Evaluating patient acceptability of clinical pharmacist engagement following clinical decision support

While Direct Oral Anticoagulant (DOAC) medications like apixaban and rivaroxaban have overtaken warfarin as first-line therapy for atrial fibrillation (AF) and venous thromboembolism (VTE), 10-20% of DOAC prescriptions deviate from the United States Food and Drug Administration (FDA) evidence-based package label instructions. To improve prescribing, we implemented electronic health record (EHR) alerts that encourage collaboration between prescribers and anticoagulation clinic pharmacists.

This study investigates patients' acceptance and perceptions of outreach from anticoagulation pharmacists with whom they may not have preexisting relationships.

We administered a 10-item structured questionnaire to 30 patients (or caregivers as proxies) who had received DOAC dosing recommendations directly from pharmacists following an EHR-based prescribing alert. The first 20 participants also answered open-ended interview questions. Mean scores were calculated for structured acceptability questions on a 5-point Likert scale. Interview transcripts were analyzed to identify facilitators and barriers to acceptance of pharmacist involvement in DOAC management. We also assessed alignment between quantitative and qualitative data.

Overall, patients found direct pharmacist outreach acceptable (mean acceptability score: 4.3, SD 0.15). Facilitators included pharmacists' expertise, clear communication, and friendly demeanor. Barriers included a perceived limit to pharmacists' prescribing authority and the timing of the advice. Pharmacists may mitigate these barriers by emphasizing that patients' doctors endorse the dosing recommendations and offering to answer additional questions at the end of calls.

Anticoagulation pharmacists' direct outreach to patients can be valuable for DOAC management and is generally well-accepted. Addressing role confusion could further facilitate their direct patient contact.