Computerized Decision Support Improves Medication Review Effectiveness: An Experiment Evaluating the STRIP Assistant’s Usability

When physicians prescribe medications to patients with certain disease states, there is no way of determining whether the medication that is being prescribed will work for the patient. For example, obtaining adequate control of chronic disease states may involve a process of testing different medications on a patient until one can be deemed as an appropriate treatment option. There are different programs that have been established in the past to provide aid to physicians looking to initiate therapy options on a patient; however, they have not been proven to cause changes in care that lead to clinically significant improvement. For this reason, a new tool referred to as STRIP (Systemic Tool to Reduce Inappropriate prescribing) has been developed to optimize the prescribing process by conducting medication reviews in the primary care setting. This program is a computer-based technology that allows physicians to analyze patients medication histories and preferences to determine the best form of therapy.

In this study, 42 physicians were asked to optimize medical records of patients utilizing multiple medications by both the traditional manner and by the STRIP analysis. Utilization of the STRIP assistance program was linked to an increase in the number of appropriate medication decisions (to 76% from 58% without). Along with this, physicians on average spent more time meeting with patients and discussing treatment options using the program. The only major negative result gathered from the study was the fact that it received a below-average score by physicians examining the usability of the system. Therefore, the STRIP assistance program was determined to be an effective tool for providing medication reviews.

I believe this study is important because it shows how one of the main roles of a pharmacist (providing medication reviews) benefits the overall experience that a patient will have with their medication. I believe having systems like this in place to aid physicians in the process of decision making will allow pharmacists to eventually become more active in the process of prescribing medications. This is something that I think is important due to the amount of knowledge that pharmacists have about medications. Optimization of prescribing methods will not only benefit the health of the individual receiving the medication, but it will also ensure that we are limiting the cost that adverse effects from drugs have on the health care system. I believe that the role of a pharmacist will only continue to expand over the next couple of decades, and as a result, the profession will be more respected by the public.

Impact of pharmacist-led educational and error notification interventions on prescribing errors in a family medicine clinic

Studies have shown that up to 21% of prescriptions have one or more prescribing errors.  These errors not only create potentially harmful situations for patients, they also increase a pharmacist’s workload.  This problem is potentially due to the small amount of classes given in medical schools for therapeutics and how to write prescriptions.

This study was conducted at a family medicine clinic and observed twenty-four resident physicians and the prescriptions they wrote while conducting outpatient visits.  In the study, the rate of prescription errors for the resident physicians was observed before and after interventions to prevent these errors were put into place.  The interventions included a prescribing educational program, audits and feedback for prescriptions each resident filled and weekly newsletters that included the most common errors, examples of the errors, ways to correct the errors, etc.  These interventions were given for three months.  The assessments of the prescriptions occurred one year apart so that prescribing habits and seasonal illnesses would not differ.

The results of the study showed that overall prescription errors went down 4.1%, from 18.6% to 14.5%.  The study also showed that the pediatric prescription rates for the physicians who took part in the educational program were 36% lower than the error rates of physicians that did not participate.

I found this study interesting because I have firsthand knowledge of how many errors prescribers make.  Working in a retail pharmacy, I see these mistakes in all types of prescriptions.  While mistakes do happen, doctors are just humans, a lot of the mistakes could be prevented just by double checking the prescription and by knowing the proper way to write a prescription and proper dosing for certain medications.  These interventions only took three months and errors went down by over 4%.  Errors not only affect patients, but they also cause increase work for pharmacists and their staff and the doctors that eventually need to fix the mistakes.  By implementing interventions, a lot of time and frustration can ben avoided and patient safety can increase.

Winder, MB, Johnson JL, Planas LG, et al. Impact of Pharmacist-led Educational and Error Notification Interventions on Prescribing Errors in a Family Medicine Clinic. J Am Pharm Assoc. 2015;55(3): 238-45.

http://www.japha.org/article/S1544-3191(15)30054-6/fulltext

The Need for More Education on Prescribing Opioids

When hearing the term “opioids” several ideas come to mind: addiction, abuse, under-treatment, overtreatment, severe pain, and suspicion are just a few. Opioids are undoubtedly an extremely successful route of treatment for severe pain and play a huge role in daily pain management cases. However, there is always a discussion of the risks associated with prescribing this medication.

There is often an air of distrust between physician and patient when a patient insists on opioid therapy. Unfortunately, pain cannot be measured, and there needs to be trust when prescribing this drug class. The prescriber will not know if the patient really needs the opioid for pain management or if they have developed a dependence on it. The physician is put in a position where they could under-treat the patient by refusing therapy because of the risk of abuse, or they could over-treat the patient by believing their plea for a medication they were addicted to.

There are several guidelines already in place regarding opioid prescribing, but still, much of it is up to the physician’s discretion. Right now, there is a big push for more prescriber education on the topic. For example, in 2012, the FDA encouraged a single shared Risk Evaluation and Mitigation Strategy (REMS) which required manufacturers of extended release or long acting opioids to fund accredited education on safe opioid prescribing. Currently, this program has not reached its goal number of prescribers. However, I believe with the advancement of this program, physicians will be able to make more educated and thorough decisions when it comes to prescribing opioids.

Managing pain is extremely complex, yet education on the topic is lacking. The ultimate goal would be to maintain a patient-centered approach and treat the patient in a manner in which they are comfortable and compliant with. Perhaps with more education on the topic, the physician and pharmacist can work together to make a confident decision in how to proceed with drug therapy, and hopefully avoid the mistakes that have been occurring concerning opioid therapy.

I personally see this as an opportunity for pharmacists to get more involved in the prescribing process, as they have a stronger background education on the topic. Do you think this could play a role in pharmacists eventually gaining prescribing rights?

 

Read the full article here.

Alford, Daniel P.  Opioid Prescribing for Chronic Pain — Achieving the Right Balance through Education. N Engl J Med. 2016;374:301-3

 

Inappropriate Antibiotic Prescribing

Researchers designed a randomized clinical trial to study and intervene with wrongly prescribed antibiotics specifically during ambulatory visits for patients with acute respiratory tract infections. The study began in November of 2011 through October of 2012 and the last follow up occurred on April of 2014. Each intervention was studied over an eighteen-month period to compare the new prescribing rates to those prior to physician intervention. Some changes made with prescribers included an “accountable justification,” which meant that the physician had to describe a reason for prescribing the patient and antibiotic. Additionally, “peer comparison” was a system that sent out emails containing the top performing clinicians who had prescribed the least amount of antibiotics. The results of the study indicated an 11% decrease in antibiotic prescribing rates leading to a 13.1% rate.

These results are significant because it proves that antibiotics are over prescribed in the ambulatory setting. Over prescribing medications for patients is a huge issue for multiple reasons. Adding additional, unnecessary drugs can cause an increase in complications of adverse effects and drug interactions that will negatively affect the patient’s health. Additionally, increasing the number of medications a patient is required to take can discourage their attitudes about health and hinder their financial stability. Double checking and ensuring that a certain medication is and should be a vital part of every prescriber’s day to avoid any unnecessary complications.

JAMA. 2016;315(6):562-570.