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Soltaninejad A, Alhani F, Rassouli M. Investigating the Possibility of Nurse Prescribing Training Development in Nursing Education System in Iran. Asian Nurs Res (Korean Soc Nurs Sci) 2024; 18:268-280. [PMID: 39089440 DOI: 10.1016/j.anr.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
PURPOSE Adequate medical knowledge and skills are fundamentals for nurse prescribing authority development. This study will explore the potential for developing nurse prescribing training in Iran, where nurses currently lack prescribing authority despite their strong academic nursing education. METHODS This is a study with two phases. At first, in a conventional qualitative content analysis method, with purposive and snowball sampling, from June 2021 to March 2023, 20 participants, including 16 nurses in different clinical, managerial, educational, and policy-making settings, three physicians, and one clinical pharmacist were interviewed. Unstructured interviews were conducted face-to-face or virtually as the situation required during the pandemic period due to Coronavirus disease, 2019 (COVID-19). Qualitative content analysis as developed by Elo and Kyngäs in 2008 was used for data analysis. In the second comparative analysis phase, four masters of science and one doctor of nursing curricula analyzed in the existence of the nurse prescribing prerequisite courses and these five curricula and two potential masters of science in community health and critical care nursing curricula were compared with John Hopkins University curricula. RESULTS In the qualitative phase, two themes emerged: nursing education challenges and the potential for nurse prescribing training development. These were further broken down into four subthemes: inadequate nurses' knowledge in prerequisite nurse prescribing courses, unprepared educational infrastructure, treatment sector potentials, and educational potentials, with a total of 12 concepts identified. During the comparative phase, it was found that none of the nursing curricula had adequate prerequisite courses for nurse prescribing. However, the Community Health and Critical Care nursing curricula showed potential for developing nurse prescribing training. CONCLUSIONS In the nursing education system, there are some challenges and potentials for prescribing training, and the community health and critical care nursing curricula have the potential capacity to prepare the graduated nurses to prescribe. It needs educational and managerial policies. More developmental research and pilot studies are recommended.
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Affiliation(s)
- Aazam Soltaninejad
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Iran
| | - Fatemeh Alhani
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Iran.
| | - Maryam Rassouli
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Iran
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Seck F, Masot O, Carey N, Roca J, Botigué T, Paraíso Pueyo E, Lavedán Santamaría A. Nurses' perceived barriers and facilitators to the implementation of nurse prescribing: Delphi study and focus group. J Adv Nurs 2024; 80:2106-2120. [PMID: 37909547 DOI: 10.1111/jan.15936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/11/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
AIM To obtain consensus on barriers and facilitators to nurse prescribing following its recent introduction in Spain. DESIGN A three round online Delphi survey and focus group. METHODS An exploratory method was used with three consecutive rounds of questionnaires based on anonymity and feedback, and a focus group. The study was carried out with primary care, specialized care, socio-health care and manager nurses. RESULTS On the basis of the Delphi study that was conducted, a list of 15 barriers and 18 facilitators of nurse prescribing was obtained. However, no general consensus was found with respect to the prioritization of these barriers/facilitators. The analysis of the results of the focus group confirmed the information obtained from the Delphi study. The main barriers highlighted were dependence on the figure of the physician, insufficient training in pharmacology, a lack of institutional support and the limited list of products that could be prescribed. The key facilitators were academic knowledge and ongoing training and education, independence in the functions and responsibilities of the nursing profession, adaptation to new roles and autonomy in the case of chronic care processes. CONCLUSION Nurses were generally positive about the introduction of nurse prescribing. The commitment of nurses to training and their accreditation as prescribers (internal forces) and health policy and nursing management (external forces) play a fundamental role in supporting the basis of nurse prescribing and ensuring that it is developed with the identified support resources, such as staff training and the provision of the materials necessary for its proper implementation, all with the aim of guaranteeing quality healthcare. