An exploratory survey on the awareness and usage of clinical practice guidelines among clinical pharmacists

Jessica M Downes; Lisa A Appeddu; Jeremy L Johnson; Kelsey S Haywood; B Jordan James; Kendrick D Wingard

doi:10.1016/j.rcsop.2021.100013

An exploratory survey on the awareness and usage of clinical practice guidelines among clinical pharmacists

Explor Res Clin Soc Pharm. 2021 Apr 21:2:100013. doi: 10.1016/j.rcsop.2021.100013. eCollection 2021 Jun.

Authors

Jessica M Downes¹, Lisa A Appeddu², Jeremy L Johnson^{2

3}, Kelsey S Haywood¹, B Jordan James², Kendrick D Wingard²

Affiliations

¹ University of Nebraska Medical Center College of Pharmacy, Nebraska Medical Center Omaha, NE 986145, USA.
² Southwestern Oklahoma State University College of Pharmacy, 100 Campus Drive Weatherford, OK, USA.
³ Oklahoma State University Department of Internal Medicine, 717 S. Houston Ave., Ste, 304 Tulsa, OK, USA.

Abstract

Background: The NHLBI has not developed clinical practice guidelines since 2007. As a result, multiple organizations have released competing guidelines. This has created confusion and debate among clinicians as to which recommendations are most applicable for practice.

Objectives: To explore preliminary attitudes, awareness, and usage of clinical practice guidelines in practice and teaching for hypertension, dyslipidemia and asthma among clinical pharmacists.

Methods: Clinical pharmacists across the US were surveyed electronically over a two week period in Spring 2019 regarding utilization and knowledge of practice guidelines for hypertension, dyslipidemia, and asthma. Clinical cases were included to evaluate application of guidelines. Descriptive statistics, Chi-square analysis, and Wilcoxon signed-rank test were conducted. Statistical significance level was set to 0.01 to account for multiple tests conducted on the same survey participants.

Results: Forty-eight, 34, and 28 pharmacists voluntarily completed hypertension, dyslipidemia, and asthma survey questions, respectively. Interactions by disease state (p < 0.001) revealed more pharmacists (93%) reporting to have ≤50% patient load in managing asthma and more pharmacists (95%) had read the full summary/report of the most recent hypertension guideline. Primary reasons why the most recent guideline was not selected were also significantly different by disease state (interaction; p < 0.001). For dyslipidemia and asthma, pharmacists had a higher mean rating of agreement (p < 0.007) in having the most confidence in the most recent as compared to older guidelines. Proportionally more clinical cases were answered correctly (interaction; p < 0.001) when pharmacists applied the most recent guideline for hypertension (84%), while the opposite outcome was found for asthma (27%).

Conclusion: While more pharmacists selected the most recent guideline for practice and teaching, there was inconsistent application of guidelines to clinical cases. Further studies with a larger representation of pharmacists are warranted to more definitively determine factors influencing guideline preference and usage.

Keywords: Asthma; Clinical pharmacists; Dyslipidemia; Hypertension; NHLBI; National Heart Lung and blood institute; Practice guideline.