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Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial
BACKGROUND: Direct oral anticoagulant medications are commonly used to treat or prevent thrombotic conditions, such as pulmonary embolism, deep vein thrombosis, and atrial fibrillation. However, up to 10–15% of patients receiving these medications get unsafe doses based on a patient’s kidney or live...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10184412/ https://www.ncbi.nlm.nih.gov/pubmed/37189171 http://dx.doi.org/10.1186/s13012-023-01273-4 |
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author | Smith, Shawna N. Lanham, Michael Seagull, F. Jacob Dorsch, Michael Errickson, Josh Barnes, Geoffrey D. |
author_facet | Smith, Shawna N. Lanham, Michael Seagull, F. Jacob Dorsch, Michael Errickson, Josh Barnes, Geoffrey D. |
author_sort | Smith, Shawna N. |
collection | PubMed |
description | BACKGROUND: Direct oral anticoagulant medications are commonly used to treat or prevent thrombotic conditions, such as pulmonary embolism, deep vein thrombosis, and atrial fibrillation. However, up to 10–15% of patients receiving these medications get unsafe doses based on a patient’s kidney or liver function, potential interactions with other medications, and indication for taking the medication. Alert systems may be beneficial for improving evidence-based prescribing, but can be burdensome and are not currently able to provide monitoring after the initial prescription is written. METHODS/DESIGN: This study will improve upon existing alert systems by testing novel medication alerts that encourage collaboration between prescribers (e.g., physicians, nurse practitioners, physician assistants) and expert pharmacists working in anticoagulation clinics. The study will also improve upon the existing alert system by incorporating dynamic long-term monitoring of patient needs and encouraging collaboration between prescribers and expert pharmacists working in anticoagulation clinics. Incorporating state-of-the-art user-centered design principles, prescribing healthcare providers will be randomized to different types of electronic health record medication alerts when a patient has an unsafe anticoagulant prescription. We will identify which alerts are most effective at encouraging evidence-based prescribing and will test moderators to tailor alert delivery to when it is most beneficial. The aims of the project are to (1) determine the effect of notifications targeting existing inappropriate DOAC prescriptions; (2) examine the effect of alerts on newly prescribed inappropriate DOACs; and (3) examine changes in the magnitude of effects over time for both the new prescription alerts and existing prescription notifications for inappropriate DOACs over the 18-month study period. DISCUSSION: Findings from this project will establish a framework for implementing prescriber-pharmacist collaboration for high-risk medications, including anticoagulants. If effectively implemented at the more than 3000 anticoagulation clinics that exist nationally, hundreds of thousands of patients taking direct oral anticoagulants stand to benefit from safer, evidence-based healthcare. TRIALS REGISTRATION: NCT05351749. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13012-023-01273-4. |
format | Online Article Text |
id | pubmed-10184412 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-101844122023-05-16 Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial Smith, Shawna N. Lanham, Michael Seagull, F. Jacob Dorsch, Michael Errickson, Josh Barnes, Geoffrey D. Implement Sci Study Protocol BACKGROUND: Direct oral anticoagulant medications are commonly used to treat or prevent thrombotic conditions, such as pulmonary embolism, deep vein thrombosis, and atrial fibrillation. However, up to 10–15% of patients receiving these medications get unsafe doses based on a patient’s kidney or liver function, potential interactions with other medications, and indication for taking the medication. Alert systems may be beneficial for improving evidence-based prescribing, but can be burdensome and are not currently able to provide monitoring after the initial prescription is written. METHODS/DESIGN: This study will improve upon existing alert systems by testing novel medication alerts that encourage collaboration between prescribers (e.g., physicians, nurse practitioners, physician assistants) and expert pharmacists working in anticoagulation clinics. The study will also improve upon the existing alert system by incorporating dynamic long-term monitoring of patient needs and encouraging collaboration between prescribers and expert pharmacists working in anticoagulation clinics. Incorporating state-of-the-art user-centered design principles, prescribing healthcare providers will be randomized to different types of electronic health record medication alerts when a patient has an unsafe anticoagulant prescription. We will identify which alerts are most effective at encouraging evidence-based prescribing and will test moderators to tailor alert delivery to when it is most beneficial. The aims of the project are to (1) determine the effect of notifications targeting existing inappropriate DOAC prescriptions; (2) examine the effect of alerts on newly prescribed inappropriate DOACs; and (3) examine changes in the magnitude of effects over time for both the new prescription alerts and existing prescription notifications for inappropriate DOACs over the 18-month study period. DISCUSSION: Findings from this project will establish a framework for implementing prescriber-pharmacist collaboration for high-risk medications, including anticoagulants. If effectively implemented at the more than 3000 anticoagulation clinics that exist nationally, hundreds of thousands of patients taking direct oral anticoagulants stand to benefit from safer, evidence-based healthcare. TRIALS REGISTRATION: NCT05351749. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13012-023-01273-4. BioMed Central 2023-05-15 /pmc/articles/PMC10184412/ /pubmed/37189171 http://dx.doi.org/10.1186/s13012-023-01273-4 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Study Protocol Smith, Shawna N. Lanham, Michael Seagull, F. Jacob Dorsch, Michael Errickson, Josh Barnes, Geoffrey D. Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial |
title | Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial |
title_full | Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial |
title_fullStr | Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial |
title_full_unstemmed | Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial |
title_short | Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial |
title_sort | implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial |
topic | Study Protocol |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10184412/ https://www.ncbi.nlm.nih.gov/pubmed/37189171 http://dx.doi.org/10.1186/s13012-023-01273-4 |
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