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

基本信息

批准号：
10487496
负责人：
Geoffrey Douglas Barnes
金额：
$ 44.9万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
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/10487496
关键词：
Implementing Prescriber Pharmacist Collaborative Care

Implementing Prescriber Pharmacist Collaborative Care

项目摘要

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.

项目摘要/摘要直接口服抗凝药物通常用于治疗或预防血小板状况，例如肺栓塞，深静脉血栓形成和心房颤动。但是，多达10-15％的接受患者这些药物根据患者的肾脏或肝功能，不安全剂量，潜在的相互作用其他药物以及服用药物的指示。警报系统可能有益于改善基于证据的处方，但可能是繁重的。这项研究将通过测试增加的增强，以鼓励开处方医疗保健提供者之间的合作（例如医师，护士从业人员）和在抗凝诊所工作的专家药剂师并合并动态的长期监控患者需求以及基于证据的指南的更新。合并处方医疗保健提供商将随机分配给最先进的和以用户为中心的设计原则当患者患有不安全抗凝剂时，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最有效地鼓励基于证据的处方，以及还将测试主持人，以量身定制警报交付，以确保基于证据的情况最有益抗凝处方。该项目的具体目的是（1）实施和评估EHR 用药物警报系统通过处方药物合作来改善安全DOAC处方；（2）量身定制和完善药物警报交付，以最大程度地减轻处置额负担，同时最大程度地提高有效性和可行性；（3）评估患者接受抗凝药剂师参与的患者接受和障碍用药改变。该项目的调查结果将建立一个实施处方者的框架 - 高风险药物的药剂师合作，包括抗凝剂。如果有效地实施在全国存在的3000多个抗凝诊所，成千上万的患者直接口服抗凝剂将从更安全的基于证据的医疗保健中受益。