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PharmAlert — Clinical Decision Support

PRIMARY CARE

Support for repeat prescribing and medication review.

Most prescribing happens in general practice, and most of it is repeat. The risk is rarely in the new medicine — it is in the regimen that has accumulated around it.

The setting

Repeat prescriptions are reissued in volume, often without the patient present and without a fresh look at the whole list. Renal function drifts, new medicines arrive from secondary care, and the regimen quietly stops matching the patient.

Where risk builds up

  • Repeat authorisation, where a dose appropriate two years ago no longer matches renal function.
  • Medicines started in hospital and continued indefinitely without review.
  • NSAIDs added to a regimen already containing an anticoagulant or an SSRI.
  • Patients on eight or more medicines, where the burden itself is the finding.

Where PharmAlert fits

The same check runs on a single prescription or across a caseload. For structured medication review it gives a prioritised list rather than an undifferentiated alert log, so the appointment time goes to the findings that matter.

A check for this setting

Repeat prescription review, eGFR 42, three medicines

Patient
F · 74 · eGFR 42
Medicines
3
WarningPA-DOS-003

Metformin · eGFR 30–44

At this level of renal function the maximum metformin dose is reduced, typically to 1 g daily in divided doses.

Well documented · Established

SuggestedReduce the dose and review renal function every three to six months — confirm against local guidance.

WarningPA-DOS-012

Apixaban · eGFR 30–59

Moderate renal impairment raises apixaban exposure. The dose remains standard for most patients, but renal function needs to be tracked rather than assumed stable.

Well documented · Established

SuggestedReview renal function at least every six months, and reassess the dose if eGFR falls further.

WarningPA-INT-022

Anticoagulant + NSAID

Additive bleeding risk through separate mechanisms — anticoagulation plus mucosal injury and platelet effect.

Well documented · Established

SuggestedParacetamol or a topical NSAID. If an oral NSAID is essential, add gastroprotection and review the indication.

3 risks · 0 critical

Demonstration only, using fictional patients. Not for clinical use.

What a pilot involves

SCOPE
One practice or a PCN, with a named clinical pharmacist.
INTEGRATION
Batch review across a caseload, or API at the point of issue.
MEASURES
Findings per review, changes made, and time taken per review compared with usual practice.
DURATION
Roughly fifteen weeks from scoping to joint evaluation.

Tell us about your setting.

We will come back with what a pilot would look like for you.

Request a pilot