Steven Asch, Carol Bates, Jeff Jackson

Co-Editors-in-Chief

Journal of General Internal Medicine

I read with great interest the report from the LEAVE SAFE group published in Journal of General Internal Medicine on 27 September 2023 titled: “Multicomponent Pharmacist Intervention Did Not Reduce Clinically Important Medication Errors for Ambulatory Patients Initiating Direct Oral Anticoagulants”.

(J Gen Intern Med. 2023 Sep 27. https://doi.org/10.1007/s11606-023-08315-z).

The title and conclusion, while strictly and accurately describing, following from, and adhering to the results from your hypothesis, seems to indict the pharmacist rather than the setting and workflows in the study that dictated how prescribers and pharmacists interacted. I can imagine that anyone trying to intervene with the DOAC checklist in this setting and workflow would encounter the same ineffectiveness, whether a technician, nurse, or other health professional performed the intervention. Moreover, all the study pharmacists were trained and validated by the principal investigator, a highly respected UMass physician, and still the intervention to change other physicians’ prescribing and monitoring behavior for a very high-risk medication was ineffective. A casual observer, reading only the title and abstract, would likely conclude that pharmacist involvement in medication management, even for high-risk medications, doesn’t work and isn’t necessary.

However, the group identified the real root cause of the study’s failure hidden deep in the discussion, that is, "providers did not follow up or act on pharmacist recommendations despite being templated in pharmacist documentation… Empowering pharmacists to order labs and deprescribe medications would be another avenue toward decreasing CIMEs as demonstrated in a previous study." It seems that the “blame” is misplaced by assigning the study’s shortcomings to the study pharmacists.

Richard H. Parrish II, BSPharm, PhD, FCCP, BCPS