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Strong models of nurse prescribing are being considered globally to address population needs. The results can help the future implementation of non-medical independent prescribing and provide guidance to the government and society on the interventions that can be used to consolidate it. IMPACT What problem did the study address? By 2027, the world's population will receive more than 4.5 trillion doses of medicine each year. However, the WHO estimates a projected shortfall of 10 million health workers by 2030. Inadequacies with traditional physician-led care systems mean that new approaches are imperative to maintain patient access to prescription medicines, with NP being a key element in this regard. In Catalonia (Spain), the accreditation process for nurses as prescribers was implemented in 2021. It is therefore of vital importance to question and consult the nurses themselves, the main promoters of the process, to find out their perceptions and thus be able to take them into consideration in the implementation process. What were the main findings? A total of 15 barriers and 17 facilitators were identified. The main perceived barriers are dependence on the figure of the physician, insufficient training in pharmacology during undergraduate studies and a lack of institutional support. The main perceived facilitators are academic knowledge and ongoing education and training, independence in nursing functions and responsibilities, and adaptation to new roles and tasks. Where and on whom will the research have an impact? These results can contribute to improving NP implementation in Spain and serve as a reference for other countries, especially where NP education and training have only recently been instigated or are in the planning process. REPORTING METHOD Standards for reporting qualitative research: a synthesis of recommendations. SRQR. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Faty Seck
- Internal Medicine Service, Santa Maria University Hospital, Lleida, Spain
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Department of Pulmonology, Biomedical Research Institute, Lleida, Spain
| | - Olga Masot
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), University of Lleida, Lleida, Spain
| | - Nicola Carey
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
| | - Judith Roca
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), University of Lleida, Lleida, Spain
| | - Teresa Botigué
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), University of Lleida, Lleida, Spain
| | - Elena Paraíso Pueyo
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
| | - Ana Lavedán Santamaría
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), University of Lleida, Lleida, Spain
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Jodaki K, Abbasi M, Nayeri ND. Nurses' Experiences of Practical Challenges Associated with Nurses' Prescription: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2024; 29:105-112. [PMID: 38333342 PMCID: PMC10849280 DOI: 10.4103/ijnmr.ijnmr_316_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 09/30/2023] [Accepted: 09/30/2023] [Indexed: 02/10/2024]
Abstract
Background Because nurse prescription has numerous benefits for the health systems, in many countries around the world, nurses are given the right to prescribe medication. In Iran, the role of nurses in prescription drugs is not well understood, and nurses face various challenges in this regard. Materials and Methods A qualitative content analysis methodology based on the Graneheim and Lundman model was used. Thirteen nurses working in medical wards of hospitals affiliated with the Tehran University of Medical Science were selected to participate in this study by purposeful sampling. Participants were interviewed via telephone using a semi-structured tool. After thirteen interviews, data saturation was reached. Data collection was undertaken between April 2020 and April 2021. Results The results of this study are summarized in one theme, four categories, and ten subcategories. The theme extracted from the data analysis was "the practical challenges of nurse prescription," which included four main categories: structure challenges, personnel-related barriers, interprofessional separation, and society's attitudes. Conclusions The results of this study explain the barriers and practical challenges of nurse prescription in Iran. Identifying these challenges and barriers provides the necessary evidence for policymakers to remove and adjust these challenges and barriers. Moreover, the elimination of identified challenges will help nurses better perform their new roles and develop the nursing scope and profession.
