Table 1 Example cases
Question | Response | Coding |
|---|---|---|
Case 1: Combination therapy for hypertension | ||
• 83-year-old female • Chronic kidney disease, hypertension, diabetes, potential heart failure • Furosemide and lisinopril • Blood pressure 170/80 to 195/95 • Recent referral to nephrology • Question to cardiologist: “Would it be a good option to switch to another ACE inhibitor? Combination therapy?” | • Confirm heart failure • Better blood pressure control is needed • Nephrology will likely advise blood pressure management • Avoid medications that can increase blood pressure, including NSAIDs • Check adherence of medications • Calcium channel blocker could be used | • Case descriptives. 83-year-old female patient, consulted cardiology, 2 medications provided, PCP accepted recommendation • Intent and type of question. PCP inquired about ACE inhibitors, PCP proposed plan and asked for additional options, PCP did not ask follow-up questions • Medication recommendations and additional information in response. Specialist recommended a different medication/class could be started than the medication/class inquired, specialist provided additional advice in the form of non-pharms (avoid drugs that increase blood pressure, check adherence) • Medication classification. Medication/class inquired: ACE inhibitor ATC code C09AA. Medication/class recommended: calcium channel blocker ATC code C08 • PIMs. Patient taking furosemide (appears on STOPPFall), has ACB score of 1 |
Case 2: Stroke/TIA prophylaxis | ||
• 88-year-old male • Recurrent peripheral vertigo, 2 previous strokes • After hospital admission unrelated to stroke, was advised to take ASA in addition to clopidogrel upon discharge • Question to stroke/TIA specialist: “Can you clarify whether he should be on clopidogrel alone or + ASA and what degree of benefit of dual therapy in a frail elderly patient like this for TIA/stroke prevention?” | • Advised that dual antiplatelet therapy is not typically used long-term because of the risk of bleeding • Generally used following an acute event, and single antiplatelet therapy is continued • If the patient has not been on ASA, take ASA • If the patient failed on ASA, then take clopidogrel | • Case descriptives. 88-year-old male patient, consulted stroke/TIA specialist, 9 medications provided, PCP accepted recommendation • Intent and type of question. PCP inquired about clopidogrel and ASA, PCP proposed plan and asked for agreement, PCP did not ask follow-up questions • Medication recommendations and additional information in response. Specialist recommended deprescribing of either ASA or clopidogrel, specialist agreed with one of the classes inquired, specialist answered the question and did not provide additional advice. • Medication classification. Medication/class inquired: clopidogrel ATC code B01AC04, ASA ATC code B01AC06. Medication/class recommended: clopidogrel ATC code B01AC04, ASA ATC code B01AC06 • PIMs. Patient taking rabeprazole (proton pump inhibitor) on AGS Beers Criteria® |