Do Prescribing Doctors Act on Pharmacist Recommendations?

Researchers examine acceptance rates and factors predicting doctor acceptance of pharmacist recommendations within a Medicare Advantage Plan.

Among their list of responsibilities, pharmacists serve as an important member of an interdisciplinary care team to protect patient health and safety while minimizing costs.

Existing literature shows that by communicating recommendations to prescribing doctors, pharmacists can help to measurably reduce costs, control chronic diseases like hypertension, diabetes, and hyperlipidemia, and improve patient outcomes.

Additionally, within a Medicare Advantage Plan (MAP), pharmacist interventions can help achieve Centers for Medicare & Medicaid Services (CMS) Part D Star Ratings, particularly for medication adherence. Even greater cost-effectiveness can result because ratings determine quality bonus payments and the timeframe by which a plan can enroll new members.

The Impact of Pharmacist Recommendations

The prevalence of prescribing doctors acting upon pharmacist recommendations has been previously studied, with results ranging anywhere from 31% to 81%. Most assessments find that a pharmacist’s recommendation succeeds in modifying a doctor’s prescription about 50% of the time.

Previous research has identified some factors associated with doctor acceptance. Doctors are more likely to accept pharmacist recommendations intended to save costs (versus safety or guideline adherence), and they are more likely to accept recommendations to change or stop a medication (50%) than they are to start a new medication (41.7%).

Finally, PCPs are more likely to accept pharmacist recommendations than are physician specialists.

A retrospective cohort study recently published in the Journal of Managed Care & Specialty Pharmacy conducted an assessment of pharmacist interventions, measuring the rate of provider acceptance and looking for member and provider factors associated with acceptance within a Texas MAP.

Members of a Texas MAP were selected for this study if a pharmacist reviewed their profile and sent a recommendation letter to their provider between July 1, 2012, and March 15, 2014.

Researchers retrieved pharmacist letters from archived files and assessed them for the following factors: type of recommendation; the member’s disease state affected by the recommendation; letter format; member and provider characteristics such as demographics; participation in the plan’s pay-for-performance program; physician specialty; and region of practice.

Acceptance was defined as a change in pharmacy claims that reflected the pharmacist’s recommendation within 6 months of the written intervention. Chi-square tests examined group differences in recommendation acceptance. Researchers used logistic regression to identify significant predictors of an accepted change.

Do Physicians Listen to Pharmacists?

Consistent with previous research, this study found about 50% of all pharmacist recommendations were accepted by providers within a Medicare Advantage Plan (115 of 228 recommendations, or 50.4%).

Recommendations to discontinue (62.5%) or change (52.8%) a drug had higher acceptance rates than recommendations to add a drug (38.9%; P = .007), but those recommendation types were not determined to be significant predictors in the multivariate model.

PCPs exhibited higher acceptance rates than physician specialists (51.9% versus 31.3%), and physicians participating in the pay-for-performance program also had higher acceptance rates (56.8% versus 47.4% for nonparticipants). But again, these differences were not significant factors in chi-square tests or multivariate adjusted models.

Significantly, recommendations for heart failure were less likely to be accepted compared with recommendations for diabetes (OR = 0.31; 95% CI = 0.10-0.96; P = .043).

Half of all written pharmacist recommendations were accepted by doctors in a relatively small sample (228 recommendations) drawn from a Texas MAP, July 1, 2012, to March 15, 2014.

The only factor found to be a significant predictor in this study was the disease state affected by the recommendation. Recommendations for heart failure were significantly less likely to be accepted by doctors than recommendations for diabetes. Upon examination, most recommendations for heart failure involved switching drugs in the beta-blocker class.

The lower acceptance rate in this category suggests that doctors did not see the value in modifying the current therapy. This finding points toward the potential need for physician education regarding the selection of beta-blocker medications.