An evaluation of Australian pharmacist's attitudes on expanding their prescribing role

Assessment of the Prescribing Pharmacist's Role in Supporting Access to Prescription-Only Medicines-Metadata Analysis in Poland

In 2020, pharmacists in Poland received additional authority to prescribe drugs. In this study, we analyzed prescribing after the implementation of this new responsibility. We assessed how the new regulation works in practice and what it means for the healthcare system in the area of access to prescription-only medicines. Data analysis included information on the prescriptions written, the type of substance according to the ATC classification, and data on the prescribing pharmacists. The study used over 2.994 million e-prescriptions written by pharmacists in Poland, which were made available by the e-Health Center. The largest group of drugs prescribed were drugs used in the treatment of cardiovascular diseases, accounting for 25% of all prescribed medications during the time of the analysis. The next prescription groups were for drugs used in gastrointestinal diseases and metabolic disorders, and those acting on the central nervous system, the respiratory system, and the musculoskeletal system. Among pharmaceutical prescriptions, 73% were pharmaceutical prescriptions issued in pharmacies at full price to the patient. The results indicate that pharmacists are eager to use their permission to prescribe drugs in authority situations. Almost three million records showed improved patient access to medicines in the healthcare system (approximately 5% of repeat prescriptions for all patients during the study period). These data confirm the possibility of cooperation between physicians and pharmacists in strengthening the efficiency of the patient healthcare system. An important conclusion from this work is the need to create the possibility for the pharmacist to access the information resources of the implemented Internet Patient Account system, including therapeutic indications for the drugs used.

Increased self-reported pharmacist prescribing during the COVID-19 pandemic: Using the Theoretical Domains Framework to identify barriers and facilitators to prescribing

Background

Community pharmacists are positioned to improve access to medications through their ever-expanding role as prescribers, with this role becoming more pronounced during the COVID-19 pandemic.

Objectives

Our research aimed to determine the extent of self-reported pharmacist prescribing pre-COVID-19 and during the COVID-19 pandemic, to identify barriers and facilitators to pharmacist prescribing, and to explore the relationship between these factors and self-reported prescribing activity.

Methods

A questionnaire based on the Theoretical Domains Framework (TDFv2) assessing self-reported prescribing was electronically distributed to all direct patient care pharmacists in NS (N = 1338) in July 2020. Wilcoxon signed-rank tests were used to examine temporal differences in self-reported prescribing activity. TDFv2 responses were descriptively reported as positive (agree/strongly agree), neutral (uncertain), and negative (strongly disagree/disagree) based on the 5-point Likert scale assessing barriers and facilitators to prescribing from March 2020 onward (i.e., ‘during’ COVID-19). Simple logistic regression was used to measure the relationship between TDFv2 domain responses and self-reported prescribing activity.

Results

A total of 190 pharmacists (14.2%) completed the survey. Over 98% of respondents reported prescribing at least once per month in any of the approved prescribing categories, with renewals being the most common activity reported. Since the pandemic, activity in several categories of prescribing significantly increased, including diagnosis supported by protocol (29.0% vs. 58.9%, p < 0.01), minor and common ailments (25.3% vs 34.7%, p = 0.03), preventative medicine (22.1% vs. 33.2%, p < 0.01). Amongst the TDFv2 domains, Beliefs about Consequences domain had the largest influence on prescribing activity (OR = 3.13, 95% CI 1.41–6.97, p < 0.01), with Social Influences (OR = 2.85, 95% CI 1.42–5.70, p < 0.01) being the next most influential.

Conclusion

Self-reported prescribing by direct patient care community pharmacists in Nova Scotia increased during the COVID-19 pandemic, particularly for government-funded services. Key barriers to address, and facilitators to support pharmacist prescribing were identified and can be used to inform future interventions.

Pharmacist non-medical prescribing in primary care. A systematic review of views, opinions, and attitudes

BACKGROUND

Uptake of non-medical prescribing by pharmacists working in primary care has been slow. This is despite benefits such as quicker and more efficient access to medicines for patients, a reduction in doctor workload, and enhanced professional satisfaction. This systematic review explores the views, opinions, and attitudes of pharmacists and graduates towards non-medical prescribing.

METHODS

Medline, ScienceDirect, Embase, and the University of Reading Summon Service were searched to identify qualitative and mixed methods papers that examined the views, opinions, and attitudes of pharmacists and graduates towards non-medical prescribing. Papers published between January 2003 and September 2017 were included. Studies were quality assessed using the CASP checklist and then analysed using thematic synthesis.

RESULTS

After 85 full-text articles were assessed, a final 14 studies were eligible for inclusion. The included studies assessed pharmacists who currently prescribe, and other pharmacists and graduates with familiarity of non-medical prescribing. Thematic synthesis identified two themes: (1) practice environment, and (2) pharmacist's role. Non-medical prescribing was considered a natural extension to the role of a pharmacist despite difficulties in completing the required training. The ability to then prescribe was dependent on funding and access to medical records, time, and support staff. Pharmacists experienced professional rivalry with both support and resistance from members of the primary care team. The provision of training was frequently referred to as unsatisfactory. Pharmacists were motivated to prescribe, deriving increased job satisfaction and a sense of professionalism; however, they often felt underprepared for the reality of unsupervised practice. Furthermore, pharmacists reported a cautious approach with a fear of making errors frequently discussed.

CONCLUSIONS

This review has identified themes and subsequent barriers and facilitators to non-medical prescribing. Many of the barriers are more perceived than real and are diminishing. Consideration of these will assist and advance pharmacist prescribing in primary care, leading to positive outcomes for both patient care and the pharmacy profession.

Pharmacists' readiness to adopt prescribing authority in Jordan

Objectives

The overall objective of this study is to assess the views and attitudes of Jordanian pharmacists on expanded pharmacist prescribing role.

Methods

A cross-sectional, questionnaire-based study was conducted using a web-based questionnaire. Pharmacists were invited to take part in this study through pharmacists' Facebook groups for pharmacists in Jordan. Descriptive statistics were used to analyze the data in addition to the t-test to compare the mean difference of support levels toward supplementary and independent prescribing.

Key findings

A total of 521 pharmacists took part in this study. The majority of respondents (n = 482; 92.5%) believe that pharmacists in Jordan should have an expanded prescribing role. Respondents were significantly in favour of supplementary prescribing (P &lt; 0.05) than independent prescribing for various medical condition (e.g. diabetes and asthma). Respondents identified securing more roles in healthcare (n = 464; 89%) and increasing pharmacy profits (n = 420; 80.7%) as key facilitators to adopt this new role. Whereas inadequate training in the diagnosis of disease (n = 457; 87.7%), and inadequate training in patient assessment and monitoring (n = 453; 86.9%) were reported as the most likely barriers.

