Off-label medications: a mixed-method analysis of pharmacist and stakeholder perceptions of collaboration and practice

Susan G. Gray, Treasure M McGuire, Peter J. Little

Research output: Contribution to conferenceAbstractResearchpeer-review


Background. Effective medication managers in a changing landscape, pharmacists must be patient-centric and accepted within collaborative care models.

Aims. To utilise the increasing use of ‘off-label’ metformin in gestational diabetes (GDM) to inform how pharmacists and other health stakeholders view pharmacists’ medication management roles in evolving practice change; to identify barriers and enablers for collaboration and knowledge exchange.

Method: An observational mixed method study used cross-sectional surveys (27 prescribers, 50 diabetes educators (DEs) and 128 pharmacists) and interviews (8 women with GDM) to triangulate how knowledge and attitudes of Australian health professionals, particularly pharmacists, influenced perceptions of inter-professional collaboration and off-label medication decision-making. Concepts explored included pharmacist confidence handling ambiguous prescribing in vulnerable cohorts, and stakeholder perceptions of pharmacist’s role in GDM care.

Results. Only 48.5% of pharmacists faced with an off-label metformin prescription for a pregnant woman felt comfortable dispensing the medicine. Of the remainder, 7% would refuse to dispense, while 41% would contact the prescriber and suggest insulin. However, empirical acceptance developed with hospital inter-professional collaboration and indication familiarity. While pharmacists were generally positive towards collaboration with prescribers, prescribers had little confidence in pharmacists’ contribution to medication decisions. DEs observed competency differences, favouring hospital over community pharmacists. Women expressed concern for general practitioner and pharmacist hesitation about metformin in pregnancy.

Discussion. Limited opportunities for inter-professional collaboration and education, geographical isolation and time pressure, leave community pharmacists and general practitioners less familiar with evolving treatments. New collaborative and information exchange pathways need to be developed to address this disparity.
Original languageEnglish
Publication statusPublished - Dec 2019
EventAustralasian Pharmaceutical Science Association (APSA) 2019 Annual Conference - Monash University, Melbourne, Australia
Duration: 1 Dec 20194 Dec 2019


ConferenceAustralasian Pharmaceutical Science Association (APSA) 2019 Annual Conference
Abbreviated titleAPSA
The Association hosts an annual conference that provides a forum for presentation of research and development applications from all branches of pharmaceutical science, pharmacy practice and pharmacy education, with an emphasis on participation by postgraduate students.

The Annual Conference is open to members and non-members from related disciplines, and is relevant for:

- academic and industrial scientists associated with drug discovery, drug formulation and drug delivery research and development

- regulatory and clinical scientists involved in bioavailability and bioequivalence study design and assessment, preparation and review of regulatory dossiers

- start-up company representatives faced with implementing strategies for rapid drug discovery and development

- researchers in the clinical and practice areas of pharmacy

- academics with an interest in pharmacy education

- students and postdoctoral fellows from Australia and New Zealand in all areas of pharmaceutical science and pharmacy
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