Writing Effective Communications to Prescribers

Over the years I have been asked by many pharmacists why Towncrest Pharmacy gets such a good response from physicians and other prescribers when we send them a SOAP note and recommendations.  My response to them is that it took having many conversations with different physicians, creating easy to use physician communication forms, and learning how to write succinct, clinically relevant notes that matter to physicians.  This experience has helped me to develop a set of criteria that I use to teach pharmacists, residents, and pharmacy students on how to write an effective SOAP note.

Criteria for Physician Communication.

  1. Keep it succinct and clear.  It is important that our SOAP notes are not lengthy nor convoluted.  The information needs to read easily and be understandable.  By using the SOAP note format (S = Subjective, O = Objective, A = Assessment, and P = Plan) pharmacist create a note in a format recognizable and understood by prescribers.  Subjective information is information that the patient has told you, objective information is something that was measure (e.g. labs, vitals, etc), assessment is the pharmacists evaluation of the subjective and objective information to identify potential or actual drug therapy problems (DTPs), and the plan is the pharmacists recommendations to resolve the DTPs.  It is important to keep the SOAP note to one page, if at all possible, and include an updated medication list.
  2. Provide the prescriber with information they do not have.  What I mean here is that pharmacists need to look at their patients and their drug therapy with a critical eye.  Pharmacists need to be asking themselves how their patients are taking their medications, if they are adherent, if they are achieving their therapeutic goals, and if they are experiencing any adverse drug reactions (ADRs) including side effects and drug interactions.   By systematically reviewing each medication in this way, pharmacists can communicate information to physicians that may be otherwise unknown to them.
  3. Describe the problem.  The assessment part of the SOAP note is where pharmacists use their critical evaluation skills to identify the drug therapy problems that patients may be experiencing.  The categories of drug therapy problems that we use to describe the problem is what has been used extensively in the literature including:
    1. Untreated indication
    2. Need for additional therapy
    3. Adherence
    4. Dosing issues (dose too low and dose too high)
    5. Unnecessary drug therapy
    6. Adverse drug reaction (side effects and drug interactions)
  4. Provide concrete recommendations to prescribers.  Over the years I have learned provide recommendations that are answered with a yes or no by theprescriber.  Also, I make it clear on the form that I use thatprescribers understand that the recommendations become a prescription if approved and signed by the physician.  For example, I recently provided the following recommendation to aprescriber.
    1. Patient is taking both sertraline 25 mg QD and trazodone 150 mg QD. She has a PMH signficant for dementia with behavior disturbances, depression, and anxiety.  Her last depression evaluation indicated minimal depression.  Due to concerns about CNS ADRs with trazodone, can we attempt a trial reduction of her trazodone to 100 mg QD, #30 tablets, 11 Refills?  _____Yes  _____No
  5. Be evidence based.  It is important that pharmacists keep current with their therapeutic are are aware of the literature to support their recommendations.  This does not mean that you have to cite a particular study, but it does mean that you are able to do this if questioned and challenged.  If prescriber become confident in your knowledge and clinical skills they will more likely become more accepting to your recommendations.

Knowing and applying these criteria will help community pharmacists impact their patient’s care and help to develop collaborative working relationships with prescribers.  It is our responsibility to ensure that our patients medications are safe and effective, but we need to effectively communicate with other providers if we are to be successful in helping our patients.