Conclusion

Overall, Jordanian pharmacists strongly supported the expanded prescribing role and favoured supplementary prescribing for chronic conditions (e.g. diabetes). The study highlighted the need for additional training in various areas (e.g. diagnosing and managing some clinical conditions) to prepare Jordanian pharmacists for this new role.

Provision of community pharmacy services during COVID-19 pandemic: a cross sectional study of community pharmacists' experiences with preventative measures and sources of information

Background An infectious disease caused by a novel coronavirus (later called COVID-19) reached pandemic levels in 2020 and community pharmacists were involved in responding to this pandemic, also in Kosovo. Objectives To explore the experiences of community pharmacists in relation to provision of community pharmacy services during COVID-19 pandemic. Setting Community pharmacists in Kosovo. Methods This was a cross-sectional study where data was collected via a self-administered online questionnaire, from 264 pharmacists actively practicing in Kosovo during the pandemic. The questionnaire consisted of a combination of closed and open-ended questions, optional statements and statements on a five-point Likert scale, derived at least in part from the Transtheoretical Model. One-way analysis of variance was used to analyze differences in responses to Likert-type items whereas categorical variables were analyzed using Chi square testing. Main outcome measures Community pharmacists’ perceptions on COVID-19 related preventative measures. Results A response rate of 40.6% was achieved. Sufficient and adequate COVID-19-related preventative measures were being implemented by a majority of pharmacies (n = 232; 87.9%), and over two-thirds of respondents agreed/strongly agreed that their pharmacies were sufficiently prepared with protective equipment for their personnel. Implementation of preventative measures was associated with respondents’ perception that pharmacists and the pharmacy profession were valued more by patients during the pandemic and to a lesser degree, by other health professionals. Most commonly stated pros dealt with employee and patient safety, while key cons dealt with increased costs and running out of the necessary protective equipment. Key barriers to pharmacy activities were price increases by wholesalers, and patients’ panic and excessive buying, whereas drivers dealt with professional obligation to assist and opportunity to prove inseparable to other health professionals. The most popular means of accessing COVID-19 related information by pharmacists was via mobile devices and information from professional organizations was considered most useful by pharmacists. Conclusions Community pharmacies actively implemented various measures as precautions to mitigate the spread of COVID-19. Our findings highlight the value of continuous provision of information by professional organizations and use of mobile devices as key means to access information by pharmacists.

Community pharmacist workflow: Space for Pharmacy-based Interventions and Consultation TimE study protocol

BACKGROUND

Pharmacists' roles are expanding to delivering a wider set of professional services including medication management optimisation, vaccinations and screening services. Robust research determining whether pharmacists have the capacity to offer such services in the Australian community pharmacy setting is lacking. This protocol details a mixed methods study that investigates the variation in pharmacists' daily tasks and the workspace they work in as a measure of their workload capacity for expanding pharmacy services.

METHODS

An observational time and motion study will be conducted in up to twenty community pharmacies in metropolitan and rural regions of Australia. A trained observer will follow a pharmacist and record the type, location and duration of tasks undertaken over the course of their working day. Data will be collected and analysed using the electronic Work Observation Method By Activity Timing (WOMBAT) tool. Pharmacists' work patterns will be described as time for each task, and by proportionating multitasking and interruptions. This information will be combined with workspace data collected using floor plans, photographs and a qualitative assessment of the working environment completed by the observer. Analysis will include heat-mapped floor plans visually highlighting pharmacist movements.

DISCUSSION

Pharmacists may provide solutions to the strained health workforce and system. There is limited quantitative evidence on whether pharmacists have the time or work setting to support such needs. The use of time and motion methodology is novel to Australian community pharmacy research, and the findings will provide a better understanding of pharmacists' capacity and work environment.

Perspectives of future pharmacists on the potential for development and implementation of pharmacist prescribing in Qatar

Background Pharmacists in many developed countries have been granted prescribing authorities under what is known as "non-medical prescribing" or "pharmacist prescribing". However, such prescribing privileges are not available in many developing countries. Objective The objective of this study was to determine the perspectives of future pharmacists (recent pharmacy graduates and pharmacy students) on pharmacist prescribing and its potential implementation in Qatar. Methods A convergent parallel mixed-methods design was used: (1) a cross-sectional survey using a pre-tested questionnaire and; (2) focus group discussions to allow for an in-depth understanding of the issue, with a focus on pharmacists prescribing competencies as well as barriers for its implementation. Main outcome measures Future pharmacists' perspectives and attitudes towards pharmacist prescribing in Qatar. Results The majority of the respondents (94.4%) indicated awareness of the prescribing competency related to selecting treatment options. Furthermore, the majority (92.4%) believed that pharmacists should undergo prescribing training and accreditation before been legally allowed to prescribe, a point that was reiterated in the focus group discussions. Participants generally expressed support for collaborative and supplementary prescribing models when developing prescribing frameworks for Qatar. Four categories emerged under the theme barriers to implementation of pharmacist prescribing: lack of prescribing competency, pharmacist mindset, lack of accessibility to patient records and counseling rooms, and diversity of education and training background. Conclusion The majority of recent pharmacy graduates and students were in favor of pharmacist prescribing been implemented in Qatar. However, a special training program was deemed necessary to qualify pharmacists to prescribe safely and effectively.

Effects of pharmacist prescribing on patient outcomes in the hospital setting: a systematic review

OBJECTIVE

The objective of the review was to synthesize the best available evidence on the safety and effectiveness of pharmacist prescribing on patient outcomes in patients who present to hospital.

INTRODUCTION

Pharmacist prescribing is legal in many countries. Different models of prescribing include dependent, collaborative and independent. Existing reviews of pharmacist prescribing focus on studies in the community setting, or both community and hospital settings. Other reviews focus on descriptions of current practice or perspectives of clinicians and patients on the practice of pharmacist prescribing. A systematic review on the effects of pharmacist prescribing on patient outcomes in the hospital has not been previously undertaken and is important as this practice can help ease the burden on the healthcare system.

INCLUSION CRITERIA

Studies with controlled experimental designs comparing pharmacist prescribing to medical prescribing in the hospital setting were included in the review. Primary outcomes of interest included clinical outcomes such as therapeutic failure or benefit, adverse effects, and morbidity or mortality. Secondary outcomes included error rates in prescriptions, medication omissions on the medication chart, time or proportion of International Normalized Ratios in therapeutic range, time to reach therapeutic range, and patient satisfaction.

