Effect of Providing Pharmacists with Patient Diagnosis on Electronic Prescription Orders: A Pilot Study

Abstract

Specific Aims: To evaluate the effect on the incidence and nature of pharmacists’ drug utilization review (DUR) interventions of including patient diagnosis on electronic prescription (e-prescription) orders. Methods: This prospective pre-post evaluation was conducted in the outpatient pharmacy of a federally funded community health center over two consecutive four-week periods. During the pre-phase, a clinical pharmacist in the clinic’s onsite pharmacy prospectively reviewed the e-prescriptions received from the clinic’s primary care providers using a standard prospective DUR process and recorded all therapy-related interventions. In the post-phase, providers added a diagnosis on each e-prescription. Interventions were documented using a standard intervention form that has been used in previous research. Chi square and t-tests were used to assess the nominal and interval data, respectively (α=0.05). The Institutional Review Boards of the two collaborating universities approved the study. Main Results: Pharmacist intervention rates on problematic e-prescription orders significantly decreased (4% pre vs. 1% post, p<0.001). Drug-drug interactions (17.5% pre vs. 20% post) and missing information (15% pre vs. 20% post) were the most frequently cited problems that prompted the need for the pharmacist’s intervention. The medication classes most frequently involved in interventions were antibiotics (53% pre vs. 50% post) and central nervous system agents (17% pre vs. 10% post). After receiving clarification, the pharmacist most often dispensed the prescription (33.3% pre vs. 38.4% post) and educated the patient regarding their treatments (18.8% pre vs. 7.7% post). Conclusions: In this small pilot project, including the patient’s diagnosis on e-prescription orders significantly reduced the incidence of pharmacists’ DUR-related interventions. If duplicated in larger studies, our results suggest that providing pharmacists with additional targeted clinical information could reduce confusion and uncertainty thereby decreasing the number of unnecessary pharmacist contacts with prescribers and improving workflow and efficiency for both.