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Affiliation(s)
- Kurosh Jodaki
- Assistant Professor of Nursing, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shohadaye Haft-e Tir Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abbasi
- Nursing Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Dehghan Nayeri
- Nursing and Midwifery Care Research Centre, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Almotairy MM, Alghamdi AT, Alzahrani AM, Alqarni MS, Alghamdi SA, Alshahrani MA. Nurses' readiness to prescribe under supervision in Saudi Arabia: A cross-sectional study. Saudi Pharm J 2023; 31:1294-1305. [PMID: 37333020 PMCID: PMC10275749 DOI: 10.1016/j.jsps.2023.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/20/2023] [Indexed: 06/20/2023] Open
Abstract
Aim To explore nurses' readiness to prescribe medications under supervision and identify associations between prescribing practices under supervision and demographic characteristics in Saudi Arabia. Design A cross-sectional study. Methods Using convenience sampling, this study used a 32-item survey to collect data on nurses prescribing medications under supervision between December 2022 and March 2023. Results A total of 379 nurses were recruited from different regions in Saudi Arabia. Approximately 7% (n = 30) of the participants were prescribing medications independently, and 70% (n = 267) expressed their likelihood of becoming prescribers. The highest motivating factors to become prescribers were improvement of patient care (52.2%) and contribution to the multidisciplinary team (52.0%). Most participants (60%-81%) agreed that prescribing medications under supervision would improve potential outcomes at the system, nurse, and patient levels. Availability of appropriate mentors or supervisors (72.9%) was the highest rated facilitating factor, followed by support of nursing colleagues (72%). Based on demographic characteristics, findings revealed significant differences in the: a) likelihood and motivators of becoming prescribers; b) required minimum qualification, years of experience, and continuing professional education hours to become prescribers; and c) type of organizations delivering educational programs for nurse prescribing. Conclusion Majority of nurses in Saudi Arabia favored becoming prescribers, and motivating factors were mostly relevant to optimizing patient care outcomes. Having the proper supervision was rated as the most facilitating factor for nurse prescribing. Nurses' views on potential outcomes, facilitating factors, and possible motivators varied based on nurses' demographical characteristics. Implications for the professional and/or patient care Nurses favored prescribing under supervision to improve patient care outcomes, which is an opportunity to expand the benefits of health services, including easy access to healthcare. Impact Results revealed that nurses support the implementation of prescribing practice under supervision. Thus, the findings may inform practice change in Saudi Arabia to allow prescribing under supervision, which was perceived to have a positive impact on patient care outcomes. Reporting Method This study adhered to STROBE guidelines.
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Affiliation(s)
- Monir M. Almotairy
- Department of Nursing Administration and Education, College of Nursing, King Saud University, P.O. Box 642, Riyadh 11421, Saudi Arabia
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Canet-Vélez O, Jodar-Solà G, Martín-Royo J, Mateo E, Casañas R, Galbany-Estragués P. Experiences of Spanish nurses in the rollout of nurse prescribing: a qualitative study. Front Public Health 2023; 11:1163492. [PMID: 37250085 PMCID: PMC10213503 DOI: 10.3389/fpubh.2023.1163492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/12/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Nurse prescribing has legal recognition in Spain, after a long regulatory process, with confusing, changing legislation that does not fully coincide with the reality of nurses' practice. There is currently no research available on how nurses have experienced the rollout of nurse prescribing. The objective of this study is to describe the experiences of nurses in the rollout of nurse prescribing in the province of Barcelona, Spain. Method A descriptive qualitative study with intentional sampling was carried out between March 2021 and July 2022. The data were collected through semi-structured individual interviews and discussion groups. The participants were 24 nurses working in the province of Barcelona who were accredited in nurse prescribing or involved in the rollout of nurse prescribing. The data were analyzed using thematic analysis, following Braun and Clark. The COREQ checklist was used to report findings. Results We describe nurses' responses on the following themes: internal and external barriers; strategies to support nurse prescribing in the initial rollout and proposals for improvement; and factors linked to nurses' satisfaction. Discussion The regulatory process has provided a safety framework for nurse prescribing. Strategies are needed for its comprehensive development and its acceptance among the public. The findings give visibility to nurse prescribing internationally.