METHODS

A comprehensive three-step search strategy was utilized. The search was conducted in January 2017 in eight major databases from database inception. Only studies in English were included. The recommended Joanna Briggs Institute approach to critical appraisal, study selection and data extraction was used. Narrative synthesis was performed due to heterogeneity of the studies included in the review.

RESULTS

The 15 included studies related to dependent and collaborative prescribing models. In four studies that measured clinical outcomes, there was no difference in blood pressure management between pharmacists and doctors while patients of pharmacist prescribers had better cholesterol levels (mean difference in low density lipoprotein of 0.4 mmol/L in one study and 1.1 mmol/L in another; mean difference in total cholesterol of 1.0 mmol/L) and blood sugar levels (mean difference of fasting blood sugar levels of 15 mg/dL, mean difference of glycosylated hemoglobin of 2.6%). In two studies, pharmacists were better at adhering to warfarin dosing nomograms than doctors (average of 100% versus 62% compliance). In six studies, when prescribing warfarin according to dosing nomograms, equivalent numbers or more patients were maintained in therapeutic range by pharmacist prescribers compared to doctors. The incidence of adverse effects related to anticoagulant prescribing was similar across arms but all six studies were underpowered to detect this outcome. Three studies found that pharmacist prescribers made less prescribing errors (20 to 25 times less errors) and omissions (three to 116 times less omissions) than doctors when prescribing patients' usual medications on admission to hospital or in the preoperative setting. Two studies reported that patients were as satisfied with the services provided by pharmacist prescribers as with doctors.

CONCLUSIONS

This review provides low to moderate evidence that pharmacists can prescribe to the same standards as doctors. Pharmacists are better at adhering to dosing guidelines when prescribing by protocol and make significantly less prescribing errors when charting patients' usual medications on admission to hospital.

Barriers to pharmacist prescribing: a scoping review comparing the UK, New Zealand, Canadian and Australian experiences

Objectives

Non-medical prescribers, including pharmacists, have been found to achieve comparable clinical outcomes with doctors for certain health conditions. Legislation supporting pharmacist prescribing (PP) has been implemented in the United Kingdom (UK), Canada and New Zealand (NZ); however, to date, Australian pharmacists have not been extended prescribing rights. The purpose of this review was to describe the barriers to PP found in the literature from the UK, Canada, NZ and Australia, and examine the implications of these for the development of PP in Australia.

Methods

We conducted a scoping review, which included peer-reviewed and grey literature, and consultation with stakeholders. Sources – Scopus, PubMed and CINAHL; Google Scholar, OpenGrey and organisational websites from January 2003 to March 2018 in the UK, Canada, NZ and Australia. Inclusion criteria – articles published in English, related to implementation of PP and articulated barriers to PP.

Key findings

Of 863 unique records, 120 were reviewed and 64 articles were eligible for inclusion. Three key themes emerged: (1) Socio-political context, (2) Resourcing issues and (3) Prescriber competence. The most common barriers were inadequate training regarding diagnostic knowledge and skills, inadequate support from authorities and stakeholders, and insufficient funding/reimbursement.

Conclusions

If implementation of PP is to occur, attention needs to be focused on addressing identified barriers to PP implementation, including fostering a favourable socio-political context and prescriber competence. As such, a concerted effort is required to develop clear policy pathways, including targeted training courses, raising stakeholder recognition of PP and identifying specific funding, infrastructure and resourcing needs to ensure the smooth integration of pharmacist prescribers within interprofessional clinical teams.

Key stakeholders' views on the potential implementation of pharmacist prescribing: A qualitative investigation

BACKGROUND

An accumulation of international evidence demonstrates that pharmacist prescribing is effective, safe and well-accepted. While there is potential for such development in the Middle East, the majority of published studies are largely reported from Western countries and the perspectives of individuals in strategic positions of policy and practice in the Middle East were unknown.

OBJECTIVE

To explore the views of key stakeholders in Qatar regarding the potential development and implementation of pharmacist prescribing.

METHODS

Qualitative, face-to-face semi-structured interviews were conducted with stakeholders in strategic positions of policy influence (i.e. medical, pharmacy and nursing department directors, health-related academics, patient safety and quality directors, professional regulators). Stakeholders were recruited via purposive and snowball sampling. The interview schedule was constructed from an extensive literature review and grounded in the Consolidated Framework for Implementation Research (CFIR) to ensure comprehensive exploration of potential facilitators and barriers. Interviews were conducted from April to August 2017, digitally recorded, transcribed, and independently analysed by two researchers using CFIR as a coding framework.

RESULTS

Thirty-seven interviews were conducted with directors of medicine (n = 5), pharmacy (n = 6) and nursing (n = 5), healthcare policy developers (n = 6), healthcare academics (n = 9), and patient safety advocates (n = 6). Interviewees were aware of pharmacist prescribing models internationally and generally supported development and implementation in Qatar due to perceived benefits of improved patient care, professional development and enhanced team working. While there were more facilitators than barriers, it was clear that there was a requirement to systematically plan the development and implementation of pharmacist prescribing, with reference to all five CFIR domains. The need for further training, demonstration of pharmacists' prescribing competence, and extensive engagement of stakeholders were considered crucial.

CONCLUSION

There is potential for pharmacist prescribing to be developed and implemented in Qatar. Further research is warranted to define the models of prescribing suitable for Qatar, and to highlight issues of education, training and accreditation.

Perspectives on privacy in the pharmacy: The views of opioid substitution treatment clients

BACKGROUND

Many pharmacists practise in settings in which protecting privacy can be difficult. To address this, some community pharmacies are rearranging their retail space to provide private areas for clinical consultations. Such facilities are deemed particularly important when dealing with clients who have sensitive medical conditions, such as opioid dependence.

OBJECTIVE

To explore Opioid Substitution Treatment (OST) patients' perceptions of privacy in a community pharmacy setting, with a particular focus on the layout of the community pharmacy.

METHODS

We conducted semi-structured interviews with OST clients. Recruitment and the interviews were conducted at state government drug and alcohol clinic. The interviews were audio recorded and transcribed verbatim. The data were analysed in NVivo using the framework approach.

RESULTS

We interviewed fourteen OST clients. Most participants were concerned about privacy and considered that the pharmacy layout could enhance or hinder privacy. However, they disagreed about exactly which pharmacy layout was most privacy-protecting. In addition, a small group of clients interviewed who had a very positive relationship with pharmacists believed that the relationship contributed to their confidence that their privacy was protected.

