E-LEARNING IN ORDER TO IMPROVE DRUG PRESCRIPTION FOR HOSPITALIZED ELDERLY PATIENTS:A CLUSTER-RANDOMIZED CONTROLLED STUDY

Objectives: The aim of the study was to evaluate the effect of an e-learning educational program meant to foster the quality of drug prescription in hospitalized elderly patients. Methods: A pilot study was undertaken before starting the full project in order to demonstrate its feasibility and to estimate the study sample size. Given that the feasibility of the study was demonstrated, the full study was performed. In the latter, 20 geriatric and internal medicine wards were randomized to intervention (e-learning educational program) or control (basic geriatric pharmacology notions). Logistic regression analysis was used in order to assess the effect of the intervention on the use of potentially inappropriate medication (PIM, primary outcome) at hospital discharge. Secondary outcomes were a reduced prevalence of at least one potential drug-drug interaction (DDI) and potentially severe DDI at discharge. Mortality rate and incidence of rehospitalizations were other secondary outcomes assessed at 12-month follow-up. Results: In final study a total of 697 patients (347 in the intervention and 350 in the control arms) were enrolled. No statistically significant difference in the prevalence of PIM at discharge was found between arms (OR 1.29 95%CI 0.87-1.91). We also found no decrease in the prevalence of DDI (OR 0.67 95%CI 0.34-1.28) and potentially severe DDI (OR 0.86 95%CI 0.63-1.15) at discharge, nor in mortality rates and incidence of re-hospitalization at 12 month follow-up. Conclusions: This e-learning educational program had no clear effect on the quality of drug prescription and clinical outcomes in hospitalized elderly patients. Given the high prevalence of PIMs and potential DDIs recorded in the frame of this study, other approaches should be developed in order to improve the quality of drug prescription in this population. Clinicaltrials.gov Identifier: NCT02339792; Agenzia Italiana del farmaco (AIFA) code: FARM87SA2B