Screening tool flags more drug-related problems

Two pharmacies in Sarnia, Ontario, proved that a Canadian-made web-based clinical decision support system (CDSS) helps pharmacists flag significantly more drug-related problems (DRPs) during medication reviews.

Karen Riley, clinical pharmacist at a Hogan Pharmacy in Sarnia, led the pilot study after securing funding from the Canadian Foundation for Pharmacy’s Innovation Fund in 2022. The study’s results were published in the Journal of Evaluation in Clinical Practice earlier this year.

Riley and four other pharmacists at two Hogan Pharmacy locations compared the outcomes of Ontario MedsCheck medication reviews with and without the use of the QMR® CDSS, which combines published, validated clinical algorithms and scoring systems, such as the Beers list, anticholinergic burden (ACB) scales and the ISMP High-Alert Medications, into a comprehensive, web-based tool. QMR Pharmacy Solutions, based in Ontario and established in 2018, developed the QMR CDSS.

Patients enrolled in the study were taking 10 or more medications on a regular basis. In phase one of the study, pharmacists conducted MedsChecks with 25 adult patients using the usual approaches. In phase two, the pharmacists were trained to use the QMR® CDSS and conducted MedsChecks with another group of 25 adult patients. In phase three, pharmacists conducted an additional set of 25 medication reviews without the aid of the CDSS “to determine if using the CDSS [during phase 2] enhanced the pharmacists’ ability to continue to independently use all the tools incorporated into the QMR.”

The three phases were completed sequentially in a one-month time frame in early 2023.

Results showed that the percentage of patients with pharmacists’ recommendations to physicians increased from 52% in phase one to 80% and 88% in phases 2 and 3, respectively. There was no difference in the number of DRPs identified per patient or in the length of time required for each MedsCheck.

Pharmacists “rated the CDSS (QMR®) very positively with respect to ease of use,” stated the study, and the majority of patients provided positive comments.

The study also noted that the QMR CDSS can overestimate potential DRPs that would be considered clinically insignificant. “This highlights the necessity and importance of continued pharmacist screening and assessment for potential DRPs in conjunction with the tool and the importance of pharmacists using their clinical judgement and assessment of what is best for patient outcomes.”

The study concluded that the QMR® CDSS facilitated effective medication reviews, especially for older adults, and recommended additional research using a larger sample. It also recommended an expansion of the QMR® CDSS to include other algorithms, such as for deprescribing, and that it be integrated into pharmacy software for routine use.