CONCLUSIONS

There is little consensus amongst consumers about how to protect privacy in the community pharmacy. The range of views expressed by clients in this study may reflect the lack of consensus about the nature of privacy in health ethics. Attention to the meaning of and rationales for privacy protections may be helpful when designing pharmacy layouts to meet the needs of a broad range of consumers. An enclosed or screened private area which can be used as a consultation area for all private pharmacy discussions, including for OST dosing, could be a solution to addressing these varying views on privacy in the pharmacy. Further attention to enhancing the pharmacist and client relationship may assist in reducing sensitivity about privacy.

Stakeholders' views and experiences of pharmacist prescribing: a systematic review

AIMS

The aims of this systematic review were to: (1) critically appraise, synthesize and present the available evidence on the views and experiences of stakeholders on pharmacist prescribing and; (2) present the perceived facilitators and barriers for its global implementation.

METHODS

Medline, CINAHL, International Pharmaceutical Abstracts, PsychArticles and Google Scholar databases were searched. Study selection, quality assessment and data extraction were conducted independently by two reviewers. A narrative approach to data synthesis was undertaken due to heterogeneity, the nature of study types and outcome measures.

RESULTS

Sixty-five studies were identified, mostly from the UK (n = 34), followed by Australia (n = 13), Canada (n = 6) and USA (n = 5). Twenty-seven studies reported pharmacists' perspectives, with fewer studies focusing on patients' (n = 12), doctors' (n = 6), the general public's (n = 4), nurses' (n = 1), policymakers' (n = 1) and multiple stakeholders' (n = 14) perspectives. Most reported positive experiences and views, regardless of stage of implementation. The main benefits described were: ease of patient access to healthcare services, improved patient outcomes, better use of pharmacists' skills and knowledge, improved pharmacist job satisfaction, and reduced physician workload. Any lack of support for pharmacist prescribing was largely in relation to: accountability for prescribing, limited pharmacist diagnosis skills, lack of access to patient clinical records, and issues concerning organizational and financial support.

CONCLUSION

There is an accumulation of global evidence of the positive views and experiences of diverse stakeholder groups and their perceptions of facilitators and barriers to pharmacist prescribing. There are, however, organizational issues to be tackled which may otherwise impede the implementation and sustainability of pharmacist prescribing.

A survey of the views and capabilities of community pharmacists in Western Australia regarding the rescheduling of selected oral antibiotics in a framework of pharmacist prescribing

Background

Antibiotic misuse in the community contributes to antimicrobial resistance. One way to address this may be by better utilizing community pharmacists’ skills in antibiotic prescribing. The aims of this study were to examine the level of support for “down-scheduling” selected antibiotics and to evaluate factors determining the appropriateness of community pharmacist prescribing for a limited range of infections, including their decision to refer to a doctor.

Methods

Self-administered questionnaires, including graded case vignette scenarios simulating real practice, were sent to Western Australian community pharmacists. In addition to descriptive statistics and chi-square testing, a General Estimating Equation (GEE) was used to identify factors associated with appropriateness of therapy and the decision to refer, for each of the seven vignettes.

Results

Of the 240 pharmacists surveyed, 90 (37.5%) responded, yielding 630 responses to seven different case vignettes. There was more than 60% respondent support for expanded prescribing (rescheduling) of commonly prescribed antibiotics. Overall 426/630 (67.6%) chose to treat the patient while the remaining 204/630 (32.4%) referred the patient to a doctor. Of those electing to treat, 380/426 (89.2%) opted to use oral antibiotics, with 293/380 (77.2%) treating with an appropriate selection and regimen. The GEE model indicated that pharmacists were more likely to prescribe inappropriately for conditions such as otitis media (p = 0.0060) and urinary tract infection in pregnancy (p < 0.0001) compared to more complex conditions. Over 80% of all pharmacists would refer the patient to a doctor following no improvement within 3 days, or within 24 h in the case of community acquired pneumonia. It was more common for younger pharmacists to refer the patient to a doctor (p = 0.0165).

Discussion

This study adds further insight into community pharmacy/pharmacist characteristics associated with appropriateness of oral antibiotic selection and the decision to refer to doctors. These findings require consideration in designing pharmacist over-the-counter prescribing models for oral antibiotics.

Expanding the clinical role of community pharmacy: A qualitative ethnographic study of medication reviews in Ontario, Canada

Medication reviews by community pharmacists are an increasingly common strategy to improve medication management for chronic conditions, and are part of wider efforts to make more effective use of community-based health professionals. To identify opportunities to optimize the medication review program in Ontario, Canada, we explored how providers and clients interpret and operationalize medication reviews within everyday community pharmacy practice. We conducted a qualitative ethnographic study at four pharmacies in Ontario, Canada, including non-participant observation of provider and client activities and interactions with specific attention to medication reviews, as well as brief ethnographic interviews with providers and clients, and in-depth, semi-structured interviews with providers. We report on 72h of field research, observation of 178 routine pharmacist-client interactions and 29 medication reviews, 62 brief ethnographic interviews with providers and clients, and 7 in-depth, semi-structured interviews with providers. We found that medication reviews were variably conducted across the dimensions of duration, provider type, location, and interaction style, and that local contexts and system-wide developments influence their meaning and practice. Medication reviews are exemplary of policy efforts to enhance the role of community pharmacies within health systems and the scope of practice of pharmacists as healthcare professionals. Our study highlights the importance of the local structure of community pharmacy practice and the clinical aspirations of pharmacists in the delivery of medication reviews.

Pharmacist prescribing: a cross-sectional survey of the views of pharmacists in Nigeria

OBJECTIVES

This study was carried out to: (1) explore the views of pharmacists in Nigeria on the extension of prescribing authority to them and determine their willingness to be prescribers and (2) identify the potential facilitators and barriers to introducing pharmacist prescribing in Nigeria.

METHOD

An online cross-sectional survey was conducted from August to October 2014 among 775 pharmacists recruited from the Facebook group of the Pharmaceutical Society of Nigeria using a simple random technique. The questionnaire used for the survey was developed based on the review of the literature and previous qualitative studies conducted in Nigeria. The instrument was evaluated for content validity by two external pharmacy practice researchers and the reliability of items assessed using internal consistency tests. Data obtained from the survey were entered into SPSS v.22, and descriptive statistics were generated. Relationships between variables were evaluated using the chi-square test, and P < 0.05 was considered statistically significant.

