Pharmacists are key to upholding guidelines
Interventions by clinical pharmacists are an effective means of encouraging doctors to adhere to prescribing guidelines that are designed to reduce the incidence of chronic heart disease in patients admitted to a US hospital with acute myocardial infarction.
A study, published in Archives of Internal Medicine (2007;167:586–90)
used computerised alerts to identify patients with elevated tropinin
I levels to hospital pharmacists. For those assigned to the study group,
a pharmacist assessed whether they were receiving all the medicines detailed
in the relevant prescribing guidelines and contacted the patient’s
doctor with recommended interventions if they were not.
Patients in the study group were significantly more likely to be discharged
on a regimen including angiotensin converting enzyme inhibitors and statins.
There was no significant impact of pharmacist interventions on beta-blocker
or aspirin use.
The authors suggest that with ongoing pressure to improve the care of
patients with coronary heart disease, their approach could be a model
for increasing adherence to evidence-based guidelines. Computerised physician
order entry clinical decision support technology might ultimately be
used to promote adherence to prescribing guidelines, the authors note.
However, such technology is not fully developed and interim approaches
are needed. Moreover, computerised prompts might be less likely to be
taken note of than reasoned advice from a colleague, they suggest.
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Hospital
Pharmacist