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

      Miller, David William; Knapp, David A. (1993)
      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.
    • Perception of Maryland community pharmacists regarding overall effort (and its dimensions) required to process prescriptions

      Poirier, Sylvie; Knapp, David A. (1993)
      The objectives of this study were (1) to determine the dimensions of pharmacists' effort (work) and (2) to measure the effort and its dimensions required when processing prescriptions with various characteristics, new/refill, presence and category of drug-related problems (DRP), drug class, patient age, and payment method. Interviews were conducted with community pharmacists to determine the dimensions of their effort when processing prescriptions. Time, cognition and communication were considered as the most important dimensions. A questionnaire containing five prescriptions with varying characteristics was mailed to 1,524 community pharmacists in the state of Maryland. On a visual analogue scale with equal intervals, respondents were asked to evaluate time, cognition, communication and overall effort required to process each prescription. Analyses were performed using factorial ANOVA with repeated measures of R{dollar}\sb{lcub}\rm x{rcub}{dollar} (new/refill-presence and category of DRP). Pharmacists' perception of time, cognition, communication, and overall effort was approximately double when prescriptions contained a DRP such as a drug interaction, or excessive dosage and was increased by approximately 50% when a prescription was processed for a non-compliant patient. Age of the patient or payment method did not influence the overall effort (nor its dimensions) involved in processing prescriptions. Drug class had an effect on overall effort (and its dimensions) and an interactive effect with R{dollar}\sb{lcub}\rm x{rcub}{dollar} on overall effort and communication scores. The results have implications for reviewing compensation of pharmacists in the provision of pharmaceutical services which can be associated with the prevention and resolution of drug-related problems. A typology of three types of pharmaceutical services has been derived from the study: (UNFORMATTED TABLE OR EQUATION FOLLOWS){dollar}{dollar}\vbox{lcub}\halign{lcub}#\hfil&&\quad#\hfil\cr &{lcub}Relative\ value{rcub}&\cr &\ \ \underline{lcub}of\ effort{rcub}&\underline{lcub}Prescription\ characteristics{rcub}\cr\cr &1.0&Prescriptions (new or refill) without\cr&&a drug-related problem;\cr &1.5&Prescriptions for non-compliant patients;\cr &2.0&Prescriptions with a drug-related problem that\cr&&require an intervention with the physician.\cr{rcub}{rcub}{dollar}{dollar}(TABLE/EQUATION ENDS) Concerning the dimensions of effort, approximately half of the variance of overall effort was explained by communication and cognition. Pharmacists did not relate overall effort to time per se.