KEY FINDINGS

The response rate was 40.6% (315/775). Three hundred and six (97.1%) respondents agreed that pharmacists should be given prescribing authority. Of these 306, 295 (96.4%) were willing to be prescribers, and just over half of them (148/295; 50.2%) would prefer to prescribe in collaboration with medical doctors. Of those willing to be prescribers, 285 (96.6%) reported that they would need additional training. The most perceived areas of training needed were in the principles of differential diagnosis (81.4%), pathophysiology of diseases (74.0%) and interpretation of laboratory results (68.1%). Respondents identified increasing patients' access to care (308/315; 97.8%) and better utilisation of pharmacists' skills (307/315; 97.5%) as the most likely facilitators to pharmacist prescribing in Nigeria. On the other hand, resistance from the medical doctors (299/315; 94.9%) and pharmacists' inadequate skills in diagnosis (255/315; 81.0%) were perceived as the most likely barriers.

CONCLUSION

Pharmacist prescribing represents an opportunity to promote patients' access to care and the utilisation of pharmacists' skills in Nigeria. The majority of pharmacists showed a positive attitude towards pharmacist prescribing and were willing to be prescribers. The findings of this study could potentially contribute to future medicine prescribing policy and pharmacy practice in Nigeria.

Assessing pharmacists' readiness to prescribe oral antibiotics for limited infections using a case-vignette technique

Background Pharmacist's skills are underutilized whilst they are directly involved with antibiotic supply to the community. Addressing this issue could lead to better use of antibiotics and hence decreased resistance. Objective Explore how pharmacists can prescribe oral antibiotics to treat a limited range of infections whilst focusing on their confidence and appropriateness of prescribing. Setting Community pharmacies, Western Australia. Method Data were collected using a self-administered questionnaire also containing case vignettes. These were distributed to a random sample of metropolitan and rural community pharmacies in Western Australia. A Generalised Estimating Equation was used to compare respondents' level of confidence in treating various infections and to assess appropriateness of prescribing. Main outcome measure Appropriateness and confidence of antibiotic prescribing. Results A response rate of 34.2% (i.e. 425 responses to case vignettes) was achieved from 240 pharmacies. There were high levels of confidence to treat simple infections such as uncomplicated UTIs (n = 73; 89.0%), impetigo (n = 65; 79.3%), mild bacterial skin infections (n = 62; 75.6%) and moderate acne (n = 61; 72.4%). Over 80% of respondents were confident to prescribe amoxicillin (n = 73; 89%), trimethoprim (n = 72; 87.8%), amoxicillin and clavulanic acid (n = 70; 85.4%), flucloxacillin (n = 70; 85.4%) and cephalexin (n = 68; 82.9%). High levels of appropriate antibiotic prescribing were shown for uncomplicated UTI (97.2%), cellulitis (98.2%) and adolescent acne (100.0%). Conclusion This study identified key limited infections and antibiotics for which pharmacists were supportive and confident to prescribe. This role could lead to better use of antibiotics in the community and minimisation of resistance.

Pharmacists’ Perceptions Regarding Optimization of Antibiotic Prescribing in the Community

Background and Objective:

The overuse of antibiotics in the community is a primary cause of antibiotic resistance. Community pharmacists are the most accessible health professionals and so they are in an ideal position to implement interventions to ensure the appropriate use of antibiotics. This study aimed to explore the role of community pharmacists in the optimization of antibiotic prescribing and utilization.

Method:

Four focus groups were conducted with community pharmacists in Perth, Western Australia. Audio-recorded data were compared with field notes, transcribed, and thematically analyzed.

Results:

There were twenty-four participants in four focus group sessions. Four main themes were identified: patient perceptions and behaviors, prescribing behaviors, pharmacists’ roles and responsibilities, and health care system interventions in relation to antibiotic utilization. A number of interventions that could be implemented by community pharmacists were identified. In addition to interventions that are currently in place in Australia, forward dispensing, improved interprofessional collaboration, an expansion of current prescribing role, and vaccination capabilities were also suggested.

Conclusions:

This study indicated that current scope of pharmacists’ roles has room for more intervention strategies aimed at improving antibiotic prescribing and utilization in the community.

Attitudes and attributes of pharmacists in relation to practice change - A scoping review and discussion

BACKGROUND

Multiple barriers and facilitators to the uptake of cognitive services in pharmacy practice have been identified. Pharmacists' attitudes and attributes have been described as barriers and facilitators in relation to the uptake of extended pharmacy services, in addition to those of a more systemic nature.

OBJECTIVES

To systematically scope and review the literature describing pharmacists' attitudes and attributes in relation to the implementation of cognitive services or role extension and to critically analyze and discuss their relevance as barriers or facilitators.

METHOD

A scoping review of the literature on attitudes and attributes of pharmacists in relation to pharmacy practice was performed, including 47 articles on attitudes and 12 on attributes, forming the basis for a critical analysis within theoretical frameworks.

RESULTS

Pharmacists' attitudes toward role extensions and new pharmacy service models are generally positive and their personal attributes and personality traits appear favorable for roles as health professionals. Pharmacists perceived a number of barriers to the uptake of extended roles.

CONCLUSION

Pharmacists' attributes, including personality traits, and attitudes favor the implementation of cognitive and patient-focused health care services and should not be regarded as major barriers to the uptake of extended pharmacy practice roles. Framing their attitudes and attributes within the theories of planned behavior and personality trait theories indicates that individual motivation needs to be underscored by systemic support for pharmacy practice change to succeed on a wide scale.

Avoiding Treatment Interruptions: What Role Do Australian Community Pharmacists Play?

OBJECTIVE

To explore the reported practice of Australian community pharmacists when dealing with medication supply requests in absence of a valid prescription.

METHODS

Self-administered questionnaire was posted to 1490 randomly selected community pharmacies across all Australian states and territories. This sample was estimated to be a 20% of all Australian community pharmacies.

RESULTS

Three hundred eighty five pharmacists participated in the study (response rate achieved was 27.9% (there were 111 undelivered questionnaires). Respondents indicated that they were more likely to provide medications to regular customers without a valid prescription compared to non-regular customers (p<0.0001). However, supply was also influenced by the type of prescription and the medication requested. In the case of type of prescription (Standard, Authority or Private) this relates to the complexity/probability of obtaining a valid prescription from the prescriber at a later date (i.e. supply with an anticipated prescription). Decisions to supply and/or not supply related to medication type were more complex. For some cases, including medication with potential for abuse, the practice and/or the method of supply varied significantly according to age and gender of the pharmacist, and pharmacy location (p<0.05).

