Electronic Theses and Dissertations

Title

Willingness to Influence Indication-Based Off-Label Prescribing: an Investigation of Hospital Pharmacists

Date of Award

2010

Document Type

Dissertation

Degree Name

M.S. in Pharmaceutical Science

First Advisor

David J. Mccaffrey

Second Advisor

Alicia S. Bouldin

Third Advisor

John P. Bentley

Abstract

Off-label prescribing is a common and legal practice in the United States. However, off-label prescribing occurs oftentimes with inadequate evidence of effectiveness. Such practice, especially when prescribing for disease conditions different from approved clinical indications (indication-based off-label prescribing), brings about controversy and raises different issues with various stakeholders. Although indication-based off-label prescribing offers advantages in terms of providing innovative therapy, it raises concerns because the safety and efficacy of such use may not be evaluated adequately. Thus, the objective of the study was to examine whether pharmacists are willing to influence physicians while evaluating an indication-based off-label medication order. Based on the extended social power typology originally proposed by French and raven (1965), the study examined the role of relative expert power, perceived appropriateness, and perceived negative relational consequences on pharmacist's willingness to influence using rationality tactic. Pharmacists practicing in hospitals were recruited from the membership rolls of state affiliates of the American Society of Health-System Pharmacists (ASHP). The state affiliates were requested to distribute to their members an invitation to participate that contained a link to the survey instrument. The study employed a 2 x 2 experimental design in which relative expert power and appropriateness were manipulated using a hypothetical vignette. Respondents who reported practicing in a hospital were randomly assigned to one of the four experimental groups. Responses from 267 pharmacists were available for analysis. After consistency inspection, 242 pharmacist respondents were included in the analysis to examine the various propositions. Results of the analysis showed that, in general, pharmacists were willing to influence physicians to ensure rationality of indication-based off-label prescribing. Although small in magnitude, pharmacists did express concern about negative impact on inter-professional relationship quality that might arise due to influence attempts. Indeed, the effect of perceived expert power differential between the physician and pharmacist and the effect of perceived appropriateness of the off-label medication order on willingness to influence were strongly (p<0.05) moderated by perceived impact on relationship quality. In addition, the perceived expert power differential was associated with pharmacists' willingness to influence. Pharmacists' willingness to influence increased as perceived appropriateness decreased.

Concentration/Emphasis

Pharmaceutics

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