PACE-RAG: Patient-Aware Contextual and Evidence-based Policy RAG for Clinical Drug Recommendation

Abstract: Drug recommendation requires a deep understanding of individual patient context, especially for complex conditions like Parkinson's disease. While LLMs possess broad medical knowledge, they fail to capture the subtle nuances of actual prescribing patterns. Existing RAG methods also struggle with these complexities because guideline-based retrieval remains too generic and similar-patient retrieval often replicates majority patterns without accounting for the unique clinical nuances of individual patients. To bridge this gap, we propose PACE-RAG (Patient-Aware Contextual and Evidence-based Policy RAG), a novel framework designed to synthesize individual patient context with the prescribing tendencies of similar cases. By analyzing treatment patterns tailored to specific clinical signals, PACE-RAG identifies optimal prescriptions and generates an explainable clinical summary. Evaluated on a Parkinson's cohort and the MIMIC-IV benchmark using Llama-3.1-8B and Qwen3-8B, PACE-RAG achieved state-of-the-art performance, reaching F1 scores of 80.84% and 47.22%, respectively. These results validate PACE-RAG as a robust, clinically grounded solution for personalized decision support. Our code is available at: https://github.com/ChaeYoungHuh/PACE-RAG.