Please select the eligibility criteria that correspond to the clinical trial below.
Title: Computer-Assisted Decision Support to Increase the Safety of Prescribing to Older Emergency Department Patients
Brief Summary: The subjects in this study are physicians working in the Wishard Emergency Department. The purpose of this study is to measure the extent to which information technology (i.e.-computers) improves emergency department care. The objective of our study is to evaluate the use of informatics in the emergency department and specifically to determine if computer reminder systems: 1) reduce the number of unsafe medications prescribed to older adults, 2) assist in more safely dosing of medications to adults of all ages, and 3) increase influenza immunization of eligible older patients in the emergency department.

Interventions: The interventions in this study are computer reminders. When releasing patients from the emergency department, physicians currently write all release orders, including prescriptions, on a computer order entry system that is linked to the Regenstrief Medical Record System. The computerized order entry system will be programmed so that physicians randomized (randomly placed) into the intervention group, the group that will receive the intervention, they will receive one of three types of reminders:

1. The medication prescribed is generally considered unsafe for use in older patients. The reminder will then list appropriate alternatives for this medication.
2. The dose of the prescribed medication is excessive and should be adjusted for the patient's creatinine clearance (or kidney function).
3. This patient may be eligible for influenza vaccination.

The physician will then choose to order or disregard the recommendation. The computer system will automatically record what the physician selected to do. The general outcome of interest is the extent to which the electronic reminders successfully improved physician practice in the emergency department setting. This outcome will be compared to physicians who were randomized to the group that did not receive the reminders (the control group).


Options:
A: Inclusion Criteria:

* 18-years old or older;
* have a diagnosis of diabetes mellitus either by ICD-billing codes or indicative medications;
* are prescribed at least (3) chronic condition medications according to the EHR medication list;
* are English or Spanish-speaking;
* have no imminent intention to move or change clinics within the next year;
* score 4 or higher on the six-question screener based on the Mini-Mental Status Exam;
* are primarily responsible for administering their own medications;
* prescribed a new chronic condition medication (including refills, and change in titrations) during their clinic visit and day.

Exclusion Criteria:

* under age of 18 years-old;
* does not speak English or Spanish;
* dependent on assistance for medication administration;
* scored less than 4 on the six-question screener;
* not prescribed a new medication or changed medication at clinical appointment;
B: For interview questionnaire:

Inclusion criteria are:

1. Accepted informed consent,
2. The healthcare professional is practicing in the involved nursing homes.

Exclusion criteria are:

1) Decline/unable to provide consent.

For team-care deprescribing study:

Inclusion criteria are:

1. Accepted informed consent (unless cognitive-impaired, with no or un-contactable next-of-kin),
2. Adult aged 65 years and above,
3. Currently on five or more medications.

Exclusion criteria are:

1. Below the age of 65 years of age,
2. Life expectancy of less than 6 months or respite care.
C: Inclusion Criteria:

* The subjects of this study will be physician providers and residents and medical students practicing under the supervision of a faculty emergency physician. Specific study subjects will include emergency medicine faculty physicians; emergency medicine and internal medicine residents; emergency medicine, surgery, and internal medicine interns; and medical students taking care of patients in our emergency department.

Exclusion Criteria:

* We will not include the members of the research team in this study.
D: Inclusion Criteria:

* 18 years of age and older
* plan to receive health care and prescriptions at study facility
* prescribed at least one blood pressure medication
* English-speaking
* access to a telephone
* no hearing impairments in the normal range of conversation

Exclusion Criteria:

* dementia

Answer: C