Using Decision Analysis to Modify Clinical Decisions Made by Pharmacists and Students

The purpose of this study was to determine if pharmacists’ decision making could be modified by providing probabilities for efficacy and adverse reactions for antihypertensive agents using case scenarios. Five groups of pharmacists were prospectively evaluated. Pharmacists recommended antihypertensive therapy for eight cases. After a two week washout pharmacists again selected antihypertensive therapy in the same eight cases. This time probabilities for efficacy and adverse reactions for antihypertensive medications were included. The pharmacists decisions were compared to a computerized decision analysis model. Data were collected on 480 cases. Pharmacists’ decisions matched the computer model 41.7 percent prior to probability information. After probabilities were supplied they matched 58.8 percent (P<0.05). Pharmacy students were the only group that did not change their decisions significantly after probabilities were supplied. Supplying probabilities for efficacy and adverse reactions can influence practicing pharmacists’ decisions. Students did not seem to utilize probability information in decision making. In addition, lack of adequate personal exposure to patient outcomes may influence students’ decision making process. New educational techniques may give students the ability to make clinical decisions based on rational decision making rather than learned biases.