Implementing Prescriber-Pharmacist Collaborative Care for Evidence-based Anticoagulant Use

The researchers hypothesize that existing-prescription notifications directed to pharmacists are more likely to lead to a prescription change than existing-prescription notifications directed to prescribers. Furthermore, the researchers hypothesize that the availability of a pharmacist referral option is associated with a higher rate of prescription changes for initial-prescription alerts that are directed to the prescriber at the time of initial-prescribing errors. Findings from this project will establish a framework for implementing prescriber-pharmacist collaboration for high risk medications, including anticoagulants

Please note that the 3rd and 4th outcome measures are conditional on the outcomes of the 1st and 2nd outcome measures respectively. Please note that enrollment of 300 will provide sufficient power to study.

An enhanced drug alert notification in the Michigan Medicine electronic health record (EHR) that is tailored to the specific type of inappropriate Direct Oral Anticoagulant (DOAC) use (e.g., dosing too high for renal dysfunction) and offers decision support to the prescriber to alter a newly prescribed DOAC prescription.

An enhanced drug alert notification in the EHR that is tailored to the specific type of inappropriate DOAC use (e.g., dosing too high for renal dysfunction) and offers decision support to the prescriber to alter new DOAC prescription. This alert will ALSO include an option for referral to the anticoagulation clinic pharmacist for assistance.

Prescriber receives a notification through the EHR indicating an existing DOAC prescription may not be appropriate (e.g. due to renal function change, new drug-drug interactions), and recommending a prescription update.

Pharmacist receives a notification through the EHR indicating an existing DOAC prescription may not be appropriate (e.g. due to renal function change, new drug-drug interactions), and recommending a prescription update.

The number (proportion) of notifications (in the existing-prescription notification conditions) that are addressed within 7 days.

The number (proportion) of alerts (in the newly prescribed DOAC alert conditions) that are addressed within 7 days.

Reported on at the institution level (not individual level). Existing-prescription notification conditions = Prescriber notification & Pharmacist notification This outcome measure analysis is based on the results of outcome #1.

Reported on at the institution level (not individual level). Newly prescribed DOAC alert condition= Medication alert & Medication alert + referral This outcome measure analysis is based on the results of outcome #2.

Prescribers: Inclusion Criteria: Michigan Medicine provider with prescribing privileges Providers in ambulatory care settings Prescribe DOAC to patients 18 years and older Exclusion Criteria: Providers in inpatient settings Providers who are members of the study team