Ability of a clinical pharmacist to make drug therapy interventions using email in patients with advanced heart failure and ventricular-assist devices

Purpose: Inpatient clinical pharmacists are often required to provide coverage to multiple patient care teams and are often limited in their ability to interface directly with physicians when suggesting drug therapy recommendations. This project explores email as a potential medium for pharmacists to communicate interventions with prescribers.

Methods: This retrospective descriptive analysis was conducted at an urban, academic teaching hospital where one clinical pharmacist is responsible for the daily pharmaceutical care for the inpatient advanced heart failure (AHF), cardiac intensive care unit (ICU), and cardiothoracic ICU teams. If the pharmacist identified a potential drug therapy problem and couldn’t make direct face-to-face contact with the attending physician, the intervention was attempted via an email communication. Eligible patients for this project were admitted to the AHF team between December 1st, 2010 and July 31st, 2011 and had at least one attempted email intervention. Data collection included patient demographics, past medical history, and the suggested intervention from the clinical pharmacist. The primary outcome was the number of interventions accepted by the physicians during the study period, while the secondary endpoint was the time between the suggested intervention and the physician email response.

Results: A total of 51 email interventions were attempted on 29 patients (mean age=53, 24 % caucasian, 59% male, 69% LVAD). Overall, 44 of the total 51 number of interventions were accepted (86.3%). The average physician time to a physician response email was 41 minutes. The most frequent type of interventions were starting therapy (33%) and changing dose, route or frequency (33%). The most common drug classes involved in email interventions were ACE inhibitors/angiotensin receptor blockers (15.7%), loop diuretics (9.8%), and antiplatelet agents (7.8%).

Conclusions: Clinical pharmacists with well-established physician relationships can effectively implement timely drug therapy recommendations using email communications in patients with advanced heart failure or ventricular assist devices.