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Affiliation(s)
- Olga Canet-Vélez
- Col·legi Oficial d'Infermeres i Infermers de Barcelona, Barcelona, Spain
- Global Health, Gender and Society Research Group, Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Gloria Jodar-Solà
- Col·legi Oficial d'Infermeres i Infermers de Barcelona, Barcelona, Spain
- Equipo Atención Primaria Sant Andreu de la Barca, Direcció d'Atenció Primària Metropolitana Sud, Institut Català de la Salut, Sant Andreu de la Barca, Spain
| | - Jaume Martín-Royo
- Unitat Bàsica de Prevenció, Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Barcelona Ciutat, Fundació Institut Universitari per a la Recerca a L'Atenció Primària de Salut Jordi Gol i Gorina, Barcelona, Spain
| | - Enric Mateo
- Col·legi Oficial d'Infermeres i Infermers de Barcelona, Barcelona, Spain
- Castelldefels Atenció Primària, Consorci Castelldefels Agents de Salut, Castelldefels, Spain
| | - Rocio Casañas
- Global Health, Gender and Society Research Group, Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Paola Galbany-Estragués
- Col·legi Oficial d'Infermeres i Infermers de Barcelona, Barcelona, Spain
- Department of Fundamental and Medical-Surgical Nursing, School of Nursing. University of Barcelona, Barcelona, Spain
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Gomis-Jimeno FJ, Lillo-Crespo M. Identifying the Enablers and Barriers to Advance Nurse Prescribing of Medication in Spain According to Experts' Views: A Delphi Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4681. [PMID: 36981590 PMCID: PMC10048874 DOI: 10.3390/ijerph20064681] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Nurses play an important role in pharmaceutical care worldwide in detecting clinical changes, communicating and discussing pharmacotherapy with patients, their families, and other healthcare professionals, proposing and implementing drug-related interventions, and ensuring the monitoring of patients and their medication regimens, among others. However, there is no global consensus across countries regarding the prescribing of medication by nurses. In Spain, for example, this topic is currently in transition since the approval of the Royal Decree 1302/2018 of October 22nd, which regulates the indication, use, and authorization for dispensing human-use medication by nurses. Our study aims to identify the enablers and barriers to advancing the nurse prescribing of medication in Spain through the views of experts in the field and according to the latest Royal Decree approved and the steps taken by the different Spanish autonomous communities. A modified qualitative Delphi study with three iterations was performed online through the perspectives of experts from the field of healthcare education, research, practice, management, and policy. Data extracted from the literature review were used to formulate the open-ended questions utilized in the three rounds. The experts involved (n = 15) belonged to different Spanish regions where the Royal Decree is being implemented with different speeds, and had distinct backgrounds and experiences. Our results highlight the importance of prospectively developing additional protocols based on chronic diseases as well as scaling up towards independent nursing prescription, the inclusion of a joint multidisciplinary pharmaceutical care model, the controversial role played by national nursing councils and boards, the variability in the speed of implementation among the autonomous communities, and the lack of nursing training in the field of medication prescription.
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Affiliation(s)
- Francisco Javier Gomis-Jimeno
- Department of Nursing, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain
- HLA Vistahermosa Hospital, 03015 Alicante, Spain
| | - Manuel Lillo-Crespo
- Department of Nursing, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain
- HLA Vistahermosa Hospital, 03015 Alicante, Spain
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Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries. Prim Health Care Res Dev 2022; 23:e60. [PMID: 36134523 PMCID: PMC9532851 DOI: 10.1017/s1463423622000470] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: To describe variation in task shifting from GPs to practice assistants/nurses in 34 countries and to explain differences by analysing associations with characteristics of the GPs and their practices and features of the health care systems. Background: Redistribution of tasks and responsibilities in primary care are driven by changes in demand, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill-mix of primary care teams. These developments are hampered by barriers between professional domains. Methods: Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7,200 general practitioners (GPs) in 34 countries. Task shifting is measured through a composite score of GPs’ self-reported shifting of tasks. Independent variables at GP and practice level are as follows: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are as follows: demand for and supply of care, nurse prescribing, and professionalisation of practice assistants/nurses. Multilevel analysis is used to account for clustering of GPs in countries. Findings: Countries vary in the degree of task shifting. Regarding GP and practice characteristics, use of electronic health records and availability of support staff in the practice are positively associated with task shifting and GPs’ working hours negatively, in line with our hypotheses. Age of the GPs is, contrary to our hypothesis, positively related to task shifting. These variables explain 11% of the variance at GP level. Two country variables are related to task shifting: a lower percentage of practices without support staff in a country and nurse prescribing rights coincide with more task shifting. The percentage of practices without support staff has the strongest relationship, explaining 73% of the country variation.
