Impact of Physician Engagement During Formulary Decision-Making on Prescribing Practices and Formulary Adherence at an Academic Medical Center

摘要

ABSTRACT Purpose: To measure the impact of physician engagement during the formulary decision-making (FDM) process on formulary adherence. Methods: A retrospective review of formulary decisions made at an academic medical center during a three-year period was conducted. Decisions that could be evaluated for formulary adherence were assessed for whether pharmacists engaged the requesting physician during the FDM process, based on email contact or P&T committee meeting attendance. Comparison of formulary adherence, specifically medication utilization compliant with formulary restrictions, was made between decisions involving and not involving physician engagement. Nonformulary use was quantified for both groups. The relationship of factors and their potential influence on formulary adherence was examined. Acceptance by the P&T committee of the initial recommendation brought forward by a pharmacist-led FDM group was compared between engaged and unengaged cohorts. Results: Of 139 decisions made effective during the evaluation period, 64 could be evaluated for adherence. Following exclusion of 22 nonformulary decisions and 13 decisions for low utilization, overall formulary adherence was 94%. Cumulative formulary adherence in the engaged and unengaged cohorts was 96% (n = 3,208 of 3,342) and 90% (n = 1,360 of 1,506), respectively. When compared based on individual decisions, no difference between adherence rates was detected and adherence between cohorts was not affected by assessed covariates. Initial formulary recommendations in the sample were more likely to be modified by the P&T committee if the physician was engaged (20% versus 11%, P - 0.48). Conclusion: Physician engagement during FDM did not significantly affect formulary adherence at an academic medical center. Keywords: formularies, hospital; pharmacy and therapeutics committee; interprofessional relations; guideline adherence; professional education