Preprescribing: pharmacist involvement in drug selection after the diagnosis and prior to the decision for a prescription or supplement therapy.
Pharmacists recognize the variations between drugs, even small differences within the same class of drugs. Trained to identify the clinical significance of drug-interactions and the risks of adverse effects balanced with the proposed benefit of a prescription, we are specially-equipped to save time and headaches in the post-prescribing phase.
You’ve heard of prescribing and e-prescribing, perhaps even familiar with deprescribing, but how much do you think about preprescribing? A more valuable, time-saving role in which the pharmacist could be practicing. It’s a great place for sports pharmacists to practice.
Let’s first define preprescribing and put it into the cognitive services sector.
“Preprescribing” may be a term used in a hospital setting where pharmacists review medication orders after the prescriber decides on a medication and before it is verified for dispensing. Antibiotic stewardship has benefited from this process, where pharmacists select a more appropriate antibiotic after reviewing a patient’s full medical profile, based on a collaborative practice agreement. Insurance companies picked up on the term and used it for driving prescribing selection to their contract medications or “pre-prescribing prior authorization” requirements.
Preprescribing, in its most useful form, is integrated into the decision making process.
Ambulatory care settings and surgical centers that employ pharmacists for cognitive services and comprehensive documentation assistance already have preprescribing happening within patient care, through planning and shared decisions. Transitions of care programs employing pharmacists also practice preprescribing, even if the term isn’t used, to plan for the best outcomes.
If a medical team is a full “team” then this is a valuable position to put
a key player–the drug expert.
Preprescribing by sports pharmacists may include:
- review the whole patient-athlete’s lifestyle and load, demographics, physiology, comorbidities/diagnoses with associated treatments (such as unintentional overlap of prescriptions from different specialists or with self-treatment)
- consider non-pharmacological alternatives or a start-if scenario to avoid use of medications in patient-athletes, when appropriate
- balancing the return to play schedule with medication use and, at times, patient-athlete advocacy for health first
- assess potential ergolytic effects (decrease sport performance or potential risk of harm) and ways to avoid or minimize bothersome side effects, or recommending a different medication/treatment
- review the clinical significance of drug-interactions (drugs, supplements/nutrients, herbals, CBD, etc)
- evaluate the status in sport and recommend an effective alternative (even if not the drug of choice) that is not banned for the athlete or assist in documentation necessary to submit an application for a medical exemption
- review the risks of dietary supplement use, benefit:risk balance and interactions (every choice, every time) to help reduce the risk
- planning for international travel, assess the legal requirement for importing personal prescriptions
As a pharmacists reads through the bullet points above, many of these are key elements we consider for any patient in the preprescribing process, given time and access to the information.
Patient-athletes get the bonus of having more targeted discussions about status in sports and the risks to them in their unique career.
Hey Sports Pharmacists, consider offering your services in the preprescribing process. It improves patient care and primary adherence, but also could nearly eliminate those post-prescribing headaches.