The Effects of Presenting AI Uncertainty Information on Pharmacists’ Trust in Automated Pill Recognition Technology: Exploratory Mixed Subjects Study
Authors: Kim Jin Yong , Marshall Vincent D , Rowell Brigid , Chen Qiyuan , Zheng Yifan , Lee John D , Kontar Raed Al , Lester Corey , Yang Xi Jessie 
Published: December 2024

Background
Dispensing errors significantly contribute to adverse drug events, resulting in substantial health care costs and patient harm. Automated pill verification technologies have been developed to aid pharmacists with medication dispensing. However, pharmacists’ trust in such automated technologies remains unexplored.

Objective
This study aims to investigate pharmacists’ trust in automated pill verification technology designed to support medication dispensing.

Methods
Thirty licensed pharmacists in the United States performed a web-based simulated pill verification task to determine whether an image of a filled medication bottle matched a known reference image. Participants completed a block of 100 verification trials without any help, and another block of 100 trials with the help of an imperfect artificial intelligence (AI) aid recommending acceptance or rejection of a filled medication bottle. The experiment used a mixed subjects design. The between-subjects factor was the AI aid type, with or without an AI uncertainty plot. The within-subjects factor was the four potential verification outcomes: (1) the AI rejects the incorrect drug, (2) the AI rejects the correct drug, (3) the AI approves the incorrect drug, and (4) the AI approves the correct drug. Participants’ trust in the AI system was measured. Mixed model (generalized linear models) tests were conducted with 2-tailed t tests to compare the means between the 2 AI aid types for each verification outcome.

Results
Participants had an average trust propensity score of 72 (SD 18.08) out of 100, indicating a positive attitude toward trusting automated technologies. The introduction of an uncertainty plot to the AI aid significantly enhanced pharmacists’ end trust (t28=–1.854; P=.04). Trust dynamics were influenced by AI aid type and verification outcome. Specifically, pharmacists using the AI aid with the uncertainty plot had a significantly larger trust increment when the AI approved the correct drug (t78.98=3.93; P<.001) and a significantly larger trust decrement when the AI approved the incorrect drug (t2939.72=–4.78; P<.001). Intriguingly, the absence of the uncertainty plot led to an increase in trust when the AI correctly rejected an incorrect drug, whereas the presence of the plot resulted in a decrease in trust under the same circumstances (t509.77=–3.96; P<.001). A pronounced “negativity bias” was observed, where the degree of trust reduction when the AI made an error exceeded the trust gain when the AI made a correct decision (z=–11.30; P<.001).

Conclusions
To the best of our knowledge, this study is the first attempt to examine pharmacists’ trust in automated pill verification technology. Our findings reveal that pharmacists have a favorable disposition toward trusting automation. Moreover, providing uncertainty information about the AI’s recommendation significantly boosts pharmacists’ trust in AI aid, highlighting the importance of developing transparent AI systems within health care.