# Reducing Potentially Inappropriate Medication Prescribing for Older Patients: Enhancing Quality of Provider Practices for Older Adults in the Emergency Department (EQUIPPED)

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2020 · —

## Abstract

Older Veterans are a vulnerable population at high risk of medication adverse drug events (ADE) especially
when they are discharged from the Emergency Department (ED). More than half of older adults discharged
from the ED leave with a new prescription medication. Multiple studies show that between 5.6%-13% of
prescriptions written for older adults at ED discharge represent a potentially inappropriate medication (PIM).
Prescribing new medications for older Veterans outside the setting of primary care increases the opportunity
for suboptimal prescribing as well as adverse drug events (ADEs), both major reasons for repeat ED visits,
hospitalization or death. In order to inform a Veterans Affairs (VA) system-wide approach to improve
prescribing safety for older Veterans, we propose a study to determine best practices for influencing provider
prescribing behavior in order to decrease PIMs prescribed for older Veterans at the time of ED discharge.
 EQUIPPED (Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the
Emergency Department) was initially established as an innovative quality improvement initiative designed to
reduce PIM prescribing for adults aged 65 years and older. The EQUIPPED QI initiative provides preliminary
data supporting this proposal written in response to the Learning Health System Provider Behavior Change
RFA. Initially funded by the Office of Geriatrics and Extended Care, the EQUIPPED QI intervention has three
components aimed at influencing provider prescribing behavior: a) provider education; b) electronic clinical
decision support via specialized geriatric pharmacy order sets at the point of prescribing; and c) academic
detailing including audit and feedback and peer benchmarking. EQUIPPED is informed by the Beers Criteria,
which indicate drugs that should be avoided in older adults because of the increased risk of ADEs. The Beers
Criteria are widely used by government agencies and supported by research in various settings as a marker of
prescribing quality.
 The EQUIPPED QI intervention has been implemented in 10 VA EDs. Results from 4 of the initial
EQUIPPED sites with in-person academic detailing demonstrated sustained pre-post improvement (reduction)
in PIM prescribing rates by nearly 50% at 6 months, suggesting the possibility of culture change with regard to
provider prescribing behavior. The EQUIPPED QI intervention typically involves in-person academic detailing
using audit and feedback with peer benchmarking, which is more resource intensive. The VA already uses
both passive feedback (i.e. dashboards to report psychotropic medication use in community living center
residents) and active feedback (i.e. implementation of a national academic detailing pharmacy program);
however, there is little guidance on which strategy is most effective in the ED. In order to inform the optimal
EQUIPPED strategy for improving provider prescribing behavior toward older Veterans in ED, we propose a
trial comparin...

## Key facts

- **NIH application ID:** 9829048
- **Project number:** 5I01HX002527-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** George L. Jackson
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-10-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9829048

## Citation

> US National Institutes of Health, RePORTER application 9829048, Reducing Potentially Inappropriate Medication Prescribing for Older Patients: Enhancing Quality of Provider Practices for Older Adults in the Emergency Department (EQUIPPED) (5I01HX002527-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9829048. Licensed CC0.

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