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

项目总结/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、深静脉血栓形成和心房纤颤。然而，高达10-15%的患者接受 这些药物根据患者的肾脏或肝脏功能，与药物的潜在相互作用， 其他药物，以及服用药物的适应症。警报系统可能有助于改善 基于证据的处方，但可能是负担。这项研究将改善现有的警报系统， 测试鼓励开处方的卫生保健提供者之间协作的增强（例如， 医生，执业护士）和专家药剂师在抗凝诊所工作， 对患者需求的动态长期监测，以及循证指南的更新。结合 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至 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在鼓励循证处方方面最有效， 还将测试主持人，以调整警报交付时，它最有益的，以确保基于证据的 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，以改善安全的DOAC处方，通过处方药师的合作;（2） 定制和改进药物警报传递，以最大限度地减少处方者负担，同时最大限度地提高疗效， 可操作性;和（3）评估患者对抗凝药剂师参与的接受程度和障碍 药物变化。该项目的结果将建立一个实施处方药的框架- 药剂师协作，用于高风险药物，包括抗凝剂。如果能有效执行， 全国有3000多家抗凝诊所，数十万患者直接口服 抗凝剂将受益于更安全、循证的医疗保健。

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.