Inappropriate PrescribingNCT07146763
A Trial to Reduce Inappropriate Prescribing to Older Adults Visiting the Emergency Department
A study testing Prescribing Feedback in people with Inappropriate Prescribing, run by Yale University at 1 site in United States.
Trial summary
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… Read more about this study
- Who is it for?
- Any age
- Conditions the study is for
- Inappropriate Prescribing
- What is being tested?
- Prescribing Feedback
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 200 participants
- Where
- 1 siteUnited States
- Study dates
- 15 Jan 2026to Mar 2028
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- 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
Who cannot join
- Failure to meet inclusion criteria
Trial locations and contacts
1 site in 1 country.
United States1 site
Yale New Haven Hospital Emergency Departments
New Haven, Connecticut, 06520
About this study
Official title: A Randomized 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.
Read the detailed description
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.
- Conditions
- Inappropriate Prescribing
- Being tested
- Prescribing Feedback
- Keywords
- Older Adults, Emergency Department, Inappropriate Prescribing
- Medical subject headings
- Emergencies
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Prescribing FeedbackBehavioural
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.
| Study group | Role | What they receive |
|---|---|---|
| Credible Peer Messenger | Experimental | Providers receive automated prescribing feedback messages from a credible peer messenger, including aspirational norms and benchmark comparisons based on Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) recommendations, to promote safer prescribing practices. Receives: Behavioral: Prescribing Feedback |
| Anonymous Messenger | Experimental | Providers receive automated prescribing feedback messages from an anonymous messenger system, including aspirational norms and benchmark comparisons based on Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) recommendations, to promote safer prescribing practices. Receives: Behavioral: Prescribing Feedback |
| Control group | No intervention | Providers continue with standard of care. No feedback messages are sent. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change PIM prescribing rate
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.
Measured: At ED discharge, calculated monthly, using rolling 90-day prescribing data, over the 12-month intervention period and 6-month follow-up
Secondary outcomes (4)
Changes in prescribing by medication class
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.
Measured: At ED discharge, calculated monthly, using rolling 90-day prescribing data, over the 12-month intervention period and 6-month follow-up
Adoption of alternative recommendations
Percentage of ED discharge encounters in which a recommended alternative medication was prescribed in place of a PIM based on percentage of eligible encounters.
Measured: Monthly during the 12-month intervention period and 6-month follow-up
Access to Epic workbench reports
Access to Epic workbench prescribing reports and message links (including Frequently Asked Questions, FAQs) based on number of accesses per clinician per month.
Measured: Monthly during the 12-month intervention period and 6-month follow-up
Mean overall readmission rate
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.
Measured: Measured at 30 days post-discharge for all eligible ED visits during the 12-month intervention period and 6-month follow-up
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Aug 2025
- Study start15 Jan 2026
- Primary completionFeb 2028 (estimated)
- Study completionMar 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Inappropriate PrescribingStudies of the same condition, open and under way.
- More trials run by Yale UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- The study population are Emergency Medicine prescribers practicing in the Yale New Haven Health System with at least 30 visits with patients over age 65. Patients are not target subjects but that their data will be utilized from the medical record, pre- and post-intervention.
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 200 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Yale University
- Sponsor type
- University, hospital or other
- Collaborators
- National Institute on Aging (NIA)
- Responsible party
- Sponsor
- Investigators
- Daniella Meeker, PhD, Principal investigator, Yale University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07146763
- Sponsor's protocol ID
- 2000036876
- Other IDs
- P30AG024968
- Status last verified
- Aug 2026
- First submitted
- 20 Aug 2025
- Last updated
- 14 Aug 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: De-identified data will be transferred to the National Archive for Computerized Data On Aging (NACDA)
Study at a glance
From the registry record, last updated by the sponsor on 14 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized Trial to Reduce Inappropriate Prescribing to Older Adults Visiting the Emergency Department
- ClinicalTrials.gov ID
- NCT07146763
- Acronym / sponsor ID
- 2000036876
- Conditions
- Inappropriate Prescribing
- Keywords
- Older Adults, Emergency Department, Inappropriate Prescribing
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 200 participants (estimated)
- Lead sponsor
- Yale UniversityUniversity, hospital or other
- Collaborators
- National Institute on Aging (NIA)
- Study start
- 15 Jan 2026 (actual)
- Primary completion
- Feb 2028 (estimated)
- Study completion
- Mar 2028 (estimated)
- First posted
- 28 Aug 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
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.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 3
- Model description
- The study population are Emergency Medicine prescribers practicing in the Yale New Haven Health System with at least 30 visits with patients over age 65. Patients are not target subjects but that their data will be utilized from the medical record, pre- and post-intervention.
| Arm | Type | Receives |
|---|---|---|
| Credible Peer Messenger | Experimental | Behavioral: Prescribing FeedbackProviders receive automated prescribing feedback messages from a credible peer messenger, including aspirational norms and benchmark comparisons based on Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) recommendations, to promote safer prescribing practices. |
| Anonymous Messenger | Experimental | Behavioral: Prescribing FeedbackProviders receive automated prescribing feedback messages from an anonymous messenger system, including aspirational norms and benchmark comparisons based on Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) recommendations, to promote safer prescribing practices. |
| Control group | No intervention | –Providers continue with standard of care. No feedback messages are sent. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (4 listed)
- 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
Key exclusion criteria (1 listed)
- Failure to meet inclusion criteria
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Prescribing FeedbackAutomated 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. | Behavioural | Anonymous Messenger, Credible Peer Messenger |
Primary outcome
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.
4 secondary outcomes
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
Adoption of alternative recommendations
Time frame: Monthly during the 12-month intervention period and 6-month follow-up
Access to Epic workbench reports
Time frame: Monthly during the 12-month intervention period and 6-month follow-up
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
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 14 Aug 2026.
- Individual participant dataSharing planned: Yes. De-identified data will be transferred to the National Archive for Computerized Data On Aging (NACDA)
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Daniella Meeker, PhD principal investigator
Yale University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Prescribing Feedback in people with Inappropriate Prescribing, run by Yale University at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 14 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
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). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Aug 2026.