Prescriber-Initiated Engagement of Pharmacists for Information and Intervention in Programs of All-Inclusive Care for the Elderly

Abstract

Little is known about the types of drug information inquiries (DIIs) prescribers caring for older adults ask pharmacists during routine practice. The objective of this research was to analyze the types of DIIs prescribing clinicians of Programs of All-Inclusive Care for the Elderly (PACE) made to clinical pharmacists during routine patient care. This was a retrospective analysis of documented pharmacists’ encounters with PACE prescribers between March through December, 2018. DIIs were classified using a developed taxonomy that describes prescribers’ motivations for consulting with pharmacists and their drug information needs. Prescribers made 414 DIIs during the study period. Medication safety concerns motivated the majority of prescribers’ inquiries (223, 53.9%). Inquiries received frequently involved modifying drug therapy (94, 22.7%), identifying or resolving adverse drug events (75, 18.1%), selecting or adjusting doses (61, 14.7%), selecting new drug therapies (57, 13.8%), and identifying or resolving drug interactions (52, 12.6%). Central nervous system medications (e.g., antidepressants and opioids), were involved in 38.6% (n = 160) of all DIIs. When answering DIIs, pharmacists made 389 recommendations. Start alternative medications (18.0%), start new medications (16.7%), and change doses (12.1%) were the most frequent recommendations rendered. Prescribers implemented at least 79.3% (n = 268) of recommendations based on pharmacy records (n = 338 verifiable recommendations). During clinical practice, PACE prescribers commonly ask pharmacists a variety of DIIs, largely related to medication safety concerns. In response to these DIIs, pharmacists provide medication management recommendations, which are largely implemented by prescribers.

Association of a Novel Medication Risk Score with Adverse Drug Events and Other Pertinent Outcomes Among Participants of the Programs of All-Inclusive Care for the Elderly

“…Underscoring these challenges, a recent study found that PACE physicians and nurse practitioners frequently initiated consultation with pharmacists for information and advice when faced with medication safety uncertainties [16]. Notably, their inquiries commonly pertained to opioids and psychoactive drugs [16], which are medication classes responsible for the disproportionate amount of ADE claims identified in the present study.…”

“…The CDSS helps pharmacists identify and resolve specific medication-related problems [12] as well as optimize medication regimens based on available pharmacogenomic information [15]. Prescribers and pharmacists commonly collaborate to improve medication safety and reduce ADE risk [12,16].…”

Evaluating the Impact of Medication Risk Mitigation Services in Medically Complex Older Adults

“…While this is likely the biggest contributor to the reduction in costs here than what was reported by Stein et al, other ancillary components of MRM that are unavailable in the EMTM setting could also help explain this difference. For example, adherence support services, pharmacogenomic consultations, and prescriber-initiated engagement of PACE pharmacists for drug information are all expected to optimize regimens and improve outcomes [ 13 , 44 , 45 ]. Future research must evaluate which MRM components are most impactful to economic and clinical outcomes.…”

“…Clinical pharmacists provide expert advice to prescribers needing drug information prior to making a clinical decision [ 13 ].…”

“…MRM encompasses a suite of clinical pharmacy services and technological solutions that aim to optimize medication use in vulnerable older adults. Specifically, MRM services and solutions include ADE risk stratification [ 10 ]; clinical decision support software (CDSS) that aids pharmacists in the optimization of medication regimens [ 11 ]; pharmacogenomic (PGx) assessments [ 12 ]; provision of expert drug information to PACE prescribers [ 13 ]; and comprehensive medication adherence support. Until now, no controlled study has evaluated the impact of MRM services on economic outcomes in PACE.…”