BCMS Medical Record Fall 2020 - 20

M e d i c a l R ec o r d F e a t u r e

DOCTOR-PHARMACIST
COMMUNICATION
IN THE HOSPITAL SETTING
by Brandon Missan
Berks County Medical Society 2020 Student Intern
Advisors: Michael T. Brown, MD, General Surgery - Tower Health
Medical Group, and Daniel B. Kimball, MD, MACP

octors and pharmacists are both professionals in the
medical field with a vast amount of knowledge, education,
and training. When it comes to providing patients with
the best care possible, it only makes sense that a combination of
doctors' and pharmacists' expertise will lead to the best possible
result. Of specific interest is the communication between
pharmacists and doctors in the hospital setting, and the possible
ways in which it can be improved.
The current system of intercommunication between doctors
and pharmacists relies heavily on electronic medical record systems
(EMRs), such as Epic. Epic is a software that is used by nearly
30% of hospitals nationwide, including those under Tower Health.
EMRs are particularly useful for streamlining correspondence
among clinicians. In addition to a multitude of other capabilities
that improve the management of medical care, it enables doctors
to post comments regarding prescriptions, allows pharmacists to
leave suggestions, and checks for drug-drug interactions. While
electronic asynchronous communication between clinicians saves
time, resulting in fewer clinical and procedural errors, it has been
shown that this system results in lower sign-off and action by
prescribers than expected (Pontefract). Although Epic and other
EMRs provide efficient communication, it is also important to
consider their effectiveness.
An action that is often overlooked is deprescribing. Often,
individuals are on an abundance of medication as they approach
the end of their lives. However, patients with life-limiting illnesses
may not necessarily benefit enough from many of their medications
to warrant continued use (Pruskowski). In a study on deprescribing
where 73% of potentially inappropriate medications were
deprescribed, roughly two-thirds of the patients involved described

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having fewer symptoms, and an estimated $4,282.27 was saved in
costs per patient (D'Arrigo). In situations like these, a physician's
and a pharmacist's joint efforts will result in decreasing negative
side effects from medications that are no longer necessary. This can
improve quality-of-life and exemplifies the benefits of improved
clinician dialogue.
It is evident that more favorable patient outcomes result when
physicians and pharmacists work together. According to a study
conducted in the Netherlands, Foekema and Hendrix found
that poor clinician-clinician communication "led to incidences
of inappropriate therapy (44%) or lack of treatment where it
was required (25% of cases)" (Gallagher). A significant number
of errors can be avoided with a joint approach. In an analysis of
multiple studies, it was found that prescribers' acceptance rates
were relatively high, ranging from 39% to 100%, when medication
reviews between pharmacists and doctors took place. All but one of
the statistically significant outcomes indicated positive clinical and
economic results regarding medical facility and patient expenses
(Graabæk). It seems clear that patients benefit when healthcare
professionals work together to create an ideal care plan.
While many pharmacists and doctors agree that there is a need
for improvements to professional collaboration, their preferred
solutions do not always coincide. Physicians express concern
regarding insurance approvals and patient counseling, whereas
pharmacists want to focus on identifying and managing drugrelated problems (Kelly). These differing motivations can increase
the chances of miscommunication.
By setting goals together, physicians and pharmacists could
more effectively meet the needs of their patients. "A seminal study
by Florentinus et al. (2007) suggested that for pharmacists to

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BCMS Medical Record Fall 2020

Table of Contents for the Digital Edition of BCMS Medical Record Fall 2020