Response forms reflect pharmacists' participation in retrospective DUR

Do community pharmacists influence prescribing?

OBJECTIVES

To evaluate whether community pharmacists have the ability to influence prescribing decisions and to determine the extent to which they do so.

DATA SOURCES

International Pharmaceutical Abstracts was searched for articles published between January 1970 and September 2002 and MEDLINE was searched for articles published between January 1966 and September 2002 that contain the terms pharmaceutical care or pharmacist and intervention.

STUDY SELECTION

Selected studies documented pharmacist interventions that resulted in a change in prescribing that required influencing the prescriber, included a complete description of methods and results, and were conducted in community pharmacies in the United States.

DATA EXTRACTION

Selected studies were examined to determine whether, in what ways, and to what extent community pharmacists influenced prescribing.

DATA SYNTHESIS

Community pharmacists in traditional practices regularly, but infrequently, recommend to prescribers that they initiate, discontinue, or change drug therapy. Prescribers usually accept and implement pharmacists' suggestions. Pharmacists are more likely to intervene to correct drug therapy problems when they have been trained to provide pharmaceutical care and have modified their practices to accommodate a more patient-centered style of practice. In the larger reviewed studies, pharmacists intervened to change therapy for the majority of their patients.

CONCLUSION

Community pharmacists routinely intervene to influence prescribing. They do so, for the most part, to correct clinical problems or to provide their patients with more affordable therapy. In the majority of interventions, physicians accept and implement pharmacists' suggestions.

Effect of practitioner education on adherence to asthma treatment guidelines

OBJECTIVE

To determine whether a letter-based intervention program submitted to prescribers and pharmacists would improve drug therapy in users of high-dose beta(2)-agonists (HDBs).

STUDY DESIGN

Retrospective drug utilization review.

PATIENTS AND METHODS

The intervention group consisted of 135 asthmatic patients (identified through ICD-9-CM codes) in the Connecticut Medicaid Program who submitted >1 claim per month for short-acting beta(2)-agonists (over a 6-mo period). Patient-specific intervention packets were mailed to the patients' prescribers and pharmacists, and their use of long-term control agents and healthcare utilization was evaluated over 6 months. These variables were compared with a comparison group (n = 510) of asthmatics drawn from the same Medicaid program who were not considered to be high-dose users of short-acting beta(2)-agonists at baseline.

RESULTS

Prior to the intervention, the intervention group used fewer long-term asthma control agents as compared with the comparison group (58% vs. 96%; p < 0.001); there was no significant difference after the intervention program (65% vs. 71%; p = 0.169). The acquisition of spacers was greater in the intervention group than in the control group after the intervention (7% vs. 2%; p = 0.007). At the end of the 6-month intervention period, 46% of patients in the intervention group were no longer HDB users (p < 0.001). The higher frequency of prescriber office visits in the intervention group than the comparison group before the intervention (0.46 +/- 0.82 vs. 0.25 +/- 0.66; p < 0.001) was not evident after the intervention program (0.24 +/- 0.63 vs. 0.18 +/- 0.60; p = 0.283).

CONCLUSIONS

This intervention program had modest impact on improving the use of long-term control agents and reducing prescriber office visits.

Comparison of targeting a DUR letter intervention at pharmacists separate from and in addition to physicians

OBJECTIVE

To examine the impact on dipyridamole prescribing of a letter mailed to pharmacists and/or physicians.

DESIGN

Interrupted time series with control series.

SETTING

State of Wisconsin.

PARTICIPANTS

Physicians and pharmacists caring for patients who were prescribed dipyridamole.

INTERVENTIONS

The state of Wisconsin was divided into four sections, three of which were designated as experimental regions (letter to physician only, letter to pharmacist only, and letter to both physician and pharmacist) and one of which served as a control region.

MAIN OUTCOME MEASURES

Cost of drug per patient per month in ambulatory and long-term care populations.

RESULTS

For 763 long-term care and 586 ambulatory Medicaid patients, letters sent to both physicians and pharmacists resulted in significant reductions in dipyridamole expenditures relative to the control group. For long-term care patients, interventions directed at both physicians and pharmacists produced significant reductions in dipyridamole prescribing relative to interventions directed at physicians alone or pharmacists alone.

CONCLUSION

Future DUR letter interventions designed to change prescribing habits would be more effective if they targeted both physicians and pharmacists, particularly in the long-term care setting.