Pharmacist Use of a Population Management Dashboard for Safe Anticoagulant Prescribing: Evaluation of a Nationwide Implementation Effort
Background Direct oral anticoagulants (DOACs) have complex dosing regimens and are often incorrectly prescribed. We evaluated a nationwide DOAC population management dashboard rollout whose purpose includes pharmacist review and correction of off‐label dosing prescriptions. Methods and Results Using...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-09-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.035859 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850269953719009280 |
|---|---|
| author | Geoffrey D. Barnes Charity Chen Rob Holleman Joshua Errickson F. Jacob Seagull Michael P. Dorsch Arthur L. Allen Patrick Spoutz Jeremy B. Sussman |
| author_facet | Geoffrey D. Barnes Charity Chen Rob Holleman Joshua Errickson F. Jacob Seagull Michael P. Dorsch Arthur L. Allen Patrick Spoutz Jeremy B. Sussman |
| author_sort | Geoffrey D. Barnes |
| collection | DOAJ |
| description | Background Direct oral anticoagulants (DOACs) have complex dosing regimens and are often incorrectly prescribed. We evaluated a nationwide DOAC population management dashboard rollout whose purpose includes pharmacist review and correction of off‐label dosing prescriptions. Methods and Results Using data from Veterans Health Affairs, we identified all patients prescribed DOACs for atrial fibrillation or venous thromboembolism between August 2015 and December 2019. Sites were grouped on the basis of the timing of moderate‐high usage of the DOAC population management tool dashboard. Effectiveness was defined as the monthly rate of off‐label DOAC prescribing and the rate of clinical adverse events (bleeding, composite of stroke or venous thromboembolism). Implementation was evaluated as the percentage of off‐label DOAC prescriptions changed within 7 days. Among the 128 652 patients receiving DOAC therapy at 123 centers, between 6.9% and 8.6% had off‐label DOAC prescriptions. Adoption of the DOAC population management tool dashboard before July 2018 was associated with a decline in off‐label dosing prescriptions (8.7%–7.6%). Only 1 group demonstrated a significant reduction in monthly rates of bleeding following implementation. All sites experienced a reduction in the composite of venous thromboembolism or stroke following dashboard adoption. There was no difference in the implementation outcome of DOAC prescription change within 7 days in any of the adoption groups. Conclusions Early adoption of the DOAC population management tool dashboard was associated with decreased rates of off‐label DOAC dosing prescription and reduced bleeding. Following adoption of the DOAC population management tool dashboard, all sites experienced reductions in venous thromboembolism and stroke events. |
| format | Article |
| id | doaj-art-95fad3e7b9fe49a69267fcdd7cf4faf7 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-95fad3e7b9fe49a69267fcdd7cf4faf72025-08-20T01:52:53ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-09-01131810.1161/JAHA.124.035859Pharmacist Use of a Population Management Dashboard for Safe Anticoagulant Prescribing: Evaluation of a Nationwide Implementation EffortGeoffrey D. Barnes0Charity Chen1Rob Holleman2Joshua Errickson3F. Jacob Seagull4Michael P. Dorsch5Arthur L. Allen6Patrick Spoutz7Jeremy B. Sussman8Frankel Cardiovascular Center University of Michigan Ann Arbor MICenter for Clinical Management Research Ann Arbor Veterans Affairs Ann Arbor MICenter for Clinical Management Research Ann Arbor Veterans Affairs Ann Arbor MICenter for Statistical Consultation and Research University of Michigan Ann Arbor MICenter for Bioethics and Social Science in Medicine University of Michigan Ann Arbor MIFrankel Cardiovascular Center University of Michigan Ann Arbor MIVeterans Affairs Salt Lake City Health Care System Salt Lake City UTPharmacy Benefits Management Veterans Integrates Service Network 20 Vancouver WACenter for Clinical Management Research Ann Arbor Veterans Affairs Ann Arbor MIBackground Direct oral anticoagulants (DOACs) have complex dosing regimens and are often incorrectly prescribed. We evaluated a nationwide DOAC population management dashboard rollout whose purpose includes pharmacist review and correction of off‐label dosing prescriptions. Methods and Results Using data from Veterans Health Affairs, we identified all