Understanding the factors influencing prescriber uptake of pharmacist recommendations in secondary care

Pharmacists are increasingly recognized as medication experts who can bring much to clinical teams and decision making. The inclusion of a pharmacist into a multidisciplinary team, including ward rounds, can be sporadic in some settings, meaning pharmacists are not always present at the point of decision making. In this way, subsequent recommendations may not always be adopted. Understanding the perceptions of prescribers to pharmacist input and preferences for receiving pharmacist input, may result in more effective and efficient patient care.

The purpose of this study is to understand how prescribers view pharmacist contributions and the factors that facilitate or hinder acceptance of pharmacist recommendations within a hospital setting.

This mixed methods study consisted of two stages, initially focus groups and an online survey. Thematic analysis of the focus group discussions was conducted, and these formed the basis of the survey. A total of 17 prescribers participated in the focus groups and 99 of 335 prescribers participated in the survey. The questions centred on 4 key aspects, 1) the perceived role of a pharmacist, 2) communication strategies 3) the value added by pharmacists and 4) barriers and enablers to adopting pharmacist recommendations.

Prescribers strongly valued dosing advice and information on medication interactions. Some prescribers did not believe that a pharmacist should attend ward rounds, with more senior clinicians seeing value of recommendations being given at the time of medication initiation. Within a busy clinical setting several barriers were identified, including communication method, differing priorities, presence of pharmacist at the time of decision making, and consultant led hierarchy.

Several factors influence acceptance of pharmacists' recommendations. Working on communication methods may overcome some, but others such as pharmacist presence on rounds and consultant led decision-making hierarchy may be harder to change.