Factors affecting physician implementation of hospital pharmacists' medication appropriateness recommendations in older adults.
Affiliation
Aoife Fleming, Pharmacy Department, Mercy University Hospital, Grenville Place, Cork T12 WE28, Ireland.Issue Date
2021-07-16Keywords
HOSPITALPharmacist
PRESCRIBING
qualitative
Theoretical Domains Framework
Metadata
Show full item recordCitation
Dalton K, Fleming A, O'Mahony D, Byrne S. Factors affecting physician implementation of hospital pharmacists' medication appropriateness recommendations in older adults. Br J Clin Pharmacol. 2021 Jul 16. doi: 10.1111/bcp.14987Publisher
WileyJournal
British journal of clinical pharmacologyDOI
10.1111/bcp.14987PubMed ID
34270111Additional Links
https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.14987Abstract
Aims: Non-implementation of pharmacist recommendations by physician prescribers may prolong potentially inappropriate prescribing in hospitalised older adults, increasing the risk of adverse clinical outcomes. The aim of this study was to ascertain the key factors affecting physician prescriber implementation of pharmacists' medication appropriateness recommendations in hospitalised older adults. Methods: Semi-structured interviews were conducted with hospital pharmacists and physicians who provided care to older adults (≥65 years) in 2 acute university teaching hospitals in Ireland. Content analysis was employed to identify the key themes that influence physician prescriber implementation of pharmacist recommendations. Results: Fourteen interviews were conducted with 6 hospital pharmacists and 8 hospital physicians between August 2018 and August 2019. Five key factors were found to affect physician implementation of pharmacist recommendations: (i) the clinical relevance and complexity of the recommendation-recommendations of higher priority and those that do not require complex decision-making are implemented more readily; (ii) interprofessional communication —recommendations provided verbally, particularly those communicated face to face with confidence and assertion, are more likely to be implemented than written recommendations; (iii) physician role and identity —the grade, specialty, and personality of the physician significantly affect implementation; (iv) knowing each other and developing trusting relationships —personal acquaintance and the development of interprofessional trust and rapport greatly facilitate recommendation implementation; and (v) the hospital environment —organisational issues such as documentation in the patient notes, having the opportunity to intervene, and the clinical pharmacy model all affect implementation. Conclusion: This study provides a deeper understanding of the underlying behavioural determinants affecting physician prescriber implementation of pharmacist recommendations and will aid in the development of theoretically-informed interventions to improve medication appropriateness in hospitalised older adults. © 2021 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.Item Type
ArticleLanguage
enEISSN
1365-2125ae974a485f413a2113503eed53cd6c53
10.1111/bcp.14987
Scopus Count
Collections
The following license files are associated with this item:
- Creative Commons
Except where otherwise noted, this item's license is described as © 2021 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.
Related articles
- Prescriber Implementation of STOPP/START Recommendations for Hospitalised Older Adults: A Comparison of a Pharmacist Approach and a Physician Approach.
- Authors: Dalton K, O'Mahony D, O'Sullivan D, O'Connor MN, Byrne S
- Issue date: 2019 Mar
- Factors Affecting Prescriber Implementation of Computer-Generated Medication Recommendations in the SENATOR Trial: A Qualitative Study.
- Authors: Dalton K, O'Mahony D, Cullinan S, Byrne S
- Issue date: 2020 Sep
- The impact of a structured pharmacist intervention on the appropriateness of prescribing in older hospitalized patients.
- Authors: O'Sullivan D, O'Mahony D, O'Connor MN, Gallagher P, Cullinan S, O'Sullivan R, Gallagher J, Eustace J, Byrne S
- Issue date: 2014 Jun
- The role of perceived impact on relationship quality in pharmacists' willingness to influence indication-based off-label prescribing decisions.
- Authors: Basak R, Bentley JP, McCaffrey DJ 3rd, Bouldin AS, Banahan BF 3rd
- Issue date: 2015 May
- Description of pharmacist interventions during physician-pharmacist co-management of hypertension.
- Authors: Von Muenster SJ, Carter BL, Weber CA, Ernst ME, Milchak JL, Steffensmeier JJ, Xu Y
- Issue date: 2008 Jan