feedback

Anonymous Messenger

EXPERIMENTAL

Providers receive automated prescribing feedback messages from an anonymous messenger system, including aspirational norms and benchmark comparisons based on Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) recommendations, to promote safer prescribing practices.

Behavioral: Prescribing Feedback

Control group

NO INTERVENTION

Providers continue with standard of care. No feedback messages are sent.

Interventions

Prescribing Feedback BEHAVIORAL

Automated prescribing feedback messages are delivered to clinician prescribers in participating emergency departments. Messages are based on Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) recommendations and include aspirational norms and benchmark comparisons. Depending on study arm, feedback is sent either from a credible peer messenger or through an anonymous messenger system.

Anonymous Messenger; Credible Peer Messenger

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Licensed clinicians with prescribing authority (physician, advanced practice registered nurse, or physician assistant)
• Practicing in one of the participating Yale New Haven Health System emergency departments
• At least 30 Emergency Department (ED) discharge encounters with patients aged 65 years or older in the 12 months preceding study enrollment
• Provides digital affirmative consent to participate

Sponsors & Collaborators

• Yale University: lead
• National Institute on Aging (NIA): collaborator

Study Sites (1)

Yale New Haven Hospital Emergency Departments

New Haven, Connecticut, 06520, United States

Location

MeSH Terms

Conditions

Emergencies

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Daniella Meeker, PhD

  Yale University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: The study population are Emergency Medicine prescribers practicing in the Yale New Haven Health System with at least 30 visits with patients over age 65. Patients are not target subjects but that their data will be utilized from the medical record, pre- and post-intervention.

Study Record Dates

• First Submitted: August 20, 2025
• First Posted: August 28, 2025
• Study Start: January 15, 2026
• Primary Completion (Estimated): May 1, 2027
• Study Completion (Estimated): November 1, 2027
• Last Updated: May 6, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will share
• Time Frame: Made available upon publication.

Locations

US (1)