An exploration of healthcare professionals' attitudes and perceptions towards a local hospital drug formulary and their impact on prescribing practice

Abstract

Background: Hospital drug formularies are developed in order to support safe, effective and cost-effective prescribing. Their utilisation is based on the assumption that prescribers and other users will follow guidance outlined within them. The role of formulary users’ attitudes has been largely overlooked in the research literature. The nature and impact of attitudes to formularies on influencing prescribing practice have not been fully investigated. This study seeks to address this issue through a local practice based research project. Objectives: To determine the attitudes and experiences of users and key stakeholders with the utilisation of a new formulary at a local hospital trust. Methodology: Semi-structured interviews were conducted exploring the views of doctors, pharmacists and non-medical prescribers. An online self-completion questionnaire was sent to all key stakeholders. In addition prescribing data was also extracted from the Pharmacy computer system to assess impact of the new formulary. Data collection was thus split into two phases with modifications made to the formulary based on preliminary findings and emerging themes. Results: The local formulary symbolises a ‘critical split’ in the approach to resource management and patient care. Pharmacists are ‘closely bound’ to the formulary, relying on it for retrospective decision-support and ultimately seen to improve pharmacists’ autonomy while prescribers consider it to be over-rationalisation eroding their professional autonomy. Although the quantitative data in this study demonstrates a statistically significant improvement in doctors’ perceptions of using the formulary, the distinct divide between doctors’ and pharmacists’ attitudes towards the formulary remained. Prescribing data extracted showed no significant impact of the formulary on prescribing practice. Conclusion: The study confirms the existence of deeper sociological constructs, particularly concerning autonomy and professionalism. Doctors claim an ability to manage uncertainty during patient consultations while pharmacists claim to be drug ‘experts’. The monopoly on drug knowledge is therefore contested ground. This study concludes that both the formulary and the pharmacy profession need to be more influential, and embrace a more ‘humanised-bureaucracy.’ It is recommended that pharmacists build on a new philosophical union with the formulary and focus on asserting their claim and dominance on the monopoly of drug knowledge.