‘Something that facilitates our work…rather than a hindrance’: Clinical pharmacist perspectives on the use of data analytics to support polypharmacy medication reviews in primary care.

Abstract

Background Polypharmacy and overprescribing is a growing concern due to increased risk of drug interaction and inefficient use of resources. Historical patient records offer a wealth of knowledge that could inform safer prescribing and deprescribing, but it is unclear how these complex data should be summarised and displayed to clinicians. The current study evaluated the perspectives of clinical pharmacists (CPs), a newly expanding workforce of primary care medication specialists, on ways that novel big data analytics could be used to improve health outcomes for frail and elderly (> 65yrs) patients. Methods Primary care clinical pharmacists (n = 14) took part in an exploratory participative design workshop to discuss examples and uses of novel analytics (including risk of negative outcomes for frail and elderly patients following treatment with a variety of medication combinations). Participant contributions (verbal and textual) were analysed using the framework method of exploratory content analysis. Results Overarching themes of data uses, reservations and digital tools acceptance factors were identified. Uses of polypharmacy analytics valued by CPs included the clinical effects of drug: drug interactions and patient risk scores to highlight patients at increased risk of harm from medication combinations (including cumulative risks). CPs were also positive about the creation of a dedicated online community of practice to enable wider peer support. CP’s current digital systems do not adequately facilitate patient medication reviews and contribute to cognitive overload. Experiencing these existing barriers mean that CPs’ acceptance of digital analytics tools is heavily contingent on ease of use, clear targeting and ability to support clinicians’ understanding and confidence in the strengths, limitations and validity of the analytics in the patient care context. Conclusions CPs would benefit from bespoke digital systems designed to meet the needs of their role. Analytics from patient records could help address a concerning deficit in wider knowledge of the real world clinical effects of polypharmacy medication interactions and help clinicians prioritise medication reviews. Based on the user acceptance themes identified, five criteria are suggested to inform user focused development of analytics tools for primary healthcare.