patients prescribed DOACs for atrial fibrillation or venous thromboembolism between August 2015 and December 2019. Sites were grouped on the basis of the timing of moderate‐high usage of the DOAC population management tool dashboard. Effectiveness was defined as the monthly rate of off‐label DOAC prescribing and the rate of clinical adverse events (bleeding, composite of stroke or venous thromboembolism). Implementation was evaluated as the percentage of off‐label DOAC prescriptions changed within 7 days. Among the 128 652 patients receiving DOAC therapy at 123 centers, between 6.9% and 8.6% had off‐label DOAC prescriptions. Adoption of the DOAC population management tool dashboard before July 2018 was associated with a decline in off‐label dosing prescriptions (8.7%–7.6%). Only 1 group demonstrated a significant reduction in monthly rates of bleeding following implementation. All sites experienced a reduction in the composite of venous thromboembolism or stroke following dashboard adoption. There was no difference in the implementation outcome of DOAC prescription change within 7 days in any of the adoption groups. Conclusions Early adoption of the DOAC population management tool dashboard was associated with decreased rates of off‐label DOAC dosing prescription and reduced bleeding. Following adoption of the DOAC population management tool dashboard, all sites experienced reductions in venous thromboembolism and stroke events.https://www.ahajournals.org/doi/10.1161/JAHA.124.035859anticoagulationatrial fibrillationdrug use reviewpopulation health managementvenous thromboembolism |
| spellingShingle | Geoffrey D. Barnes Charity Chen Rob Holleman Joshua Errickson F. Jacob Seagull Michael P. Dorsch Arthur L. Allen Patrick Spoutz Jeremy B. Sussman Pharmacist Use of a Population Management Dashboard for Safe Anticoagulant Prescribing: Evaluation of a Nationwide Implementation Effort Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease anticoagulation atrial fibrillation drug use review population health management venous thromboembolism |
| title | Pharmacist Use of a Population Management Dashboard for Safe Anticoagulant Prescribing: Evaluation of a Nationwide Implementation Effort |
| title_full | Pharmacist Use of a Population Management Dashboard for Safe Anticoagulant Prescribing: Evaluation of a Nationwide Implementation Effort |
| title_fullStr | Pharmacist Use of a Population Management Dashboard for Safe Anticoagulant Prescribing: Evaluation of a Nationwide Implementation Effort |
| title_full_unstemmed | Pharmacist Use of a Population Management Dashboard for Safe Anticoagulant Prescribing: Evaluation of a Nationwide Implementation Effort |
| title_short | Pharmacist Use of a Population Management Dashboard for Safe Anticoagulant Prescribing: Evaluation of a Nationwide Implementation Effort |
| title_sort | pharmacist use of a population management dashboard for safe anticoagulant prescribing evaluation of a nationwide implementation effort |
| topic | anticoagulation atrial fibrillation drug use review population health management venous thromboembolism |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.035859 |
| work_keys_str_mv | AT geoffreydbarnes pharmacistuseofapopulationmanagementdashboardforsafeanticoagulantprescribingevaluationofanationwideimplementationeffort AT charitychen pharmacistuseofapopulationmanagementdashboardforsafeanticoagulantprescribingevaluationofanationwideimplementationeffort AT robholleman pharmacistuseofapopulationmanagementdashboardforsafeanticoagulantprescribingevaluationofanationwideimplementationeffort AT joshuaerrickson pharmacistuseofapopulationmanagementdashboardforsafeanticoagulantprescribingevaluationofanationwideimplementationeffort AT fjacobseagull pharmacistuseofapopulationmanagementdashboardforsafeanticoagulantprescribingevaluationofanationwideimplementationeffort AT michaelpdorsch pharmacistuseofapopulationmanagementdashboardforsafeanticoagulantprescribingevaluationofanationwideimplementationeffort AT arthurlallen pharmacistuseofapopulationmanagementdashboardforsafeanticoagulantprescribingevaluationofanationwideimplementationeffort AT patrickspoutz pharmacistuseofapopulationmanagementdashboardforsafeanticoagulantprescribingevaluationofanationwideimplementationeffort AT jeremybsussman pharmacistuseofapopulationmanagementdashboardforsafeanticoagulantprescribingevaluationofanationwideimplementationeffort |