Trends in Physician Acceptance of Pharmacist Recommendation Letters

A recent study found that physicians within a Medicare Advantage Plan (MAP) accepted an average of 50% of pharmacist-written recommendation letters, but acceptance for heart failure was significantly lower than diabetes.

The cohort study used Texas MAP beneficiaries with prescription drug coverage who were 18-years-old or older. Participants involved had pharmacist written drug recommendations to their providers between July 1, 2012 and March 15, 2014. The study had 158 pharmacist-written letters comprised of 228 recommendations from physicians.

Those considered ineligible for the study included beneficiaries who did not have a Part D plan with MAP or had letters that were written to 2 or more providers (n=18); letters with less than 6 months of pharmacy claims dated after the letter was written (n=45); and letters that did not include a recommendation for a specific medication change that could be evaluated through the pharmacy claims database (n=29).

In order to determine the acceptance of the recommendations, researchers used the RxClaim database with MAP member prescription claim records. Then MAP’s internal computerized database was used to retrieve the provider and member variables.

Provider variables included physician age, gender, type, region where the physician practices, and participation in the health plan pay-for-performance program. The demographics collected for members was age, gender, and qualification for low-income subsidy.

The analysis was conducted with descriptive statistics that used the outcome variable of accepted recommendations versus unaccepted recommendations, and determined the overall percentages.

Additionally, the chi-square analyses was used to examine group differences in recommendation acceptance with various members and prescriber characteristics, as well as letter and recommendation variables. The logistic regression model was used to identify significant predicators of an accepted change.

The results of the study showed that 115 or 50.4% of recommendations were accepted. Of these acceptances, 95 (41.7%) were to add a drug, 80 (35.1%) were to discontinue a drug, and 53 (23.2%) were to change a drug.

The member population affected by these recommendations had a mean ± standard deviation (SD) age of 69 (± 11) years and 58.3% were female.

Although the recommendation type was not determined as a significant predictor in the multivariate model, it was found to be more likely for recommendations to be accepted for discontinued or drug changes than for adding a drug (P = 0.007).

Recommendations for patients with heart failure were less likely to be accepted compared with diabetes recommendations (OR = 0.31; 95% CI = 0.10-0.96; P = 0.043). Furthermore, recommendations were more likely to be granted among different regions evaluated, however, this did not reach a significant level and could be due to the relatively small sample size.

The study has shown that a majority of pharmacist recommendations are accepted by providers. However, there is still opportunity for additional physician education that could benefit patient care, especially in individuals with heart failure who physicians may not see the value in modifying their current therapy.

Researchers state that more research is needed with larger samples to help determine the reasons for recommendations being denied and to help improve acceptance rates. If this is able to be identified, it can result in better relationships between physicians and pharmacists while improving patient care.