Category: Professional Posters
Purpose: Primary Care Providers (PCP’s) are tasked with many responsibilities, including reviewing prescription renewal requests for patients needing chronic prescription medications. A primary responsibility of pharmacists in any setting is to ensure medication therapy is safe and effective for patients. As a patient care activity and learning activity, fourth-year pharmacy students on Advanced Practice Pharmacy Experiential (APPE) ambulatory care rotations reviewed prescription renewal requests received from community pharmacies. The primary objective of this study is to assess whether this activity was an effective learning process for students. A secondary objective is to assess if student recommendations were well-received by PCP’s.
Methods: This retrospective review was approved by the University of Hawaii Institutional Review Board. As part of an ambulatory care APPE rotation, pharmacy students were tasked with reviewing all prescription renewal requests that the clinic received from community pharmacies. While reviewing these requests, students reviewed the patient's electronic medical record (EMR) to decide whether this prescription should be renewed. Students were trained to assess each prescription for safety, efficacy, and convenience, a process that is similar to verify medication orders in a dispensing pharmacy. If everything is appropriate with the prescription, students forward the request to the PCP for final review. When students identified a potential intervention, they presented the case to their preceptor. If approved, the student forwarded the recommendation to the PCP for consideration. At the end of the academic year, participating students were surveyed on how this activity impacted their overall learning experience. The survey included likert-scale based questions inquiring whether the experience helped students learn monitoring parameters, effects on confidence in verifying prescription orders, and improving written interprofessional communication skills. Additionally, the EMR was retrospectively reviewed to identify what types of recommendations were made and if they were accepted by PCP’s. Recommendations were categorized into the following six categories: (1) patient appointment scheduling, (2) dosage change, (3) discontinue medication, (4) labs, (5) new medication, and (6) quantity change.
Results: A total of 8 fourth-year pharmacy students participated in this study over the course of three separate six-week APPE rotation blocks from May-August 2018 and January-February 2019. Of the 7 survey respondents, all (100%) reported agreeing or strongly agreeing that this activity helped students learn monitoring parameters of drugs, improved written interprofessional communication skills, and improved self-confidence in the ability to verify prescription orders. A total of 879 unique requests that were reviewed during this period, averaging roughly 18 requests per clinic day. Pharmacy students made a total of 131 recommendations from the 879 requests that were reviewed. Of the 131 recommendations, 104 were accepted by the PCP (79.4%). The most common type of intervention accepted was to adjust the quantity of the prescription, including increasing the number of refills or the quantity of medication per fill (29.8%). The second most common type of intervention made was to recommend ordering of lab tests that related to either medication safety or efficacy (26%). The remaining recommendations were to schedule the patient for a follow-up appointment (20.2%), change the drug dose or dosage form (16.3%), discontinue the drug (5.8%), or prescribe a new medication (1.9%).
Conclusion: The findings from this study demonstrate that this prescription renewal review process was helpful to pharmacy students as a learning activity. The benefits of this activity was multifaceted, increasing students confidence in order verification, improving knowledge of drug monitoring parameters, and providing experience for written interprofessional communication. Additionally, many recommendations made through this process were accepted by the PCP’s. This activity will be continued due to the dual benefit as a learning tool for pharmacy students and positive impact on patient care. Further studies will assess if this service has a long-term effect on prescribing patterns.