Reducing proton pump inhibitors overuse with an advisory, risk-based, context-aware electronic alert system: A controlled interrupted time series analysis.

Abstract

Proton pump inhibitors (PPI) are frequently overprescribed despite guidelines recommending cautious use. Electronic alert systems have shown potential in improving prescribing practices, but their effectiveness varies. This study evaluates a novel electronic alert system designed to reduce perioperative PPI overuse by leveraging real-time, patient-specific clinical data. A retrospective controlled interrupted time series analysis was conducted from February 2015 to October 2021 in a tertiary care hospital. The intervention group comprised patients undergoing internal fixation surgeries in the orthopedic department, while the control group included patients receiving appendectomies in the general surgery department. A novel electronic alert system was integrated into the computerized physician order entry system, providing risk assessments and advisory alerts for intravenous PPI prescriptions. The system operated from July 2019 to November 2020. Key outcomes measured every two weeks included Defined Daily Doses (DDD) and Days of Therapy (DOT) per patient, prescription rates, and proportions of high-dose and alert-triggering orders. The study included 8,303 patients in the intervention group and 5,728 in the control group. Post-implementation, the intervention group showed a significant decrease in DDD per patient (β = -1.21, p = 0.003) and DOT per patient (β = -0.698, p = 0.011), primarily due to reduced intravenous administration. Prescription rates for PPI decreased significantly (OR = 0.710, p = 0.002), and there was a reduction in high-dose prescriptions (OR = 0.243, p < 0.001). While consumption metrics remained sustained after alert deactivation, quality indicators showed partial rebounds but remained improved compared to baseline. The advisory, risk-based, context-aware electronic alert system effectively reduced PPI overuse and improved prescribing quality in a surgical department. The differential impact post-intervention, with more durable effects on consumption metrics than on prescribing quality, suggests a certain degree of sustainability in prescribing behaviors. Implementing advisory, context- aware electronic alerts may offer a scalable solution for optimizing medication use in healthcare settings.