Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial.
Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial.
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DOI：
10.1186/s13012-023-01273-4
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发表时间：
2023-05-15
影响因子：
7.2
通讯作者：
Barnes, Geoffrey D. D.
中科院分区：
文献类型：
--
作者：
Smith, Shawna N. N.;Lanham, Michael;Seagull, F. Jacob;Dorsch, Michael;Errickson, Josh;Barnes, Geoffrey D. D.
直接口服抗凝药物通常用于治疗或预防血栓性疾病，如肺栓塞、深静脉血栓形成和心房颤动。然而，根据患者的肾脏或肝脏功能、与其他药物的潜在相互作用以及服用药物的适应症，多达10-15%的患者接受这些药物的剂量是不安全的。警报系统可能有利于改善循证处方，但可能会造成负担，而且目前无法在初始处方编写后提供监测。这项研究将改进现有的警报系统，通过测试新的药物警报，鼓励处方者（如医生、执业护士、医师助理）和在抗凝诊所工作的专家药剂师之间的合作。该研究还将改进现有的警报系统，纳入对患者需求的动态长期监测，并鼓励在抗凝诊所工作的开处方者和专业药剂师之间的合作。结合最先进的以用户为中心的设计原则，当患者使用不安全的抗凝药物处方时，处方医疗保健提供者将被随机分配到不同类型的电子健康记录药物警报。我们将确定哪些警报在鼓励循证处方方面最有效，并将测试管理员，以便在最有益的时候定制警报发送。该项目的目的是：(1)确定针对现有不适当DOAC处方的通知的效果；(2)检查警报对新规定的不适当doac的影响；(3)在18个月的研究期间，检查新处方警报和现有处方通知对不适当doac的影响程度随时间的变化。该项目的研究结果将建立一个框架，用于实施高风险药物（包括抗凝剂）的处方-药剂师合作。如果在全国3000多家抗凝诊所有效实施，数十万直接口服抗凝剂的患者将受益于更安全、循证的医疗保健。NCT05351749。在线版本包含补充资料，下载地址：10.1186/s13012-023-01273-4。
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. 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. 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. NCT05351749. The online version contains supplementary material available at 10.1186/s13012-023-01273-4.
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影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
DOI：
10.1093/jamia/ocv159
发表时间：
2016-05-01
影响因子：
6.4
作者：
Awdishu, Linda;Coates, Carrie R.;El-Kareh, Robert
通讯作者：
El-Kareh, Robert
影响因子：
1.8
作者：
Murphy, A;Kirby, A;Bradley, C
通讯作者：
Bradley, C
影响因子：
9.6
作者：
Kearon, Clive;Akl, Elie A.;Moores, Lisa
通讯作者：
Moores, Lisa