Evidence map›Paper›PMID 41398697›Full record

Trial reportImplementation science : IS2025

Implementing prescriber-pharmacist collaboration to improve evidence-based medication prescribing using asynchronous, non-interruptive electronic health record notifications.

Geoffrey D Barnes, Seo Youn Choi, Michael Sm Lanham, Michael P Dorsch, Joshua Errickson, Morris Fabbri, Anish Saraswat, F Jacob Seagull, Shawna N Smith

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Implementation science : IS, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05351749 (Implementing Prescriber-Pharmacist Collaborative Care for Evidence-based Anticoagulant Use), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05351749 nacompletednot on this map

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

TypeinterventionalSponsorUniversity of MichiganRan2022 to 2024Enrolled306ConditionsPulmonary Embolism, Venous Thromboembolism, Atrial FibrillationArmsNew-prescription Alert, New-prescription Alert with referral option, Existing-prescription notification to prescriber, Existing-prescription notification to pharmacist
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Trial
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Geoffrey D BarnesFrankel Cardiovascular Center and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. gbarnes@umich.edu.ORCID 0000-0002-6532-8440
Seo Youn ChoiSchool of Public Health, University of Michigan, Ann Arbor, MI, USA.
Michael Sm LanhamDepartment of Learning Health Sciences, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
Michael P DorschCollege of Pharmacy, Frankel Cardiovascular Center and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Joshua ErricksonDepartment of Statistics, Consulting for Statistics, Computing & Analytics Research, University of Michigan, Ann Arbor, MI, USA.
Morris FabbriCenter for History, Humanities, Arts, Social Sciences and Ethics in Medicine, University of Michigan, Ann Arbor, MI, USA.
Anish SaraswatUniversity of Michigan Medical School, Ann Arbor, MI, USA.
F Jacob SeagullCenter for History, Humanities, Arts, Social Sciences and Ethics in Medicine, University of Michigan, Ann Arbor, MI, USA.
Shawna N SmithSchool of Public Health and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.

Funding

AHRQ HHS R18 HS028562AHRQ HHS R18HS028562
6 · The paper itself

Abstract

backgroundInappropriate prescribing of Direct Oral Anticoagulants (DOACs) is a leading cause of adverse outcomes. Electronic health record (EHR)-based notification strategies may support evidence-based prescribing and reduce adverse events. Engaging clinical pharmacists (vs. prescribers) through EHR-based notifications that review inappropriate DOAC prescribing may be an effective strategy for ensuring evidence-based medication prescribing.

methodsWe conducted a pragmatic, single-center, parallel-group, randomized implementation trial using notifications (asynchronous EHR-based notifications) to prompt correction of inappropriate DOAC prescriptions that had arisen after the initial prescription of the DOAC (e.g., due to changes in patient condition). Notifications were sent for adult ambulatory patients with DOAC prescriptions not adhering to the package insert instructions or having significant drug-drug interactions. Notifications directed either to the prescribing clinician or to the clinical anticoagulation pharmacist, randomized at the prescriber level. The primary outcome was the proportion of notifications adopting any prescription change within 7 days. Moderator analyses examined the influence of prescriber, patient, and prescription characteristics.

resultsFrom May 2023 to December 2024, 388 notifications for potentially inappropriate DOAC prescriptions among 183 prescribers were analyzed. Overall, 23.2% of notifications led to a prescription change within 7 days, 26% among prescriber-directed and 21% among pharmacist-directed notifications (p = 0.36). Nearly all (97.8%) changes made were clinically appropriate changes aligned with notification recommendations. Subgroup and moderator analyses showed that pharmacists made more changes than prescribers when errors were further from dosing cutoffs and managed cases with polypharmacy or complex thresholds more consistently. Clinical pharmacists spent an average of 7.9 min per notification.

conclusionsPrescribers and clinical pharmacists both responded similarly and consistently to correct inappropriate DOAC prescriptions in response to EHR asynchronous notifications. While pharmacists did not outperform prescribers overall, they demonstrated more nuanced application of medication prescribing guidelines in complex cases. Engaging clinical pharmacists directly may be an efficient implementation strategy for addressing medication prescribing issues. Optimal EHR-based implementation strategies for complex prescribing guidelines should consider both workflow integration and recipient expertise.

trial registration(ClinicalTrials.gov: NCT05351749).

Indexed as

Electronic Health RecordsInappropriate PrescribingPharmacistsPractice Patterns, Pharmacists'AdultAgedAnticoagulantsFemaleHumansImplementation ScienceMaleMiddle AgedPractice Patterns, Physicians'AnticoagulantsAnticoagulantsAtrial fibrillationClinical decision support systemImplementation sciencePharmacistsVenous thromboembolism

Identifiers

PMID41398697
PMCPMC12914967

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.