Reasons for non-use of proven pharmacotherapeutic interventions: systematic review and framework development.

RATIONALE, AIMS AND OBJECTIVES: The quality of patient care and safety is dependent on addressing both errors of commission (e.g. overuse of medications) and errors of omission (e.g. patients receiving too little care). Despite guidelines recommending the use of certain proven pharmacotherapeutic interventions, a large gap exists between the patients that have an indication for, and those that actually receive such interventions. To address how the rate of implementation of proven interventions can be improved is dependent on a comprehensive knowledge of the factors contributing to their underuse. The aim of the review is to create an evidence-based framework of reasons why eligible patients do not receive proven pharmacotherapeutic interventions. METHODS: A systemic review of the published reasons for non-use based on the Cochrane methodology. RESULTS: The systematic review identified 67 articles meeting the inclusion criteria. The reasons for non-use were extracted from the studies and a framework was created from the results. CONCLUSIONS: The factors associated with lack of implementation of proven pharmacotherapeutic interventions are complex and heterogeneous but can be understood from the perspectives of clinicians, patients and health care delivery systems. Efforts to increase the utilization of proven interventions should focus on disease/intervention-specific programmes that take into account the identified modifiable clinician, patient and system factors.

Reasons for Non-use of Proven Interventions for Hospital Inpatients: Pharmacists' Perspectives.

BACKGROUND: Recently, health care institutions have been using performance indicators to measure and improve quality of care. One such indicator, the Ideal Medication Intervention Index, reflects the rate of implementation of proven pharmacologic interventions, which studies have shown are underutilized. Identifying the reasons why proven interventions are underused is essential to determining how their rate of use can be improved. OBJECTIVE: To characterize the reasons for non-use of proven interventions from the perspective of clinical pharmacists within the authors' health care organization. METHODS: A survey of all clinical pharmacists within the organization was conducted. The survey used standardized, case-based scenarios involving pharmacologic interventions known to improve health outcomes. Respondents were asked to rank potential reasons why a patient might not receive a proven intervention. RESULTS: Of the 115 pharmacists invited, 53 (46%) participated in the survey. Most of the respondents practised on medical wards. The 2 most common reasons for non-use of proven interventions were a team preference to defer management of such issues to the outpatient care provider and issues related to workload. CONCLUSIONS: Clinical pharmacists revealed that their perceptions of priorities, communication with their interdisciplinary teams, and workload issues contributed to non-use of proven pharmacologic interventions among patients in their care. Efforts to increase the utilization of the proven clinical interventions studied here should focus on changing pharmacists' perceptions of priorities.