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NCT Number: NCT07146763

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

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.

Active, Not Recruiting

This study is active but is not currently recruiting participants.

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Key information

Conditions

Inappropriate Prescribing Disease Attributes Emergencies Pathologic Processes Pathological Conditions, Signs and Symptoms

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Yale New Haven Hospital Emergency Departments

New Haven, Connecticut, 06520, United States

About this study

The goal of this trial is to compare the effectiveness of prescribing feedback delivered by a credible peer messenger and by an anonymous messaging system against standard of care in emergency departments. This intervention to Emergency Department (ED) clinician prescribers is a modification of previous studies that optimizes feedback about Potentially Inappropriate Medications (PIMs) using findings from behavioral science. Clinician prescribers who meet eligibility criteria and provide digital affirmative consent will be enrolled if they have encounters in a participating ED facility. The Joint Data Analytics Team (JDAT) will identify patients aged 65 years and older who were seen in the ED to evaluate prescribing outcomes. The focus of this registration is the randomized trial.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • 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

Exclusion criteria

  • Failure to meet inclusion criteria

Treatment and study plan

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.

Primary outcomes

  1. Change PIM prescribing rate

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

    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.

Secondary outcomes

  1. Changes in prescribing by medication class

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

    Changes in prescribing rates for high-risk medication classes identified in the GEMS-Rx based on percentage of ED discharge prescriptions for each targeted medication class among patients aged 65 years or older.

  2. Adoption of alternative recommendations

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

    Percentage of ED discharge encounters in which a recommended alternative medication was prescribed in place of a PIM based on percentage of eligible encounters.

  3. Access to Epic workbench reports

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

    Access to Epic workbench prescribing reports and message links (including Frequently Asked Questions, FAQs) based on number of accesses per clinician per month.

  4. Mean overall readmission rate

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

    All-cause readmission rates will be monitored to assess safety based on percentage of ED discharge encounters followed by any hospital readmission within 30 days.

Sponsors and collaborators

Lead sponsor

Yale University

Other

Collaborators

  • National Institute on Aging (NIA)

Registry information

Official study title

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

Important dates

Study start
2026
Primary completion
2027
Study completion
2027
First posted
Aug 28, 2025
Registry last updated
May 6, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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