CONCLUSIONS

Although being a regular customer does not guarantee a supply, results of this study reinforce the importance for patients having a regular pharmacy, where pharmacists were more likely to continue medication supply in cases of patients presenting without a valid prescription. We would suggest, more flexible legislation should be implemented to allow pharmacists to continue supplying of medication when obtaining a prescription is not practical.

Pharmacist prescribing: A scoping review about the views and experiences of patients and the public

BACKGROUND

Policy-makers and health professionals' views about pharmacist prescribing have been well studied, but less is known about the views of the public and patients.

OBJECTIVE

To describe from existing literature the views and experiences of patients as well as the views of the public about pharmacist prescribing.

METHODS

Sources: Medline, EMBASE, and International Pharmaceutical Abstracts from inception to November 2015; reference lists of included studies.

INCLUSION CRITERIA

English-language studies describing the views and experiences of patients and the views of the public about pharmacist prescribing. Two reviewers independently screened titles and abstracts and one reviewer charted data. The University of British Columbia Patient Experience Framework was used to categorize and synthesize findings about patients' experience. Views were described using a descriptive thematic synthesis approach.

RESULTS

Out of 2377 unique records, 35 articles were reviewed in full for eligibility. Three studies were excluded because participants were not patients or the public, eight studies were not about prescribing, and four studies were abstracts. Two articles were identified from the bibliographies of included studies. In total, twenty-two studies met inclusion criteria. Fourteen studies were quantitative (63.6%), six were qualitative (27.3%) and two were mixed design (9.1%) studies. Four studies (18.2%) were conducted in Canada (Saskatchewan, Newfoundland and Labrador, Nova Scotia), one (4.5%) in Australia, one (4.5%) in the United States (Washington) and the remaining in the United Kingdom (n = 16, 72.7%). The most commonly explored dimensions of patient experiences were access, interpersonal communication, and patient-reported impacts of care. Patients reported high satisfaction with appointment times, communication with the pharmacist prescriber and the services received. The public supported pharmacist prescribing in limited situations (chronic conditions, minor ailments, repeat medications). The public were concerned about privacy during consultations but patients were less so. Both patients and the public shared concerns regarding lack of adequate resources to ensure safe prescribing by pharmacists (e.g., lack of pharmacists' access to medical records, lack of additional staff support to fulfill prescribing responsibilities).

CONCLUSION

Patients' experiences with pharmacist prescribing were generally positive. There were shared concerns between patients and the public about pharmacist prescribing. Opportunities for further research include strategies for building public experience with pharmacist prescribing and methods for addressing concerns identified by patients and the public.

From "retailers" to health care providers: Transforming the role of community pharmacists in chronic disease management

Community pharmacists are the third largest healthcare professional group in the world after physicians and nurses. Despite their considerable training, community pharmacists are the only health professionals who are not primarily rewarded for delivering health care and hence are under-utilized as public health professionals. An emerging consensus among academics, professional organizations, and policymakers is that community pharmacists, who work outside of hospital settings, should adopt an expanded role in order to contribute to the safe, effective, and efficient use of drugs-particularly when caring for people with multiple chronic conditions. Community pharmacists could help to improve health by reducing drug-related adverse events and promoting better medication adherence, which in turn may help in reducing unnecessary provider visits, hospitalizations, and readmissions while strengthening integrated primary care delivery across the health system. This paper reviews recent strategies to expand the role of community pharmacists in Australia, Canada, England, the Netherlands, Scotland, and the United States. The developments achieved or under way in these countries carry lessons for policymakers world-wide, where progress thus far in expanding the role of community pharmacists has been more limited. Future policies should focus on effectively integrating community pharmacists into primary care; developing a shared vision for different levels of pharmacist services; and devising new incentive mechanisms for improving quality and outcomes.

Preferences for the delivery of community pharmacy services to help manage chronic conditions

BACKGROUND

To optimize positive outcomes, the design of new pharmacy services should consider the preferences of consumers with chronic condition(s) and their carers.

OBJECTIVES

(i) To evaluate the relative importance of community pharmacy service characteristics, from the perspective of consumers with chronic condition(s) and carers; (ii) To compare consumer and carer preferences to health professional beliefs about ideal service characteristics for consumers.

METHOD

A discrete choice experiment was completed by consumers with chronic condition(s) and/or carers (n = 602) and health professionals (n = 297), recruited from four regions in Australia. Participants were each randomized to one survey version containing four (from a total 72) different choices between two new pharmacy services. Consumer and carer participants were also given an 'opt out' alternative of current service. Each service was described using six attributes related to pharmacy service characteristics: continued medicines supply, continuity and coordinated care, location, medication management, education and information, and cost.

RESULTS

Consumers and carers placed highest priority on continued medicines supply by a pharmacist for regular and symptom flare up medicines (100 priority points), a pharmacy located within a 'one-stop' health center (61 points) and home delivery of medicines (52 points). Although continued medicines supply was most important for consumers and carers, pharmacy location was perceived by health professionals to be the most important characteristic for consumers. Participants were less inclined to choose new services if their current pharmacy offered high quality services that were person-centered, easy to access and responsive to their needs. Younger, more highly educated and employed participants, and those with established condition(s) were more likely to choose new services.

CONCLUSIONS

Person-centered care is a fundamental tenet for pharmacy services. The provision of continued medicines supply (e.g. through pharmacist prescribing), convenient and coordinated care delivered through a one stop health centre, and home delivery of medicines, should be prioritized when planning pharmacy services to best assist consumers to manage chronic conditions.

Evaluating pharmacist prescribing for minor ailments

OBJECTIVES

Saskatchewan is the second Canadian province to allow pharmacists to prescribe medications for minor ailments and the only province that remunerates for this activity. The aim of this project was to determine whether patients prescribed such treatment by a pharmacist symptomatically improve within a set time frame.

METHODS

Pharmacists were asked to hand a study-invitation card to anyone for whom they prescribed a medication for a minor ailment during the 1-year study period. Consenting participants contacted the study researchers directly and were subsequently instructed to complete an online questionnaire at the appropriate follow-up time.

KEY FINDINGS

Ninety pharmacies in Saskatchewan participated, accruing 125 participants. Cold sores were the most common minor ailment (34.4%), followed by insect bites (20%) and seasonal allergies (19.2%). Trust in pharmacists and convenience were the most common reasons for choosing a pharmacist over a physician, and 27.2% would have chosen a physician or emergency department if the minor ailment service were not available. The condition significantly/completely improved in 80.8%; only 4% experienced bothersome side effects. Satisfaction with the pharmacist and service was strong; only 5.6% felt a physician would have been more thorough.

