Study says pharmacists should be trusted more
Pharmacists are conservative by nature
Gandhi SK, et.al. Risk taking propensity and drug product selection behavior of pharmacists. J Managed Care Pharm 1997; 3:439-443.
A behavioral study of risk factors related to drug substitution suggests that pharmacists can be trusted to make good decisions and should be empowered to do so.
Three major points were made by the authors:
• Managed care organizations and pharmacy benefit management firms should give pharmacists increased autonomy in patient care areas such as drug selection.
• Pharmacists, in turn, should begin to consider taking more risks as their part in overall wellness increases.
• Managed care companies should work with pharmacists to establish formularies and substitution guidelines aimed at fending off the threat of having state legislatures do it for them.
In the two-phase study, 152 pharmacists rated their substitution choices for a list of 18 drugs. The authors then matched the results with a scale of risk-taking choices based on unrelated and hypothetical clinical settings. The study found that pharmacists overwhelmingly choose drugs with a low to moderate substitution risk over drugs deemed high-risk substitutions.
An outside panel of pharmacists chose 18 drugs and gave each a low, moderate, or high risk rating. Responding pharmacists were asked to note which drug they would have a tendency to substitute. (See chart, below right.)
Of the responding pharmacists, 69.6% worked in chain or independent settings, while 53.8% worked as staff pharmacists. The mean percentage of overall substitution was 73.52%. More than 90% of the drugs with low or moderate risk levels would be substituted, according to the survey results.
Pharmacists choosing drug substitutions did so under the assumptions that there was no physician or patient objection to a substitution; the pharmacist was making the decision without any existing "external pressures"; the generic drugs were available; and the substitution met any state product selection laws.
The authors identified "inherent risk" as the potential for the drug to cause therapeutic problems if a biologically inequivalent substitute were used. A scale was used designating low-risk drugs from 1-2, moderate-risk drugs from 2.01-3, and high-risk drugs 3.01-4.
To calculate risk-taking propensity, respondents chose between two courses of action, one of which carried greater risk but offered greater reward. Risk-taking propensity was defined simply as the extent to which a decision maker is willing to be exposed to possible failure.
The study’s authors noted that by furthering the logic and methods behind the study, related aspects of risk taking could be gauged, including dosage selection, drug suppliers, drug information given to patients, drug use monitoring, and the reporting of adverse reactions.
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