Reducing high-risk medication use through pharmacist-led interventions in an outpatient setting

Area of Science:

• Geriatric Pharmacy
• Health Informatics
• Medication Safety

Background:

• High-risk medications (HRMs) pose significant risks to older adults.
• Reducing HRM prescribing is a key goal in geriatric pharmacotherapy.
• Electronic health record (EHR) systems offer potential for targeted interventions.

Purpose of the Study:

• To decrease high-risk medication (HRM) prescribing among patients aged 65 and older.
• To evaluate the effectiveness of direct electronic medical record (EMR) messaging by pharmacists to providers.

Main Methods:

• An observational, single-center study utilized quality improvement methodology (Define, Measure, Analyze, Improve, Control).
• Pharmacists sent EMR messages to providers regarding HRM indications, alternatives, and timing recommendations before patient visits.
• Intervention involved 89 patients receiving 115 HRM prescriptions initially, with follow-up on 19 additional patients.

Main Results:

• Clinical pharmacist EMR communications led to a 71.2% therapy modification rate.
• High-risk medication prescribing decreased from a peak national benchmark of 10.7% to 1.9% within 18 months (P = 0.014).
• The goal of <3% HRM prescribing was achieved and sustained from February to May 2019.

Conclusions:

• Interdisciplinary EMR access facilitated significant HRM discontinuation.
• Timely pharmacist messaging before clinic visits supports shared decision-making and improves medication safety.
• This intervention demonstrates a successful strategy for reducing HRM prescribing in a federally qualified health center.