Hospital pharmacists’ perceived beliefs and responsibilities in indication-based off-label prescribing

Abstract

Background Off-label prescribing is prevalent in healthcare. There is a lack of understanding of pharmacists’ attitudes toward the practice of off-label prescribing, especially those that are prescribed for other indications than approved ones (termed as indication-based off-label prescribing). Objective Explore hospital pharmacists’ attitudes toward and perceived responsibility in off-label and indication-based off-label prescribing in hospital pharmacy practice. Setting Pharmacists practicing in hospitals in the United States were investigated. Method Pharmacists were contacted via email through State affiliates of the American Society of Health-System Pharmacist. The survey described an indication-based off-label medication order for a hospitalized patient and the prescribing physician. Data were collected via Qualtrics. Main outcome measure Questions focused on awareness, beliefs, and responsibility—including, risk assessment and monitoring outcomes—related to off-label and indication-based offlabel prescribing. Results Of 107 pharmacist respondents, about 79% and 98% reported being familiar with offlabel and indication-based off-label prescribing, respectively. While 77.6% pharmacists believed that patients should be informed, only 37.4% agreed that they had responsibility of informing physicians; presence of policy was associated (p < 0.02) with pharmacist agreeing to inform physicians. Over 70% agreed that patients should be closely monitored for outcomes and 43.1% believed physicians had predominant responsibility of monitoring outcomes. Conclusion Pharmacists’ perceived responsibility and beliefs regarding off-label prescribing are insightful that can be utilized for improving patient care.