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PHARMACEUTICAL EDUCATION

Written Versus Oral Recommendations Made by Pharmacy Students During Internal Medicine Rotations

Assistant Professor of Pharmacy Practice, School of Pharmacy, Campbell University, Buies Creek, NC

Susan M Miller, PharmD BCPS

Clinical Associate Professor; Director of Pharmacotherapy Education, School of Pharmacy, University of North Carolina, Chapel Hill, NC; Southern Regional Area Health Education Center, Fayetteville, NC

Reprints: Dr. Pound, Campbell University School of Pharmacy, Post Office Box 1090 Buies Creek, NC 27506, fax 910/609-7548, mpound{at}capefearvalley.com

BACKGROUND: Pharmacy students use a variety of methods to communicate with physicians during clinical rotations regarding pharmacotherapy concerns. Documented acceptance rates for oral or written recommendations, when studied individually, range between 64% and 95%.

OBJECTIVE: To compare the acceptance rates of written versus oral recommendations made by pharmacy students on internal medicine (IM) rotations.

METHODS: Fourth-year pharmacy students completing an IM rotation made oral or written recommendations to physicians at a large, community-based medical center from November 2005 through April 2006 (excluding December). The types of recommendations and outcomes of the interventions were recorded using a data collection form. The primary endpoint was to determine differences in acceptance rates for written versus oral recommendations. Secondary endpoints included comparing the recommendation types and their corresponding acceptance rates. Additionally, the acceptance rates for evidence-based medicine (EBM) interventions were determined.

RESULTS: A total of 625 recommendations were made by 10 pharmacy students during the 5 month study period; 47.5% of these were oral. A total of 82.8% of oral recommendations were accepted compared with 54.2% of written recommendations (p < 0.0001). Over 90% of the total recommendations were drug related. Overall, 68% of these recommendations were accepted. The major types of drug-related recommendations were indication for use (42.7%), inappropriate dose (17.2%), inappropriate route (11.3%), inappropriate drug (8.5%), and duplicate therapy (6.5%). The remaining types of interventions were laboratory related (6.4%) and requests for drug information (3.2%). A total of 227 (36.3%) recommendations were based on EBM guidelines, with an acceptance rate of 67.8%.

CONCLUSIONS: Pharmacy student recommendations are well received by IM physicians. Oral recommendations are accepted at a statistically significantly higher percentage compared with written recommendations. High acceptance rates for recommendations may have the ability to positively impact patient care.

Key Words: interventions, pharmacy student

Published Online, April 3, 2007. www.theannals.com, DOI 10.1345/aph.1H668