CONCLUSIONS

Participants were very satisfied with their symptomatic improvement and with the service in general, albeit for a small number of conditions. Participants reported getting better, and side effects were not a concern. These results are encouraging for pharmacists; however, a comparison of physician care with pharmacist care and unsupported self-care is required to truly know the benefit of pharmacist prescribing.

Using scenarios to test the appropriateness of pharmacist prescribing in asthma management

OBJECTIVE

To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists' confidence, and appropriateness, in the context of asthma management.

METHODS

Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers.

RESULTS

In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios.

CONCLUSIONS

Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way.

Patient attitudes towards a new role for pharmacists: continued dispensing

BACKGROUND

In Australia, "continued dispensing" (CD) is a new model for supply of prescription medications. Under specific circumstances, community pharmacists are allowed to dispense a further one month supply of prescription only medications without a valid prescription. It allows continuation and treatment adherence when patients run out of statin and/or oral contraceptive (OC) medications, when it is not practical or they fail to plan accordingly to get a new prescription.

OBJECTIVE

The aim of this study was to explore patient attitudes towards a CD model, including any perceived concerns or associated risks with CD prior to its introduction.

METHODS

An Australia-wide computer-assisted telephone interview survey of statin and OC users aged 18 years or older was conducted in July 2013 prior to implementation of the CD model. A telephone number list was generated via a random number generation function based on a broad breakdown of the Australian population as outlined in the June 2013 Australian Bureau of Statistics data. The sample target for the survey was 300, consisting of 150 statin users and 150 OC users.

RESULTS

There were a total of 301 respondents, comprising 151 statin users and 150 OC users. Approximately 37% of all respondents had experienced running out of their medications in the past 12 months, of whom 35.4% had temporarily stopped treatment and 33.6% requested their medication from a pharmacist without a valid prescription. OC users were more likely to run out of their medications (P=0.021). The majority of respondents had a regular pharmacy (86%) and therefore would be eligible for CD in the future. The majority of those surveyed had no concerns about CD or perceived it as posing no risks. Concerns raised included consultation privacy and the pharmacist's lack of access to their medical records.

CONCLUSION

Australian users of statin and OC medications showed a high level of support for CD. Given that a significant proportion of patients temporarily stopped treatment when they ran out of medications and had no valid prescription, implementation of CD may alleviate the negative consequences of therapy interruption in statin and OC users in the short term. Longer-term solutions and opportunities to expand CD require further exploration.

Expanded prescribing: a comparison of the views of Australian hospital and community pharmacists

BACKGROUND

Community pharmacies and hospitals are the two main professional areas for pharmacists. There is currently a lack of comparison of pharmacists working in these two distinct settings in relation to an expanded prescribing role.

OBJECTIVE

To compare the attitudes of hospital and community pharmacists regarding an expanded prescribing role.

SETTING

Australian pharmacists.

METHODS

A self-administered postal survey was used to collect the data. Data analysis was performed using SPSS(®) v19. Kendall's tau-c test was used to compare the mean values between categorical variables (i.e. hospital or community pharmacists) and continuous variables measuring attitudes on a Likert scale (i.e. reasons in favour and barriers of pharmacist prescribing, preferred therapeutic areas of prescribing and prescribing models). A Chi square test was used to analyse categorical variables (i.e. demographics).

MAIN OUTCOME MEASURE

The opinion of hospital and community pharmacists regarding an expanded prescribing role.

RESULTS

A response rate of 40.4% was achieved (1,049/2,592). Where significant differences were located, community pharmacists were more supportive of all proffered potential reasons in favour of pharmacist prescribing (p < 0.05) whereas hospital pharmacists were more in agreement with all suggested barriers to such a role (p < 0.05). In a supplementary (collaborative) prescribing model, hospital pharmacists were more confident than community pharmacists in prescribing for heart failure (p < 0.001) and anticoagulant therapies (p = 0.004). In an independent prescribing model hospital pharmacists were more supportive of prescribing anticoagulant therapies (p = 0.002). Significant differences were found between the two groups in relation to their support for independent prescribing (p = 0.020) and extension of the emergency supply 3 days rule to 30 days (p = 0.011).

CONCLUSION

This study suggests that there are differences between hospital and community pharmacists in what they regard as potential reasons in favour of an expanded pharmacist prescribing role, perceived barriers to such a role and whether to prescribe independently of doctors. Hospital pharmacists' attitudinal differences in terms of support for certain therapeutic areas of prescribing reflects probably their existing active role in clinical decision making processes in patients who are often seriously ill.

Identifying the perceived training needs for Australian pharmacist prescribers

OBJECTIVE

To explore pharmacists' perceived needs on training required to undertake an expanded prescribing role taking account of their years of registration, current professional practice area and preferred prescribing model.

METHODS

A piloted self-administered questionnaire was distributed nationally to a random sample of pharmacists. Data were analysed using SPSS version18 software where data cross-tabulations, chi-squared and one-way analyses of variance were performed.

KEY FINDINGS

A response rate of 40.4% (1049/2592) was achieved. Pathophysiology of conditions, principles of diagnosis, and patient assessment and monitoring were the most preferred training topics. There was no difference (P=0.620) in pharmacists' perceived needs for additional training with respect to the model of prescribing (i.e. supplementary or independent or both) and years of registration as pharmacists (P=0.284). However, consultant pharmacists were less supportive of the need for additional training (P=0.013). Pharmacists' years of registration and professional practice influenced their training topic preferences. Supporters of an independent prescribing model only demonstrated a weaker preference for training in key therapeutic topics (P=0.001).

CONCLUSIONS

This study provides information on key areas for consideration when training pharmacists for an expanded prescribing role. Although most pharmacists preferred a supplementary model of prescribing where doctors retain their diagnostic role, their strongest training preferences were for topics that provided pharmacists with further skills in patient diagnosis, assessment and monitoring.

Preparing hospital pharmacists to prescribe: stakeholders' views of postgraduate courses

OBJECTIVES

To explore pharmacy stakeholders' views on developing a postgraduate course to prepare hospital pharmacists for collaborative prescribing in Australia.

METHODS

Semi-structured interviews were conducted with pharmacy stakeholders from universities, hospitals and professional organisations (n = 25) to gather views on the content, structure and delivery methods of a possible postgraduate prescribing course for pharmacists. Transcripts were analysed thematically and coded using NVivo software.