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Ashiru-Oredope D, Casale E, Harvey E, Umoh E, Vasandani S, Reilly J, Hopkins S. Knowledge and Attitudes about Antibiotics and Antibiotic Resistance of 2404 UK Healthcare Workers. Antibiotics (Basel) 2022; 11:antibiotics11081133. [PMID: 36010002 PMCID: PMC9404832 DOI: 10.3390/antibiotics11081133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Using the COM-B model as a framework, an EU-wide survey aimed to ascertain multidisciplinary healthcare workers’ (HCWs’) knowledge, attitudes and behaviours towards antibiotics, antibiotic use and antibiotic resistance. The UK findings are presented here. Methods: A 43-item questionnaire was developed through a two-round modified Delphi consensus process. The UK target quota was 1315 respondents. Results: In total, 2404 participants responded. The highest proportion were nursing and midwifery professionals (42%), pharmacists (23%) and medical doctors (18%). HCWs correctly answered that antibiotics are not effective against viruses (97%), they have associated side effects (97%), unnecessary use makes antibiotics ineffective (97%) and healthy people can carry antibiotic-resistant bacteria (90%). However, fewer than 80% correctly answered that using antibiotics increases a patient’s risk of antimicrobial resistant infection or that resistant bacteria can spread from person to person. Whilst the majority of HCWs (81%) agreed there is a connection between their antibiotic prescribing behaviour and the spread of antibiotic-resistant bacteria, only 64% felt that they have a key role in controlling antibiotic resistance. The top three barriers to providing advice or resources were lack of resources (19%), insufficient time (11%) and the patient being uninterested in the information (7%). Approximately 35% of UK respondents who were prescribers prescribed an antibiotic at least once in the previous week to responding to the survey due to a fear of patient deterioration or complications. Conclusion: These findings highlight that a multifaceted approach to tackling the barriers to prudent antibiotic use in the UK is required and provides evidence for guiding targeted policy, intervention development and future research. Education and training should focus on patient communication, information on spreading resistant bacteria and increased risk for individuals.
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Affiliation(s)
- Diane Ashiru-Oredope
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London SW1P 3JR, UK
- Correspondence:
| | - Ella Casale
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London SW1P 3JR, UK
| | - Eleanor Harvey
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London SW1P 3JR, UK
| | - Eno Umoh
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London SW1P 3JR, UK
| | - Sagar Vasandani
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London SW1P 3JR, UK
| | - Jacqui Reilly
- NHS National Services Scotland, Edinburgh EH12 9EB, UK
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Susan Hopkins
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London SW1P 3JR, UK
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Edwards J, Coward M, Carey N. Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review. BMJ Open 2022; 12:e052227. [PMID: 35676011 PMCID: PMC9185484 DOI: 10.1136/bmjopen-2021-052227] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To support workforce deficits and rising demand for medicines, independent prescribing (IP) by nurses, pharmacists and allied health professionals is a key component of workforce transformation in UK healthcare. This systematic review of qualitative research studies used a thematic synthesis approach to explore stakeholders' views on IP in primary care and identify barriers and facilitators influencing implementation. SETTING UK primary/community care. PARTICIPANTS Inclusion criteria were UK qualitative studies of any design, published in the English language. Six electronic databases were searched between January 2010 and September 2021, supplemented by reference list searching. Papers were screened, selected and quality-appraised using the Quality Assessment Tool for Studies with Diverse Designs. Study data were extracted to a bespoke table and two reviewers used NVivo software to code study findings. An inductive thematic synthesis was undertaken