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- Adverse Drug Events (ADE) (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 6 of 6 Research Studies DisplayedKaufman BG, Holland DE, Vanderboom CE
Multicomponent pharmacist intervention did not reduce clinically important medication errors for ambulatory patients initiating direct oral anticoagulants.
The aim of this randomized controlled trial study was to evaluate the effectiveness of a multicomponent intervention for decreasing clinically important medication errors (CIMEs). The researchers included ambulatory patients beginning a DOAC or resuming one after a complication. The intervention included pharmacist evaluation and monitoring based on the implementation of a recently published checklist. The primary measure was anticoagulant-related CIMEs and non-anticoagulant-related CIMEs over 90 days from DOAC initiation. Primary variables included evaluation of the appropriateness of DOAC, need for DOAC affordability assistance, three pharmacist-initiated telephone consultations, access to a DOAC hotline, documented hand-off to the patient's continuity provider, and monitoring of follow-up laboratory tests. A total of 561 patients contributed 479 anticoagulant-CIMEs including 31 preventable and ameliorable ADEs and 448 significant anticoagulant medication errors without subsequent documented ADEs. The most common anticoagulant-related CIMEs were failure to perform required blood tests and concurrent, inappropriate usage of a DOAC with aspirin or NSAIDs despite pharmacist documentation systematically identifying these issues when present. There was no reduction in anticoagulant-related CIMEs among intervention patients or non-anticoagulant-related CIMEs.
AHRQ-funded; HS02592401.
Citation: Kaufman BG, Holland DE, Vanderboom CE .
Multicomponent pharmacist intervention did not reduce clinically important medication errors for ambulatory patients initiating direct oral anticoagulants.
J Gen Intern Med 2023 Dec; 38(16):3526-34. doi: 10.1007/s11606-023-08315-z..
Keywords: Provider: Pharmacist, Medication, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Blood Thinners, Medication: Safety, Patient Safety
Ranusch A, Lin YJ, Dorsch MP
Role of individual clinician authority in the implementation of informatics tools for population-based medication management: qualitative semistructured interview study.
The objective of this study was to examine how individual authority of clinical pharmacists and anticoagulation nurses is affected by the implementation success of an electronic health record (EHR) direct oral anticoagulant (DOAC) Dashboard for safe DOAC medication prescribing. Researchers conducted semistructured interviews with pharmacists and nurses after the implementation of the EHR DOAC Dashboard at three clinical sites. Results showed that a high level of individual clinician authority was associated with high levels of key facilitators for effective use of the DOAC Dashboard; conversely, a lack of individual authority was associated with key barriers to effective use. The researchers concluded that increased individual clinician authority is a necessary antecedent to the effective implementation of an EHR DOAC Population Management Dashboard.
AHRQ-funded; HS026874.
Citation: Ranusch A, Lin YJ, Dorsch MP .
Role of individual clinician authority in the implementation of informatics tools for population-based medication management: qualitative semistructured interview study.
JMIR Hum Factors 2023 Oct 24; 10:e49025. doi: 10.2196/49025..
Keywords: Medication, Provider: Pharmacist, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Nurse, Blood Thinners
Smith SN, Lanham M, Seagull FJ
Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial.
This article described a study designed to improve existing alert systems for direct oral anticoagulant medications (DOAC) by testing novel alerts that encourage collaboration between prescribers and expert pharmacists working in anticoagulation clinics. Its goals were to determine the effect of notifications targeting existing inappropriate DOAC prescriptions, to examine the effect of alerts on newly prescribed inappropriate DOACs, and to examine changes in the magnitude of effects over time for both the new and existing prescription alerts. Prescribing healthcare providers would be randomized to different types of electronic health record medication alerts when a patient has an unsafe anticoagulant prescription; the authors identified which alerts are most effective at encouraging evidence-based prescribing.
AHRQ-funded; HS028562.
Citation: Smith SN, Lanham M, Seagull FJ .
Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial.
Implement Sci 2023 May 15; 18(1):16. doi: 10.1186/s13012-023-01273-4..
Keywords: Provider: Pharmacist, Blood Thinners, Medication, Evidence-Based Practice
Wilson AS, Pham T, Mbusa D
Pharmacist-led, checklist intervention did not improve adherence in ambulatory patients starting/resuming DOACs.
