Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial

Area of Science:

• Pharmacology and Therapeutics
• Health Informatics
• Patient Safety

Background:

• Direct oral anticoagulants (DOACs) are widely used for thrombotic conditions but pose risks due to improper dosing.
• Up to 15% of patients receive unsafe DOAC doses influenced by kidney/liver function, drug interactions, and indication.
• Current alert systems lack long-term monitoring and prescriber-pharmacist collaboration.

Purpose of the Study:

• To test novel electronic health record (EHR) medication alerts designed to enhance prescriber-pharmacist collaboration for DOAC prescribing.
• To incorporate dynamic, long-term patient monitoring into alert systems.
• To identify the most effective alerts for promoting evidence-based DOAC prescribing and tailor alert delivery.

Main Methods:

• Randomizing healthcare providers to different EHR medication alert types for unsafe anticoagulant prescriptions.
• Utilizing user-centered design principles for alert development.
• Evaluating the impact of alerts on existing and newly prescribed inappropriate DOACs over 18 months.

Main Results:

• The study will identify which novel EHR alerts are most effective in improving DOAC prescribing.
• It will assess the impact of alerts on both new and existing inappropriate DOAC prescriptions.
• Changes in alert effectiveness over the 18-month study period will be examined.

Conclusions:

• This project will establish a framework for prescriber-pharmacist collaboration in managing high-risk medications like DOACs.
• Successful implementation could benefit hundreds of thousands of patients nationally across over 3000 anticoagulation clinics.
• The findings aim to promote safer, evidence-based healthcare for patients on DOACs.