Physicians endorse pharmacy-run clinics
MDs comfortable with RPh-run clinics
A survey published in the July/August 1998 Journal of Managed Care Pharmacy,1 helps make the case that if pharmacists can get certified and therefore become eligible for reimburse ment, physicians willingly will provide oversight and/or protocol development if necessary.
Although the survey focuses solely on military doctors with experience with pharmacy-run clinics dating to the 1970s, the authors note that physician attitudes have been getting better across the board in recent years. But it wasn't until the mid-1990s, they write, that even military doctors began to better accept pharmacy-run clinics. Their acceptance was based on the advent of protocol guidelines that led military base and Veterans Affairs hospitals to move anticoagulation clinics from the internal medicine department to pharmacy.
In this survey, 138 physicians from five military hospitals responded to sets of demographic and attitudinal questions. The survey targeted physicians in cardiology, endocrinology, hematology, nephrology, pulmonology, orthopedics, and family practice - in other words, physicians likely to prescribe anticoagulants and come into contact with specialized clinics.
The authors designed the study in part to test four hypotheses, three of which were confirmed. The first assumed that physicians with less than 10 years spent in military practice would be more receptive to pharmacy-run clinics than those practicing more than 10 years.
Not only did the survey bear this hypothesis out, but it noted that physicians who had practiced for more than 10 years tended to believe that physicians should control every aspect of anticoagulation therapy, not just major clinical ones.
A second hypothesis was that doctors having experience with pharmacy-run clinics would be more open to them. This was clearly supported. Unsupported, however, was the hypothesis that physician attitudes would be different based on where in the country they practice.
The final hypothesis was that if physicians support a pharmacist-run anticoagulation clinic, they also will support "pharmacist involvement in multidisciplinary patient care services." Researchers relied on matching statements 4 and 11 (see p. 179) to determine a positive attitude, focusing on physicians experienced with pharmacy-run clinics.
Going deeper into the comparisons, the survey found attitudes "much more favorable" among those doctors with that experience than those without. The authors close with several survey-related and forward-looking conclusions:
o Anticoagulation clinics are increasing in number throughout the Department of Defense, and many are administered by pharmacists.
o Pharmacist-run anticoagulation clinics are cost-effective and may provide a partial solution to dwindling access to the military health care system.
o A model for pharmacist-run anticoagulation clinics in civilian managed care organizations, similar to the military system, may save health care dollars.
o The primary obstacle to expanding those clinics lies in persuading civilian physicians in private practice to allow pharmacists to control dosing algorithms and to abide by the clinical decisions of the pharmacists.
The authors also note that among the spectrum of potential "nonphysician providers," pharmacists fare better as the group physicians feel more comfortable with in obtaining increased clinical privileges. Specifically, physicians were asked to rate the following 12 statements on a scale of one -"strongly agree"- to seven - "strongly disagree." (Mean scores are in parentheses after each statement.)
1. A nonphysician, nonpharmacist health care professional (with appropriate training), under protocol and with physician oversight, can adequately monitor/maintain a patient's anticoagulation therapy in an outpatient setting. (2.949)
2. A pharmacist (with appropriate training), under protocol and with physician oversight, can adequately monitor/maintain a patient's anticoagulation therapy in an outpatient setting. (1.920)
3. A pharmacist-run anticoagulation clinic is an asset to a managed health care setting. (2.268)
4. My experience with pharmacist-run anticoagulation clinics has been positive. (This question directly related to 57 of the 138 respondents with such experience.) (1.579)
5. All aspects (initiation, monitoring, dose adjustments, and discontinuation) of anticoagulation therapy should be the sole responsibility of the patient's primary physician. (4.862)
6. Properly trained pharmacists should be authorized to make independent dosage adjustments, under protocol, in routine (nonalert) value, international normalized ratio (INR) <4.00 cases. (2.333)
7. Properly trained pharmacists should be authorized to make independent dosage adjustments, under protocol, on alert value INR >4.00 cases. (4.051)
8. Properly trained nonphysician, nonpharmacist health care professionals should be authorized to make independent dosage adjustments, under protocol, on later value INR >4.00 cases.
9. Properly trained pharmacists should be authorized to sign prescriptions for Coumadin refills within the scope of the anticoagulation clinic protocols. (3.094)
10. Properly trained nonphysician, nonpharmacist health care professionals should be authorized to sign prescriptions for Coumadin refills within the scope of the anticoagulation clinic. (4.471)
11. A pharmacist-run anticoagulation clinic supports multidisciplinary care. (2.210)
12. A pharmacist-run anticoagulation clinic infringes on physician control of patient management. (5.167)
Reference
1. Shalita, E.A., et al. Physician attitudes toward pharmacist-run anticoagulation clinics in Department of Defense health services region 5. J Managed Care Pharm 1998; 4:413-419.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content