Medication decision support tools focused on individual patients can help pharmacists effectively analyze risk of unintended harm, identify and assess potential interventions, and facilitate longitudinal care.
Modern, sophisticated medication risk management is critical tominimize the chance that a patient’s drug regimen could potentially cause medication-related harm. When patients regularly take multiple drugs, analyzing that risk for harm can become more complex.
Pharmacists have unique training and experience in drug therapy, making them well-positioned to analyze patient risk and address the safe use of medication. However, most medication risk management systems currently being used are not truly patient specific. As a result, they do not provide pharmacists with full visibility into a patient’s full medication profile.
Traditional pharmacy systems generally employ drug reviews, which consider how drug “A” effects drug “B,” how drug “A” effects drug “C,” how drug “B” effects drug “C,” and so on. These 1-to-1 reviews, however, can be inadequate for patients who take multiple medications, as they focus on general drug combinations instead of the aggregate impact of a specific patient’s medication regimen.
Effective Risk Analysis
In contrast, Tabula Rasa HealthCare’s (TRHC) MedWise® Science uses the active ingredients from the complete medication list, including OTC drugs, to identify the risk of simultaneous, accumulative, multidrug interactions, and predict the possibility of medication problems—reducing trial-and-error prescribing.
Research co-authored by our team highlights how accounting for this aggregate impact can help identify patient risk.1 This research—1 of 3 studies published in the American Journal of Managed Care—employed TRHC’s MedWise Risk Score™, which considers specific risk factors when analyzing the active ingredients in a patient’s medication list. The aggregated values of these risk factors help determine a patient’s overall score. A high risk score is indicative of a greater possibility of adverse drug events, including falls, hospital admissions, emergency department visits, and mortality.1,2
Once risk is determined, the researchers showed that pharmacists can assess and prioritize potential recommendations or interventions to avoid multi-drug interactions or to take into account other factors.3 Finally, results of the third study demonstrated that the study group that participated in pharmacist-led medication safety reviews had more moderate increases in year-over-year Medicare Part A expenditures, Medicare Part B expenditures, and emergency department visits, among other impacts, compared with group that did not participate.4
In addition to improving such outcomes, there are other factors to consider in tailoring interventions to patients. For example, a patient who works during the day may need to take medication that causes drowsiness at a different time than a patient who works at night. Just as risk stratification should be patient specific, patient-specific interventions lead to better outcomes.
A Stepped Approach to Longitudinal Care
For patients who take long-term medications, medication optimization requires longitudinal care. To facilitate such care, systems that promote the safe use of medication are most effective when also supporting pharmacists, in particular in their consultation with patients, over time to implement interventions that reduce the risk of preventable medication-related harm and avoid premature death.2 The ultimate goal is to reach a point where patients feel comfortable, avoid side effects and adverse events, and adhere to a schedule that fits their lifestyles. Taking a stepped approach helps to develop trust between patients and their pharmacists and enables patients to build confidence in their medication regimens.
Once a patient’s regimen is well-established, moving medication optimization systems from retrospectiveto prospective analysis is the ideal method to optimize outcomes through medication-related risk prevention. This way, potential risks can be spotted before patients take newly prescribed medications. With this type of sophisticated decision support system, pharmacists can help each patient avoid medication-related harm and get the full benefit of their drug regimen.
Michael S. Awadalla, PharmD, BCGP, is Executive Vice President Office of Applied Pharmacotherapy at Tabula Rasa HealthCare, a leading healthcare technology company advancing the safe use of medications.
1. Michaud V, Smith MK, Bikmetov R, et al. Association of the MedWise Risk Score with health care outcomes. Am J Manag Care. 2021;27(suppl 16):S280-S291. doi: 10.37765/ajmc.2021.88753
2. Ratigan AR, Michaud V, Turgeon J, et al. Longitudinal association of a medication risk score with mortality among ambulatory patients acquired through electronic health record data. J Patient Saf. 2021;17(4):249-255. doi:10.1097/PTS.0000000000000829.
3. Bankes D, Pizzolato K, Finnel S, et al. Medication-related problems identified by pharmacists in an enhanced medication therapy management model. Am J Manag Care. 2021;27(suppl 16):S292-S299. doi: 10.37765/ajmc.2021.88754
4. Stein A, Finnel S, Bankes D, et al. Health outcomes from an innovative Enhanced Medication Therapy Management model. Am J Manag Care. 2021;27(suppl 16):S300-S308. doi: 10.37765/ajmc.2021.88755