KEY FINDINGS

There was strong support for collaborative prescribing as an appropriate role for advanced pharmacist practitioners and acknowledgement that further training is needed to implement this new role. It was proposed that postgraduate training for hospital pharmacists should be based on a national prescribing competency framework and participants highlighted key aspects of the prescribing process in which pharmacists need particular up-skilling: diagnosis, physical assessments, clinical decision-making and consultations. The training model used in the UK was favoured, where candidates undertake university-based study combined with collaborative training with a doctor and a practical assessment of competency.

CONCLUSIONS

The findings from this study have provided valuable information which can provide a pathway for the development of a postgraduate course to prepare Australian hospital pharmacists for prescribing. Future research should focus on uncovering the perceptions of Australian doctors, nurses and policy makers on the training requirements needed for pharmacist prescribing in the hospital setting. Stakeholders' views on pharmacist prescribing training in the community setting could also be explored.

Assessing the contribution of prescribing in primary care by nurses and professionals allied to medicine: a systematic review of literature

Background

Safe and timely access to effective and appropriate medication through primary care settings is a major concern for all countries addressing both acute and chronic disease burdens. Legislation for nurses and other professionals allied to medicine to prescribe exists in a minority of countries, with more considering introducing legislation. Although there is variation in the range of medicines permitted to be prescribed, questions remain as to the contribution prescribing by nurses and professionals allied to medicine makes to the care of patients in primary care and what is the evidence on which clinicians, commissioners of services and policy makers can consider this innovation.

Methods

A integrative review of literature on non-medical prescribing in primary care was undertaken guided by dimensions of health care quality: effectiveness, acceptability, efficiency and access.

Results

19 papers of 17 empirical studies were identified which provided evidence of patient outcome of non medical prescribing in primary care settings. The majority were undertaken in the UK with only one each from the USA, Canada, Botswana and Zimbabwe. Only two studies investigated clinical outcomes of non-medical prescribing. Seven papers reported on qualitative designs and four of these had fewer than ten participants. Most studies reported that non medical prescribing was widely accepted and viewed positively by patients and professionals.

Conclusions

Primary health care is the setting where timely access to safe and appropriate medicines is most critical for the well-being of any population. The gradual growth over time of legislative authority and in the numbers of non-medical prescribers, particularly nurses, in some countries suggests that the acceptability of non-medical prescribing is based on the perceived value to the health care system as a whole. Our review suggests that there are substantial gaps in the knowledge base to help evidence based policy making in this arena. We suggest that future studies of non-medical prescribing in primary care focus on the broad range of patient and health service outcomes and include economic dimensions.

An elective course in differential diagnostics

OBJECTIVE

To design an elective course to teach the principles of differential diagnostics to second-year pharmacy students, critically evaluate the benefits of this approach to self-directed learning, and assess obstacles to implementation that other programs may encounter.

DESIGN

Students attended seven 2-hour class sessions in which the instructor presented a chief complaint, and the class researched and discussed possible causes and arrived at the accurate diagnosis. Each student also was assigned a unique, simulated patient case to work on outside of class. Students asked questions and researched the answers, providing a written rationale for needing the information and the source of the information. Students gave a 10-minute presentation on their diagnosis and treatment recommendations during the last class session.

ASSESSMENT

All students (N = 21) successfully determined their patients' diagnoses and made appropriate treatment recommendations. Fifteen students reported that the most valuable information in solving their case was subjective rather than objective in nature (ie, interviewing the patient rather than reviewing laboratory test results). The majority of the 15 students who completed a post-course survey instrument agreed or strongly agreed that this elective allowed them to practice varied skill sets and integrate past and future curricular content.

CONCLUSION

PharmD students may benefit from instruction in the basic principles of differential diagnostics.

An expanded prescribing role for pharmacists - an Australian perspective

Expanded pharmacist prescribing is a new professional practice area for pharmacists. Currently, Australian pharmacists' prescribing role is limited to over-the-counter medications. This review aims to identify Australian studies involving the area of expanded pharmacist prescribing. Australian studies exploring the issues of pharmacist prescribing were identified and considered in the context of its implementation internationally. Australian studies have mainly focused on the attitudes of community and hospital pharmacists towards such an expansion. Studies evaluating the views of Australian consumers and pharmacy clients were also considered. The available Australian literature indicated support from pharmacists and pharmacy clients for an expanded pharmacist prescribing role, with preference for doctors retaining a primary role in diagnosis. Australian pharmacists and pharmacy client's views were also in agreement in terms of other key issues surrounding expanded pharmacist prescribing. These included the nature of an expanded prescribing model, the need for additional training for pharmacists and the potential for pharmacy clients gaining improved medication access, which could be achieved within an expanded role that pharmacists could provide. Current evidence from studies conducted in Australia provides valuable insight to relevant policymakers on the issue of pharmacist prescribing in order to move the agenda of pharmacist prescribing forwards.

Pharmacy clients' attitudes to expanded pharmacist prescribing and the role of agency theory on involved stakeholders

Objective

To examine the views of regular pharmacy clients on pharmacist prescribing and employ agency theory in considering the relationship between the stakeholders involved.

Methods

Computer assisted telephone interviews were conducted with 400 pharmacy clients recruited around Australia. Potential respondents were identified using a random number generation function in Microsoft Excel. Data were analysed with SPSS version 17 using one-way analysis of variance, principal component analysis and linear regression. The relationships between the main stakeholders involved were explored using agency theory.

Key findings

A total of 1153 answered calls recruited 400 consenting pharmacy clients. Most respondents (71%) trusted pharmacists adopting an expanded role in prescribing, however the majority (66%) supported this only after a diagnosis had been made by a doctor. Those who accepted pharmacist diagnosing and prescribing preferred that this was limited to pain management and antibiotics. Most respondents (64%) considered that expanded pharmacist prescribing would improve their access to prescription medicines, although those over 65 years of age were less supportive than younger respondents. Factors which contributed positively to clients' perception of trust in an expanded prescribing role for pharmacists were identified, and improved access to medicines was found to be the strongest predictor (P &lt; 0.0001).

Conclusion

Most pharmacy clients trusted pharmacists adopting an expanded prescribing role, but preferred that this was limited to doctors performing the initial diagnosis. Agency theory would conceptualize the introduction of pharmacist prescribers, as disrupting the principal (patient) agent (doctor) relationship. Its introduction would best be facilitated by careful change management.