Optimizing Medication Use and Reducing Falls in Older Adults Using the ADFICE_IT Clinical Decision Support System

Introduction

Falls are the leading cause of injury-related mortality and hospitalization in older adults and are frequently related to medication use. In the ADFICE_IT study, we examine the effectiveness of a clinical decision support system (CDSS) for optimizing medication use and reducing fall risk increasing drugs (FRIDs). We describe the study design and present preliminary findings on physicians’ satisfaction with the CDSS. 

Methods

To evaluate the effect of the CDSS on time to first injurious fall, a multicenter, cluster-randomized controlled trial was conducted in nine Dutch hospitals from June 2022 - March 2027 (expected n≈856). The CDSS delivers guideline-based recommendations for medication optimization and an individual fall risk estimation using an embedded prediction model. Hospitals in the control arm provided care-as-usual. Physicians’ satisfaction with the CDSS was assessed through semi-structured interviews conducted between March and June 2025. Data were analyzed using thematic analysis with inductive coding.

Results

A total of 11 semi-structured interviews were conducted. The first results show that physicians generally viewed the CDSS as valuable for preparing consultations and organizing clinical discussions. Some physicians primarily used the CDSS to review medication risks and generate deprescribing options, while others also employed it actively during consultations to guide the conversation or visually convey the patient’s fall risk. Some physicians mentioned that using the CDSS increased their administrative workload. 

Conclusion

This study’s findings will provide valuable insights into how computerized tools targeting physicians and older adults can support medication optimization in clinical practice.