Association Between Real-Time Alerts in Electronic Prescribing Systems and Potentially Inappropriate Prescribing Among Older Adults Publisher Pubmed



Aminzade Z ; Mehrizi R ; Mirian S ; Asl IM ; Nasehi MM ; Effatpanah M ; Gholamnezhad M ; Armand N ; Karami H ; Ghamkhar L
Source: Journal of the American Geriatrics Society Published:2026

Abstract

Background: Older adults are highly susceptible to adverse effects from potentially inappropriate medications (PIMs). Real-time clinical decision support systems (CDSS) may reduce unsafe prescribing; yet evidence from low- and middle-income countries is limited. This study assessed the association between a national electronic alert system and outpatient PIM prescribing in Iran. Methods: We examined 230,719 electronic outpatient prescriptions for adults aged 65 years and older. Prescriptions from May to August 2023 (pre-alert) were compared with those from May to August 2024 (post-alert). The primary outcome was the proportion of prescriptions containing ≥ 1 PIM, defined using the 2023 AGS Beers Criteria. Subgroup analyses stratified outcomes by age, sex, physician specialty, and drug class. Results: Across 2023–2024, 230,719 prescriptions were recorded. After alert implementation, the greatest reductions occurred in adults aged 85–100 years (−9.85%) and in women (−7.89%). Significant declines were also observed in gastrointestinal drugs (−14.14%), pain medications (−11.99%), central nervous system agents (−3.03%), antihistamines (−4.60%), and in specific medications including ketorolac, clidinium-chlordiazepoxide, methocarbamol, nortriptyline, chlorpheniramine, indomethacin, and dicyclomine. By specialty, the largest reductions were seen in Surgery (−18.13%), Internal Medicine (−12.56%), and General Practice (−6.99%). Conclusions: A national, real-time, non-interruptive alert system was associated with meaningful reductions in PIM prescribing among older adults. Scalable CDSS tools may enhance medication safety in resource-constrained settings. © 2026 The American Geriatrics Society.