This study’s aim was to determine whether checklist-driven care from a clinical pharmacist improved adherence in ambulatory patients starting a direct-acting anticoagulant (DOAC) or resuming it after a setback (thromboembolic event or bleeding) in an ambulatory setting. Clinical pharmacists using the DOAC checklist verified DOAC appropriateness, instructed dose de-escalation, educated through 3 tele-visits, fielded hotline calls, and handed off to a continuity provider after 3 months. Coupons and help with completing manufacturer-based medication assistance applicants were made available to intervention and control patients. Using pharmacy dispense records, the authors measured medication possession ratio (MPR) at 90 days (primary outcome) and proportion of days covered (PDC) at 90 days and MPR and PDC at 180 and 365 days (secondary outcomes). Of the 561 patients randomized, only 427 had sufficient records to analyze. Adherence was high with only 41 patients having MPR less than 80% at 90 days. There was no difference in adherence between intervention and control patients for primary outcome (odds ratio 0.94)) or secondary outcomes. The authors felt that given the already high levels of adherence in both study groups, reassessing the DOAC checklist outside of a traditional trial may be more fruitful.
AHRQ-funded; HS02592401.
Citation: Wilson AS, Pham T, Mbusa D .
Pharmacist-led, checklist intervention did not improve adherence in ambulatory patients starting/resuming DOACs.
J Am Pharm Assoc 2023 May-Jun; 63(3):878-84.e3. doi: 10.1016/j.japh.2023.02.019..
Keywords: Provider: Pharmacist, Patient Adherence/Compliance, Blood Thinners, Medication
Pham T, Patel P, Mbusa D
Impact of a pharmacist intervention on DOAC knowledge and satisfaction in ambulatory patients.
This randomized clinical trial’s goal was to assess the impact on knowledge and satisfaction of an intervention framed around a newly developed direct oral anticoagulants (DOAC) Checklist to guide and educate patients initiating or resuming DOACs. The cohort included ambulatory patients starting a DOAC or resuming one after setback (bleeding, stroke, or transient ischemic attack) in an ambulatory setting (office, emergency department, or short stay hospitalization). The study included three educational clinical pharmacist tele-visits, hotline access to the pharmacist, and coordination with continuity providers in 3 months. An abbreviated version of the Duke Anticoagulation Satisfaction Survey was administered to 463 patients. Scores were similar for the 233 intervention patients vs. 203 control patients (63.7% vs 62.2% correct). Satisfaction scores on the 7-point Likert scale were also virtually identical. The pharmacist-led intervention framed around the DOAC checklist had little impact on knowledge and satisfaction. There were delays between the intervention end and completion of the follow-up questionnaires, which may have obscured benefits experienced earlier.
AHRQ-funded; HS026859.
Citation: Pham T, Patel P, Mbusa D .
Impact of a pharmacist intervention on DOAC knowledge and satisfaction in ambulatory patients.
J Thromb Thrombolysis 2023 Feb;55(2):346-54. doi: 10.1007/s11239-022-02743-0.
Keywords: Provider: Pharmacist, Blood Thinners, Medication, Patient Experience, Ambulatory Care and Surgery
Jones AE, King JB, Kim K
The role of clinical pharmacy anticoagulation services in direct oral anticoagulant monitoring.
The objective of this study was to describe direct oral anticoagulant (DOAC) management in patients who were and were not managed by an anticoagulation management service (AMS). Subjects were patients with atrial fibrillation at the University of Utah Health (UUH) who received DOAC therapy. Results showed that patients managed by AMS providers were more complex and had more frequent encounters regarding their DOAC therapy than those managed by non-AMS providers. However, there was evidence of duplicative DOAC therapy management efforts. No difference between AMS and non-AMS groups in the composite clinical endpoint was detected.
AHRQ-funded; HS026156.
Citation: Jones AE, King JB, Kim K .
The role of clinical pharmacy anticoagulation services in direct oral anticoagulant monitoring.
J Thromb Thrombolysis 2020 Oct;50(3):739-45. doi: 10.1007/s11239-020-02064-0..
Keywords: Blood Thinners, Medication, Provider: Pharmacist, Provider, Care Management, Healthcare Delivery