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.
Highlights
It is estimated that prescribers caring for older adults (PCOAs) raise about two clinical questions for every patient seen during an encounter, and drug information typically accounts for the largest proportion of these questions [1]
While more research is needed to determine whether pharmacist-provided drug information to PCOA results in improved patient outcomes, we showed that pharmacists’ recommendations were implemented at a high frequency (80%) and resulted in drug regimen alterations
We found that inquiries made by non-physician prescribers and physicians were not significantly different in terms of motivations and needs, which suggests that the value of pharmacist collaboration may transcend both prescriber role and practice experience
Summary
It is estimated that prescribers caring for older adults (PCOAs) raise about two clinical questions for every patient seen during an encounter, and drug information typically accounts for the largest proportion of these questions [1]. For patient care, PCOAs have indicated that they do not find or pursue answers to about 50% of their questions [1]. Writing prescriptions in spite of unmet drug information needs can lead to poor care quality and adverse drug events, both of which disproportionately affect older adults [1,2,3,4,5,6]. Evidence indicates that when prescribers have an opportunity to collaborate with pharmacists, they pose drug information inquiries (DIIs) [7,8,9,10,11]. Information-seeking behavior can improve prescribing practices and patient outcomes, such as mortality [12,13,14,15]
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