At first glance, indications data may not seem like the most essential piece of information for pharmacists to have when reviewing and/or dispensing a prescription. There are certain medications for which the indication is fairly certain. Furthermore, a brief conversation with the patient can help the pharmacist evaluate whether the patient understands for which condition the medication is prescribed.
While much of the research on the value of knowing a drug’s indication is based more on opinion and consensus rather than definitive findings, publications on this topic agree on the premise that synchronizing the list of patient diagnoses between providers and pharmacies improves drug screening and benefits patient safety. Indications data also may have value beyond that, including:
- Enhancing patient counseling and additional product recommendations
- Enabling caregivers to better support patients
- Supporting medication therapy management (MTM) or similar activities
- Optimizing pharmacy and/or medical data analysis
Improving prescription safety
Knowing the drug indication helps the healthcare team in assessing the safety and efficacy of the medication for the reason it was prescribed. A 2016 New England Journal of Medicine article by Schiff, et al, discussed a variety of ways indications data enhances the prescribing process and medication use, including:
- Improving the efficacy of the prescribing process and increasing medication safety by reducing prescribing and dispensing errors, particularly when used in an indications-based prescribing system
- Increasing medication adherence by improving patient’s understanding of the intent of treatment
- Assisting with medication reconciliation
- Assessing clinical effectiveness of medications
Indications data could prove “crucial” to the safety screening process performed by pharmacists, according to a 2019 article by Grissinger that reexamined the above-mentioned article by Dr. Schiff. Having the indication would help identify “drug selection errors, dosing errors, or wrong-patient errors.”
An Australian study by Garada, et al, reported that consumers believed including indications for use on medication labels assist with making “medication less confusing, especially for those on multiple medications or people who are forgetful.” The pharmacists in this study expressed that including drug indications on prescriptions “may reduce prescribing and dispensing errors of ‘look-alike, sound-alike’ medications.” Similarly, prescribers noted that, “errors could be reduced by matching the correct drug and dosage for the correct indication.”
Building a smarter (and more privacy-conscious) drug data system
Since the publication of the Schiff article in 2016 and its call for greater sharing of indications data, healthcare practices have not progressed much in terms of helping a pharmacist make more in-depth assessments of patient medications based on indication information. The NCPDP SCRIPT standard allows for a number of data inputs to be passed from the prescriber to the pharmacy, including diagnosis codes. While the means may be out there, the processes and procedure to widely implement them are lacking, and progress is slow.
Two of the major concerns that are repeatedly mentioned in literature with respect to sharing of indications data are:
- Impact on workflows
- Privacy concerns when including indications on medication labels
Impact on workflows
Transmission of indication information for a prescription from a prescriber to a pharmacy involves having proper systems and workflows at both ends. Whether inclusion of information on a prescription entails selecting a condition from a picklist or using a system that incorporates indications-based prescribing, the process must be efficient and user-friendly for prescribers.
In one commentary article by Baysari, et al, the authors presented their case for why inclusion of indication information may not always be possible in a hospital setting. This is partly due to patients not being able to communicate the reason why they are taking certain current medications and the fact that obtaining this information can be time-consuming.
Another challenge for prescriber workflows, regardless of practice setting, is the variety of content provided by various knowledge and system vendors, particularly with respect to off-label use. This stems from various vendors having their own policies and criteria for inclusion of off-label uses within their systems which can become problematic when attempting to include indications with medications prescribed.
Not all pharmacy systems may have a designated area to record and store medication indication information on patient profiles. While some may have disease states connected to the patient profiles, these may not be linked to a specific medication. Furthermore, it may be a challenge for many pharmacy systems to differentiate billing codes for disease states/diagnoses from drug indications.
The variety of terminology and classifications used for expressing indications and diagnoses by different systems and terminology providers can also present its own challenges when prescribing or when needing to devise patient-friendly terms for use on prescription labels.
In 2019, a study by Garabedian and colleagues published in JAMA Health Informatics reported the results of testing a prototype indications-based electronic prescribing system, versus two commercial systems available in the market using eight scenarios. The study showed the indications-based system saved users time, reduced medication errors, and increased clinician satisfaction.
Privacy concerns with indications on medication labels
Having indications on prescription labels has many proponents including patients. However, privacy is a huge concern for many, particularly when the indication is a more sensitive condition such as HIV or mental health. Giving the patient the choice of whether or not to include such information is an option. More than likely this will require systems upgrades that could be both time-consuming and costly. Regardless of where a clinician or patient falls on the question of privacy, some object to the inclusion of the indication on the label because it simply makes the label too crowded.
Additional considerations
In the U.S., some states dictate that patient instructions must be an exact copy of what the prescriber wrote on the prescription. Therefore, states must first pave the way to allow for inclusion of medication indications on labels when they are transmitted with the prescription, but not as a part of the patient instructions.
At times, what is transmitted to the pharmacy are billing or diagnosis codes, which are not always an exact representation of a drug’s indication. System and standard enhancements are needed to consistently provide patient-friendly terms for inclusion on labels. This will prevent pharmacists from needing to interpret codes or infer conditions that are not explicitly included on prescriptions.
Beyond the script — how else could indications help?
Beyond immediate safety checks and medication reconciliation activities, the transmission of indications data could provide additional benefits to pharmacists, patients, and other players within the healthcare industry.
MTM
More than ever, we are seeing a greater number of provider collaboration models in healthcare. An example of this would be MTM services performed by pharmacists and other healthcare professionals in various settings such as call centers and community pharmacies.
Having indication information will help improve the efficacy of the process by reducing the time spent on MTM preparation work that might be performed prior to contacting patients and/or providers. Not having indications while performing MTM activities can make assessment of medication safety and efficacy difficult, particularly when patients may not know why their medications were prescribed.
Patient and caregiver support
Having the indication may help pharmacists make recommendations for additional products or supplies that might prove useful in a patient’s care. Furthermore, as mentioned by various authors referenced here, indications on prescription labels can help patients and caregivers, particularly those with multiple medications, by reducing confusion, errors and improving adherence.
Data analysis
Including an indication on a prescription could also optimize the process of pharmacy and/or medical data analysis. For example, often when looking at pharmacy spend by different indications, a health plan or PBM will need to integrate pharmacy and medical data in order to reasonably arrive at such numbers or analyze trends. Having indications included on prescriptions that are passed on to various organizations involved in patient care can possibly reduce the effort involved in pharmacy and medical data integration and arrive at more accurate numbers and conclusions.
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