Dear Editor,
We agree with the concern of Dr. Parrish with regard to attributing absence of harm reduction from the Leave Safe intervention to the pharmacists delivering the intervention. Our intervention consisting of pharmacist consultation delivered remotely over three months as part of a larger checklist to facilitate a transition in care from the ambulatory setting to home for patients taking DOACs does not appear to be able to reduce clinically important medication errors in the first three months after initiating anticoagulation or resuming it after complication. As we mentioned in the article, the absence of this reduction provides indirect evidence that providers did not follow up or act on pharmacist recommendations despite being templated in pharmacist documentation. Reducing errors may require an intervention beyond what pharmacists can provide without active collaboration of providers. We also highlight that there is an acculturation phase during which providers and patients increasingly expect and value communication from pharmacists before being willing to consistently implement their recommendations. We encourage institutional leadership and professional societies to facilitate this acculturation process.
Declarations
Conflict of Interest:
Dr. Kapoor has received research grant support from Pfizer through its Independent Grants for Learning and Change funding mechanism and from Bristol Myers Squibb for independent medical education grants. Recently, he has received research grant support through a competitive process adjudicated and funded by the alliance, which is formed by both Pfizer and Bristol Myers Squibb. He has also been awarded a grant by Pfizer to examine conversations between patients and providers. Dr. McManus has received sponsored research support from Bristol Myers Squibb, Boehringer Ingelheim, Pfizer, Biotronik, and Philips Healthcare and has consulted for Bristol Myers Squibb, FlexCon, Samsung, Philips, and Pfizer. Dr. McManus has equity in Mobile Sense Technologies, LLC. Drs. Crawford, Mazor, and Gurwitz have also received research grant support from Bristol Meyers Squibb in the past 3 years (as coinvestigators on the grants secured by Dr. Kapoor). Dr. Gurwitz also serves as a consultant to United Healthcare.
Footnotes
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