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

项目摘要/摘要 直接口服抗凝药物通常用于治疗或预防血栓形成情况，如 肺栓塞、深静脉血栓形成和心房颤动。然而，高达10%-15%的患者接受了 这些药物根据患者的肾或肝功能，潜在的相互作用而获得不安全的剂量 其他用药情况及服药适应症。警报系统可能有助于改进 以证据为基础的处方，但可能会带来负担。这项研究将通过以下方式改进现有的警报系统 测试鼓励处方健康护理提供者之间协作的增强(例如， 医生、执业护士)和在抗凝诊所工作的专业药剂师 对患者需求的动态长期监测，以及对循证指南的更新。合并 最先进的和以用户为中心的设计原则，处方医疗保健提供者将随机到 当患者服用不安全的抗凝剂时，不同类型的电子健康记录药物治疗会发出警报 处方药。我们将确定哪些警报在鼓励基于证据的处方方面最有效，以及 还将测试主持人，以量身定制警报发布时间，以确保基于证据的 开抗凝处方。该项目的具体目标是：(1)实施和评估电子健康记录 药物警报系统，通过处方医生和药师的合作，提高DOAC的安全处方；(2) 量身定做和改进药物警报传递，以最大限度地减少处方人员的负担，同时最大限度地提高有效性和 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。 药物会有变化。该项目的结果将为实施处方药建立一个框架- 药剂师合作开发高风险药物，包括抗凝剂。如果有效地在 全国现有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.