Impact of Health Information Exchange Access on Medication Management Recommendations in a Community-based Pharmacy Setting

Rachel Kestin; Amie Howe; Joe Moose; Macary Weck Marciniak; Laura A Rhodes

doi:10.1016/j.japh.2024.102104

Impact of Health Information Exchange Access on Medication Management Recommendations in a Community-based Pharmacy Setting

J Am Pharm Assoc (2003). 2024 Apr 23:102104. doi: 10.1016/j.japh.2024.102104. Online ahead of print.

Authors

Rachel Kestin¹, Amie Howe², Joe Moose³, Macary Weck Marciniak⁴, Laura A Rhodes⁵

Affiliations

¹ Clinical Pharmacist, Moose Pharmacy, Concord, NC; at the time of study, was PGY1 Community-based Pharmacy Resident, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC and Moose Pharmacy, Mt. Pleasant, NC and Concord, NC.
² Pharmacy Manager at Moose Pharmacy of Mt. Pleasant, Mt. Pleasant, NC and Residency Site Coordinator, Moose Pharmacy, Mt. Pleasant, NC and Concord, NC.
³ Pharmacy Owner at Moose Pharmacy, Mt. Pleasant, NC and Concord, NC.
⁴ Associate Professor and Director, PGY1 Community-based Pharmacy Residency Program, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
⁵ Assistant Professor and Assistant Director, PGY1 Community-based Pharmacy Residency Program, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: laura_rhodes@unc.edu.

PMID: 38663535
DOI: 10.1016/j.japh.2024.102104

Abstract

Background: Community-based pharmacists have historically lacked access to electronic medical records and clinical markers. Research was needed to assess the impact of obtaining clinical markers from a Health Information Exchange (HIE) on pharmacist recommendations during a medication management encounter.

Objective: The objective of this project was to quantify and characterize clinical recommendations by pharmacists, resident pharmacists, or student pharmacists within an independent pharmacy setting that had access to patient information via an HIE.

Practice description: Moose Pharmacy is one of few community pharmacies in North Carolina with access to a large health-system HIE.

Practice innovation: This cohort study reviewed data over four months. Patients were identified for medication management based on filling eligible medications for atherosclerotic cardiovascular disease (ASCVD), hypertension, diabetes, dyslipidemia, or heart disease. Pharmacy personnel utilized the HIE to acquire lab results. At the medication management appointment, the pharmacist collected blood pressure (BP), assessed smoking history, and medication/disease concerns. ASCVD risk score, statin therapy, A1c, and BP were assessed. Follow up with the patient or provider was determined, if needed, and documented.

Evaluation methods: Collected records were reviewed to quantify the number and type of clinical recommendations made by the pharmacist, and their acceptance status by the prescriber. Descriptive analyses were used to analyze results.

Results: Thirty-four encounters were included. Most participants had diabetes (n=21, 62%) and hypertension (n=31, 91%). Nearly one-third (n=11, 32%) of encounters resulted in a pharmacist recommendation. Recommendations were for BP dose adjustments (n=4, 36%), diabetes medication changes (n=3, 27%), and statin initiations/escalations (n=4, 36%). Four (36%) recommendations were accepted, with one requiring modifications from the provider, 3 (27%) recommendations were declined, and 3 (27%) recommendations were unanswered.

Conclusion: Access to progress notes and lab values using an HIE enhanced the pharmacist's ability to provide enhanced patient care recommendations during medication management consultations.