Evaluation of missed opportunity for clinical pharmacist practitioner impact on medication management in a traumatic brain injury population

Abstract

Background

Traumatic brain injury (TBI) is a traumatically induced physiological disruption of normal brain function often with structural brain injury. Patients with TBI may have impaired cognitive function, which may affect medication adherence and patients’ understanding of their medication regimen, making medication management challenging. Clinical pharmacist practitioner (CPP)–driven medication management has been shown to decrease polypharmacy, increase medication adherence, and prevent adverse drug reactions in various disease states; however, there are few interventions for patients with TBI.

Objectives

This evaluation aimed to determine whether there are missed opportunities for CPP impact on medication management for patients with TBI at 1 Veterans Affairs medical center.

Methods

This was a single-center, retrospective, QI project. Patients were identified via a generated report of all patients with a diagnosis of TBI seen by a rehabilitation medicine provider between October 21, 2022, and January 1, 2023. Retrospective chart reviews were performed to determine the number of patients with polypharmacy, adherence concerns, duplicative therapy, and medications missing an indication.

Results

Ninety-two rehabilitation medicine visits for 78 unique patients were identified over the 3-month time period. Twenty-four of the 78 patients were identified to have all of the following: polypharmacy, adherence concerns, duplicative therapy, and medications without an indication. Of the 78 patients, 10 (15.6%) were followed by a primary care CPP within the 6 months before their rehabilitation medicine appointment.

Conclusion

This QI project identifies potential opportunities for CPP impact on medication management of patients diagnosed as having TBI.