An electronic prompt in dispensing software to promote clinical interventions by community pharmacists: a randomized controlled trial

Abstract

What is already known about this subject • Computerized prompts and reminders have been shown to be effective in changing the behaviour of health professionals in a variety of settings. • There is little literature describing or evaluating electronic decision‐support for pharmacists. What this study adds • An electronic prompt in dispensing software for a targeted clinical intervention has a significant effect on pharmacists' behaviour. A markedly increased rate of recording and performing the targeted clinical intervention was found. • The effect of the prompt reduces markedly once the prompt is deactivated. Aim To evaluate the effect of an electronic prompt in dispensing software on the frequency of clinical interventions recorded by community pharmacists. Method An electronic decision‐support prompt identifying patients for a targeted proactive clinical intervention was developed and implemented. Each time an oral antidiabetic agent was dispensed, a prompt was displayed reminding pharmacists to discuss the suitability of aspirin therapy in eligible patients with diabetes. The prompt was randomly assigned to 31 of 52 metropolitan pharmacies in Melbourne (Australia) for 6 weeks, with the remaining pharmacies as controls. Results One hundred and fifty pharmacists in 52 pharmacies recorded a total of 2396 clinical interventions at an intervention rate of 0.92 interventions per 100 patients [95% confidence interval (CI) 0.58, 1.23]. Pharmacists recorded a total of 201 target interventions related to aspirin therapy in diabetes at an intervention rate of 2.55 interventions per 100 diabetic patients (95% CI 0.85, 4.24). All of the targeted clinical interventions were recorded in the prompt arm; no targeted interventions were recorded in the control group. The effect of the prompt decreased over the study period and was not maintained after prompt deactivation. Conclusion An electronic prompt significantly increased pharmacists' recording of the targeted clinical intervention in diabetic patients. An electronic decision‐support prompt has significant potential to promote community pharmacists' contribution to the quality use of medicines.

Effectiveness of implementation strategies for clinical guidelines to community pharmacy: A systematic review

“…They involved chronic disease states [57,60,65,71,75], guidelines for the supply of particular classes of medications [55,56,59,61,64,66,[68][69][70]72], community pharmacy's role in preventative health [58,67,73] and guidelines for appropriate pharmacy practice [63,74]. The variation did not allow for any conclusions to be made about the effectiveness of implementation based on guideline characteristics.…”

“…Of these, 11 studies were evaluated as having a high risk of bias [55-59, 61, 63-67] and three studies assessed as having an unclear risk of bias [54,60,62]. Several domains contributed to risk of bias in multiple studies.…”

“…The 22 studies comprised 10 RCTs [54][55][56][57][58][59][60][61][62][63], 3 NRCTs [64][65][66], 1 CBA trial [67] and 8 quasi-experimental or observational studies [68][69][70][71][72][73][74][75] (Tables 1 and 2). The studies were conducted in Australia (n = 8) [54-56, 60, 64, 65, 68, 69], the USA (n = 4) [57][58][59]73], the UK (n = 3) [62,63,75], the Netherlands (n = 2) [61,72], Belgium (n = 1) [67], Canada, (n = 1) [71], Finland (n = 1) [74], Germany (n = 1) [70] and Switzerland (n = 1) [66].…”

“…visits or phone calls) to provide motivation and support to practitioners post education inadequacies were due to lack of reporting or flaws in research design. Two of the studies evaluated as having an overall unclear risk of bias used implementation strategies involving a computer prompt [54,60]. The Newcastle-Ottawa tool for cohort studies was used to evaluate eight studies [68][69][70][71][72][73][74][75].…”

“…Implementation activities were targeted to community pharmacy, and in particular to pharmacists in 20 studies [54][55][56][57][58][59][60][61][62][65][66][67][68][69][70][71][72][73][74][75] and pharmacy support staff in 11 studies [56, 58, 61-64, 66, 68, 69, 72, 75]. In two studies, implementation activities were directed exclusively to pharmacy support staff, while three studies involved implementation activities to other health professionals and/or patients as well as community pharmacy staff [58,65,70].…”