Access to clinical data for direct oral anticoagulant prescriptions in community pharmacy and implications for medication optimisation: a mixed-methods study

INTRODUCTION: Inappropriate direct oral anticoagulant (DOAC) prescribing is a frequent cause of harm to patients. Pharmacists could play an important role in optimising prescribing, but they need access to relevant clinical data to do so. Little is known about community pharmacists' access to clinical data to assess the appropriateness of DOAC prescriptions. AIM: To investigate the availability of relevant clinical data for DOAC prescriptions and whether additionally requesting such data supports community pharmacists in assessing and optimising DOAC prescriptions. This study also explored behavioural factors influencing pharmacists' decisions to request additional clinical data. METHOD: In this mixed-methods study, 166 community pharmacies were approached to collect quantitative data. This included the prevalence of missing clinical data, pharmacists' requests for missing data including reasons for requesting these data, and prescription adjustments made by the pharmacist. Missing clinical data was defined as absence of patient information on the DOAC prescription to assess its appropriateness: treatment indication, renal function, body weight, treatment duration, or concomitant use of antithrombotics. A random sample of 10 participating pharmacies was approached for semi-structured interviews on perceptions whether to request missing clinical data. Quantitative data were analysed descriptively. Interviews were thematically analysed using the Capability, Opportunity, Motivation, Behaviour (COM-B) framework to understand behaviour. Quantitative and qualitative data were triangulated through discussion of the findings. RESULTS: We collected quantitative data of 583 DOAC prescriptions in 92 pharmacies and interviewed 11 pharmacists from 10 approached pharmacies. On 92.8% (n = 541) of DOAC prescriptions clinical data were missing. Additional clinical data (particularly, treatment indication and renal function) were requested in 51.9% (n = 281), mainly for dose evaluation (39.6% (n = 231)), leading to 5.0% (n = 14) adjustments of these prescriptions. Pharmacists applied clinical reasoning to determine the need for additional data, with providing optimal patient care as their primary motivation. The main opportunity was collaboration with other healthcare professionals. CONCLUSION: Using their clinical reasoning competence, pharmacists frequently requested missing clinical data, particularly treatment indication and renal function, to verify DOAC prescriptions and to ensure optimal patient care. Clinical data sharing could be optimised by streamlined collaboration between healthcare professionals.