An examination of an on-line prospective drug use review system and the dispensing decisions of pharmacists

Abstract

The objective of this study was to describe the frequency of and examine the factors associated with the dispensing decisions that pharmacists make after notification of possible drug-related problem by an on-line prospective drug use review (DUR) system. Three dispensing decisions were investigated: (1) the drug therapy with the possible drug-related problem was dispensed; (2) no drug therapy was dispensed; or (3) an alternative drug therapy was dispensed.;This study used data from a nationwide on-line prospective DUR system to examine the frequency of the three dispensing decisions after the pharmacist is alerted of a possible drug-related problem. Data to suggest that pharmacists respond to these alerts was evaluated. An analysis of the relationship between the decisions and selected factors hypothesized to effect them was also conducted.;Pharmacists were found to have reversed only 1.5% and to have submitted alternative claims after only 0.17% of the alerted prescription claims in the study. The following factors were found to be associated with the reversal of prescription claims with alerts: (1) increasing number of alerts; (2) increasing reimbursement amount; (3) drug over-dose alerts; (4) drug under-dose alerts; (5) submission of the claim during the work week; (6) increasing pharmacy volume; (7) submission of the claim from a chain pharmacy; (8) decreasing patient age; and (9) among prescription claims with drug-drug interactions and therapeutic duplications, submission of the claim from a pharmacy that was different than the pharmacy that dispensed the conflicting or duplicative therapy. Following reversal of a prescription claim with an alert, only decreasing amounts reimbursed of the reversed claim was found to promote the submission of a claim for an alternative drug therapy. Despite discovering statistically significant predictors of dispensing decisions, the principal finding of this study is the low frequency of pharmacist intervention by reversing prescriptions or submitting claims for alternative drug therapies. This may suggest that: (1) pharmacists identified and resolved possible drug-related problems before submission of prescription claims to the on-line prospective DUR system; (2) pharmacists are ignoring valid alerts; (3) pharmacists are overriding invalid alerts; (4) pharmacists are using alternative interventions to resolve the possible drug-related problem.