Impact of health information exchange access on medication management recommendations in a community-based pharmacy setting

Abstract

BackgroundCommunity-based pharmacists have historically lacked access to electronic medical records and clinical markers. Research was needed to assess the impact of obtaining clinical markers from a health information exchange (HIE) on pharmacist recommendations during a medication management encounter. ObjectiveThe objective of this project was to quantify and characterize clinical recommendations by pharmacists, resident pharmacists, or student pharmacists within an independent pharmacy setting that had access to patient information via an HIE. Practice descriptionMoose Pharmacy is one of few community pharmacies in North Carolina with access to a large health-system HIE. Practice innovationThis cohort study reviewed data over 4 months. Patients were identified for medication management based on filling eligible medications for atherosclerotic cardiovascular disease (ASCVD), hypertension, diabetes, dyslipidemia, or heart disease. Pharmacy personnel used the HIE to acquire laboratory test results. At the medication management appointment, the pharmacist collected blood pressure (BP), assessed smoking history, and medication/disease concerns. ASCVD risk score, statin therapy, A1c, and BP were assessed. Follow-up with the patient or provider was determined, if needed, and documented. Evaluation methodsCollected records were reviewed to quantify the number and type of clinical recommendations made by the pharmacist, and their acceptance status by the prescriber. Descriptive analyses were used to analyze results. ResultsThirty-four encounters were included. Most participants had diabetes (n = 21, 62%) and hypertension (n = 31, 91%). Nearly one-third of encounters (n = 11, 32%) resulted in a pharmacist recommendation. Recommendations were for BP dose adjustments (n = 4, 36%), diabetes medication changes (n = 3, 27%), and statin initiations/escalations (n = 4, 36%). Four recommendations (36%) were accepted, with 1 requiring modifications from the provider; 3 recommendations (27%) were declined; and 3 recommendations (27%) were unanswered. ConclusionAccess to progress notes and laboratory values using an HIE enhanced the pharmacist’s ability to provide enhanced patient care recommendations during medication management consultations.