{"paper_id":"2efcaaca-8dcc-4d7b-9f79-4d88f0f2c5b5","body_text":"Association Between Real-Time Alerts in Electronic Prescribing Systems and Potentially Inappropriate Prescribing Among Older Adults\nZahra Aminzade and Reza Mehrizi share the first authorship of this paper.\nABSTRACT\nBackground\nOlder 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.\nMethods\nWe 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.\nResults\nAcross 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%).\nConclusions\nA 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.\nSummary\n-\nKey points\n- ○\nA national real-time alert system integrated into electronic prescriptions significantly reduced potentially inappropriate medication (PIM) use in older adults.\n- ○\nImplementing a clinical decision support system (CDSS) across a national platform proved scalable, low-cost, and impactful, even in a resource-limited setting.\n- ○\nThe association was largest among the oldest age group (85+), who experienced the greatest relative decline in PIM prescriptions.\n- ○\nThe system used soft, non-blocking alerts (nudges) based on the 2023 AGS Beers Criteria, which aligned with clinician workflow and minimized alert fatigue.\n- ○\nThis study offers rare, population-level data from a low- and middle-income country, demonstrating that digital tools can enhance patient safety globally.\n- ○\nConflicts of Interest\nThe authors declare no conflicts of interest.\nData Availability Statement\nAll data from this study are included in this published article and its Supporting Information.","source_license":"public-domain-us","license_restricted":false}