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Provider Responsiveness to Pharmacist Recommendations in a Population Health Setting.

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    A just-in-time messaging system successfully prompted primary care providers (PCPs) to change potentially inappropriate medications for geriatric patients. This pharmacist-led intervention improved medication safety in older adults.

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    Area of Science:

    • Geriatric Medicine
    • Clinical Pharmacy
    • Health Services Research

    Background:

    • Geriatric patients exhibit increased sensitivity to medications and are prone to polypharmacy, necessitating regular medication reviews.
    • Potentially inappropriate medication (PIM) use is a significant concern in older adults, increasing the risk of adverse drug events.
    • Primary care providers (PCPs) manage complex medication regimens for geriatric patients, often requiring support for medication optimization.

    Purpose of the Study:

    • To evaluate the effectiveness of a just-in-time messaging system for pharmacist recommendations on PIMs in geriatric patients.
    • To determine the acceptance rate of pharmacist recommendations by PCPs for medication changes in older adults.
    • To assess the impact of pharmacist colocation on the acceptance of medication recommendations.

    Main Methods:

    • A prospective, quality improvement study design was employed in health-system-based primary care facilities.
    • Pharmacist recommendations, derived from a Beers criteria-based algorithm, were delivered to PCPs two business days before patient appointments.
    • Medical records of patients aged 65 and older were reviewed for the use of tricyclic antidepressants and benzodiazepines.

    Main Results:

    • A total of 252 recommendations were made, with an overall acceptance rate of 26.2% (22.1% for benzodiazepines, 22.7% for tricyclic antidepressants).
    • Of the accepted recommendations, 56% occurred when a pharmacist was collocated within the clinic.
    • The preferred communication method for PCPs was a message within the patient's electronic medication record (96.7% preference).

    Conclusions:

    • A just-in-time approach to delivering pharmacist recommendations is effective in facilitating medication changes for geriatric patients.
    • No statistically significant difference in PCP acceptance rates was observed based on whether a pharmacist was embedded in the clinic.
    • Optimizing communication methods, such as electronic health record messaging, is crucial for improving pharmacist recommendation acceptance in primary care settings.