Implementing Prescriber-Pharmacist Collaborative Care for Evidence-based Anticoagulant Use

University of Michigan306 enrolled

Overview

The researchers hypothesize that existing-prescription notifications directed to pharmacists are more likely to lead to a prescription change than existing-prescription notifications directed to prescribers. Furthermore, the researchers hypothesize that the availability of a pharmacist referral option is associated with a higher rate of prescription changes for initial-prescription alerts that are directed to the prescriber at the time of initial-prescribing errors. Findings from this project will establish a framework for implementing prescriber-pharmacist collaboration for high risk medications, including anticoagulants

Please note that the 3rd and 4th outcome measures are conditional on the outcomes of the 1st and 2nd outcome measures respectively. Please note that enrollment of 300 will provide sufficient power to study. Study data was obtained through data downloads and not from individual participant interactions. Final data collection for all outcomes took place on Dec 15, 2024.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Enrollment

306

Conditions

Pulmonary Embolism Venous Thromboembolism Atrial Fibrillation

Interventions

New-prescription AlertBEHAVIORAL

An enhanced drug alert notification in the Michigan Medicine electronic health record (EHR) that is tailored to the specific type of inappropriate Direct Oral Anticoagulant (DOAC) use (e.g., dosing too high for renal dysfunction) and offers decision support to the prescriber to alter a newly prescribed DOAC prescription.

New-prescription Alert with referral optionBEHAVIORAL

An enhanced drug alert notification in the EHR that is tailored to the specific type of inappropriate DOAC use (e.g., dosing too high for renal dysfunction) and offers decision support to the prescriber to alter new DOAC prescription. This alert will ALSO include an option for referral to the anticoagulation clinic pharmacist for assistance.

Existing-prescription notification to prescriberBEHAVIORAL

Prescriber receives a notification through the EHR indicating an existing DOAC prescription may not be appropriate (e.g. due to renal function change, new drug-drug interactions), and recommending a prescription update.

Existing-prescription notification to pharmacistBEHAVIORAL

Pharmacist receives a notification through the EHR indicating an existing DOAC prescription may not be appropriate (e.g. due to renal function change, new drug-drug interactions), and recommending a prescription update.

Outcomes

Primary Outcomes

The Number (Proportion) of Notifications (in the Existing-prescription Notification Conditions) That Are Addressed Within 7 Days.

Existing-prescription notification conditions = Prescriber notification \& Pharmacist notification The number of notifications (in the existing-prescription notification conditions) that are addressed within 7 days/ total number of notifications

Time frame: Up to 7 days

Secondary Outcomes

The Number (Proportion) of Alerts (in the Newly Prescribed DOAC Alert Conditions) That Are Addressed Within 7 Days.

Newly prescribed DOAC alert conditions= Medication alert \& Medication alert + referral Data reported represents the number of alerts (in the newly prescribed DOAC alert conditions) that are addressed within 7 days/ total number of alerts

Time frame: Up to 7 days

Change in Effect Size for the Existing-prescription Notification Over Time

Reported on at the institution level (not individual level). Existing-prescription notification conditions = Prescriber notification \& Pharmacist notification The number of notifications (in the existing-prescription notification conditions) that are addressed within 7 days/ total number of notifications, shown over multiple time periods. This outcome measure analysis is based on the results of outcome #1.

Time frame: Month 0 to 19 months

Change in Effect Size for the Initial Alert Over Time

Reported on at the institution level (not individual level). Newly prescribed DOAC alert condition= Medication alert \& Medication alert + referral The number of new prescription alerts that are addressed within 7 days/ total number of alerts, shown over multiple time periods. This outcome measure analysis is based on the results of outcome #2.