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

为循证抗凝药物的使用实施处方者-药剂师协作护理

• 批准号: 10330852
• 负责人: Geoffrey Douglas Barnes
• 金额: $ 45万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10330852
• 关键词: Implementing; Prescriber; Pharmacist; Collaborative; Care

Project Summary/Abstract 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. This study will improve upon existing alert systems by testing augmentations that encourage collaboration between prescribing health care providers (e.g., physicians, nurse practitioners) and expert pharmacists working in anticoagulation clinics and incorporating dynamic long-term monitoring of patient needs, as well as updates to evidence-based guidelines. Incorporating state-of-the-art and 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 also test moderators to tailor alert delivery to when it most beneficial to ensure evidence-based anticoagulation prescribing. The specific aims of the project are to (1) implement and evaluate an EHR medication alert system to improve safe DOAC prescribing through prescriber-pharmacist collaboration; (2) tailor and refine medication alert delivery to minimize prescriber burden while maximizing effectiveness and actionability; and (3) assess patient acceptance of and barriers to anticoagulation pharmacist involvement in medication changes. 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.

项目概要/摘要 直接口服抗凝药物通常用于治疗或预防血栓性疾病，例如 肺栓塞、深静脉血栓和心房颤动。然而，高达 10-15% 的接受治疗的患者 根据患者的肾功能或肝功能，这些药物的剂量不安全，与潜在的相互作用 其他药物，以及服用该药物的指示。警报系统可能有助于改善 循证处方，但可能会很麻烦。这项研究将通过以下方式改进现有的警报系统 测试鼓励处方医疗保健提供者之间合作的增强措施（例如， 医生、执业护士）和在抗凝诊所工作的专业药剂师，并将 对患者需求的动态长期监测以及循证指南的更新。纳入 最先进和以用户为中心的设计原则，处方医疗保健提供者将被随机分配 当患者使用不安全的抗凝剂时，不同类型的电子健康记录药物警报 处方。我们将确定哪些警报对于鼓励循证处方最有效，并且 还将测试主持人以调整警报发送到最有利于确保基于证据的时间 抗凝处方。该项目的具体目标是 (1) 实施和评估 EHR 药物警报系统，通过处方者与药剂师合作提高 DOAC 处方的安全性； (2) 定制和完善药物警报交付，以最大限度地减少处方者的负担，同时最大限度地提高有效性和 可操作性； (3) 评估患者对抗凝药剂师参与的接受度和障碍 药物变化。该项目的调查结果将建立一个实施处方者的框架 高风险药物（包括抗凝剂）的药剂师合作。如果有效实施 全国有3000多家抗凝诊所，数十万患者直接口服药物 抗凝剂将从更安全、循证的医疗保健中受益。