Frequency and characteristics of prescription adaptations requested and made by chain community pharmacists

Community pharmacists in Indiana have the ability to make some prescription adaptations which do not require a collaborative practice agreement. The frequency and characteristics of prescription adaptations requested and made by chain community pharmacists in Indiana during routine practice is unknown.

The objective of this study was to determine the frequency and characteristics (e.g., type of adaptation, time required) of prescription adaptations requested and made by chain community pharmacists during routine care delivery.

An electronic card study was used to collect observational, cross-sectional data. During an assigned two-week period, pharmacists documented each prescription adaptation requested or made via an online data collection form that took less than one minute to complete. The form consisted of a minimum of five questions and a maximum of 15 questions in a multiple-choice format with branching logic. Years in practice, budgeted pharmacist and technician hours, store prescription volume, age, and time in minutes making requests were described with means and standard deviations.

A total of 188 prescription adaptations were documented by the 17 participating pharmacists. Over half (101, 53.7%) were adaptation requests where the prescriber was contacted. The remaining were completed by the pharmacist without prescriber contact. Some reasons pharmacists reported the need to contact the prescriber included: Indiana law not permitting the adaptation (56, 55.4%), clinical nuance (35, 34.7%), company policy (10, 9.9%), and "other" (10, 9.9%). Of the 56 adaptation requests made because the pharmacist perceived the adaptation was not permitted per Indiana law for the pharmacist to make independently, 31 (55.4%) were actually legally permissible. The adaptations pharmacists most commonly completed on their own included: changing quantity/package size (47, 54.0%) and changing dosage form (23, 26.4%). Notably, 36 (19%) adaptations were needed due to missing or incorrect information included on the prescription.

These findings point to potential opportunities to educate chain community pharmacists on current Indiana prescription adaptation rules, while also identifying potential opportunities to widen the scope of practice. These actions could help decrease time spent reaching out to prescribers and delays in patient care.