Implementing prescriber-pharmacist collaboration to improve evidence-based medication prescribing using asynchronous,...

Area of Science:

• Pharmacology
• Health Informatics
• Clinical Pharmacy

Background:

• Inappropriate prescribing of Direct Oral Anticoagulants (DOACs) leads to adverse events.
• Electronic health record (EHR)-based notifications can improve evidence-based prescribing.
• Engaging clinical pharmacists via EHR notifications may enhance medication safety.

Purpose of the Study:

• To evaluate the effectiveness of EHR-based notifications in correcting inappropriate DOAC prescriptions.
• To compare the impact of notifications directed to prescribers versus clinical pharmacists.
• To identify factors influencing the adoption of prescription changes.

Main Methods:

• A pragmatic, randomized implementation trial was conducted.
• Asynchronous EHR notifications were sent for inappropriate DOAC prescriptions.
• Notifications were directed to either the prescribing clinician or the clinical anticoagulation pharmacist.
• The primary outcome was prescription change within 7 days.

Main Results:

• Overall, 23.2% of notifications resulted in a prescription change within 7 days.
• Pharmacist-directed notifications showed a 21% change rate, while prescriber-directed notifications had a 26% rate (p=0.36).
• Pharmacists demonstrated more consistent management of complex cases, including polypharmacy and dosing threshold issues.

Conclusions:

• Both prescribers and pharmacists responded similarly to EHR notifications for correcting DOAC prescriptions.
• Clinical pharmacists showed nuanced application of guidelines in complex scenarios.
• Engaging clinical pharmacists directly is an efficient strategy for addressing prescribing issues, especially in complex cases.