LTHOUGH NUMEROUS STUDies have evaluated the patterns and quality of prescription medication use among the elderly, 1-5 information related to the incidence of preventable adverse drug events in the ambulatory geriatric population is limited. Even though most medication errors do not result in injury, 6,7 the extensive use of medications by the geriatric population suggests that sizeable numbers of older persons are affected. The prevalence of prescription medication use among the ambulatory adult population increases with advancing age. A recent national survey of the US noninstitutionalized adult population indicated that more than 90% of persons aged 65 years or older used at least 1 medication per week. 8 More than 40% used 5 or more different medications per week, and Author Affiliations and Financial Disclosures are listed at the end of this article.

Research ArticleWhile organizations implement information technology (IT) to effect change, current theories of IT-associated organizational change pay insufficient attention to the change goals, the role of IT in organizational change, and the multilevel nature of change processes. We take a fresh look at IT-associated organizational change using grounded theory methods. Our longitudinal study of an electronic health record (EHR) system implementation in a multi-site medical group found user behaviors that did not fit well with existing theories. Instead, we found that they fit better with the concept of affordances from ecological psychology. In developing our affordance-based theory of IT-associated organizational change from our field data, we discovered three gaps in the affordance literature; namely, the lack of theory for (1) the process of actualizing an affordance's potential, (2) affordances in an organizational context, and (3) bundles of interrelated affordances. This paper extends the theory of affordances to handle these three gaps and, in doing so, develops a mid-range theory for EHR-associated organizational change in a healthcare organization. While the resulting theory is specific to EHR implementations, it offers a template for other mid-range affordanceactualization theories and a more general affordance-actualization lens. Our affordance-actualization lens considers the materiality of the IT artifact, the non-deterministic process by which IT leads to organizational effects, the multilevel nature of IT-associated change processes, and the intentionality of managers and users as agents of change, and thus addresses important criteria for theories of IT effects in organizations. The paper also provides practical guidance for implementing EHR systems and other organizational systems.

Prevention efforts to reduce ADEs should be targeted toward older adults with multiple medical conditions or taking multiple medications, nonopioid analgesics, anticoagulants, diuretics, and antiseizure medications.