Impact of Health Information Exchange Access on Medication Management Recommendations in a Community-based Pharmacy Setting

Background Community-based pharmacists have historically lacked access to electronic medical records and clinical markers. Research was needed to assess the impact of obtaining clinical markers from a Health Information Exchange (HIE) on pharmacist recommendations during a medication management encounter. Objective The objective of this project was to quantify and characterize clinical recommendations by pharmacists, resident pharmacists, or student pharmacists within an independent pharmacy setting that had access to patient information via an HIE. Practice Description Moose Pharmacy is one of few community pharmacies in North Carolina with access to a large health-system HIE. Practice Innovation This cohort study reviewed data over four months. Patients were identified for medication management based on filling eligible medications for atherosclerotic cardiovascular disease (ASCVD), hypertension, diabetes, dyslipidemia, or heart disease. Pharmacy personnel utilized the HIE to acquire lab results. At the medication management appointment, the pharmacist collected blood pressure (BP), assessed smoking history, and medication/disease concerns. ASCVD risk score, statin therapy, A1c, and BP were assessed. Follow up with the patient or provider was determined, if needed, and documented. Evaluation Methods Collected records were reviewed to quantify the number and type of clinical recommendations made by the pharmacist, and their acceptance status by the prescriber. Descriptive analyses were used to analyze results. Results Thirty-four encounters were included. Most participants had diabetes (n=21, 62%) and hypertension (n=31, 91%). Nearly one-third (n=11, 32%) of encounters resulted in a pharmacist recommendation. Recommendations were for BP dose adjustments (n=4, 36%), diabetes medication changes (n=3, 27%), and statin initiations/escalations (n=4, 36%). Four (36%) recommendations were accepted, with one requiring modifications from the provider, 3 (27%) recommendations were declined, and 3 (27%) recommendations were unanswered. Conclusion Access to progress notes and lab values using an HIE enhanced the pharmacist’s ability to provide enhanced patient care recommendations during medication management consultations.