1. When integrating a pharmacist into a practice, consider the following: identify pharmacist roles; decide how the practice can benefit from including a pharmacist; find a pharmacist match; prepare and set expectations for the team and patients; determine the resources the pharmacist needs and the impact on the physician’s workflow; and measure impact.

2. Determine prior authorization (PA) requirements before providing services or sending prescriptions to a pharmacy. Establish a protocol to document the required PA data in the medical record. For a particular prescribing situation, determine the most efficient PA method. After a PA is submitted, follow up to ensure timely approval. If a PA is denied inappropriately, submit an appeal with supporting clinical information.

3. In drug deprescribing, consider cessation of a drug as an intervention similar to initiation of a new drug. Also consider patient preferences, priorities, and perceptions (eg, benefits, tolerability, affordability) in deprescribing.

4. When deprescribing a drug to reduce inappropriate polypharmacy, determine all drugs the patient is taking and the indication for each, consider the risk factors for drug-induced harm, assess the risks and benefits of each drug, determine the drugs to discontinue and implement a deprescribing plan, and monitor the discontinuation process.

Resources

1. Strength of Evidence: SORT C

   Source: American Medical Association, reference 14

Website: https://edhub.ama-assn.org/steps-forward/module/2702554#section-247174415

2. Strength of Evidence: SORT C

   Source: American Medical Association, reference 50

Website: https://www.ama-assn.org/media/7411/download

3. Strength of Evidence: SORT C

   Source: Am Fam Physician, reference 85

Website: https://www.aafp.org/afp/2019/0701/p32.html

4. Strength of Evidence: SORT C

   Source: JAMA Intern Med, reference 83

Website: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2204035