to identify descriptive themes and interpret these into higher order analytical themes. The Diffusion of Innovations and Consolidated Framework for Implementation Research were guiding theoretical anchors. PRIMARY AND SECONDARY OUTCOME MEASURES N/A. RESULTS Twenty-three articles addressing nurse, pharmacist and physiotherapist IP were included. Synthesis identified barriers and facilitators in four key stages of implementation: (1) 'Preparation', (2) 'Training', (3) 'Transition' and 4) 'Sustainment'. Enhancement, substitution and role-specific implementation models reflected three main ways that the IP role was used in primary care. CONCLUSIONS In order to address global deficits, there is increasing need to optimise use of IP capability. Although the number of independent prescribers continues to grow, numerous barriers to implementation persist. A more coordinated and targeted approach is key to overcoming barriers identified in the four stages of implementation and would help ensure that IP is recognised as an effective approach to help alleviate workforce shortfalls in the UK, and around the world. PROSPERO REGISTRATION NUMBER CRD42019124400.
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Affiliation(s)
- Judith Edwards
- School of Health Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Melaine Coward
- School of Health Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Nicola Carey
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
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Garg S, Tripathi N, Datla J, Zapata T, Mairembam DS, Bebarta KK, Krishnendhu C, de Graeve H. Assessing competence of mid-level providers delivering primary health care in India: a clinical vignette-based study in Chhattisgarh state. HUMAN RESOURCES FOR HEALTH 2022; 20:41. [PMID: 35550154 PMCID: PMC9097044 DOI: 10.1186/s12960-022-00737-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The global commitment to primary health care (PHC) has been reconfirmed in the declaration of Astana, 2018. India has also seen an upswing in national commitment to implement PHC. Health and wellness centres (HWCs) have been introduced, one at every 5000 population, with the fundamental purpose of bringing a comprehensive range of primary care services closer to where people live. The key addition in each HWC is of a mid-level healthcare provider (MLHP). Nurses were provided a 6-month training to play this role as community health officers (CHOs). But no assessments are available of the clinical competence of this newly inducted cadre for delivering primary care. The current study was aimed at providing an assessment of competence of CHOs in the Indian state of Chhattisgarh. METHODS The assessment involved a comparison of CHOs with rural medical assistants (RMAs) and medical officers (MO), the two main existing clinical cadres providing primary care in Chhattisgarh. Standardized clinical vignettes were used to measure knowledge and clinical reasoning of providers. Ten ailments were included, based on primary care needs in Chhattisgarh. Each part of clinical vignettes was standardized using expert consultations and standard treatment guidelines. Sample size was adequate to detect 15% difference between scores of different cadres and the assessment covered 132 CHOs, 129 RMAs and 50 MOs. RESULTS The overall mean scores of CHOs, RMAs and MOs were 50.1%, 63.1% and 68.1%, respectively. They were statistically different (p < 0.05). The adjusted model also confirmed the above pattern. CHOs performed well in clinical management of non-communicable diseases and malaria. CHOs also scored well in clinical knowledge for diagnosis. Around 80% of prescriptions written by CHOs for hypertension and diabetes were found correct. CONCLUSION The non-physician MLHP cadre of CHOs deployed in rural facilities under the current PHC initiative in India exhibited the potential to manage ambulatory care for illnesses. Continuous training inputs, treatment protocols and medicines are needed to improve performance of MLHPs. Making comprehensive primary care services available close to people is essential to PHC and well-trained mid-level providers will be crucial for making it a reality in developing countries.
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Affiliation(s)
- Samir Garg
- State Health Resource Centre, Chhattisgarh, Raipur India
| | | | - Jayathra Datla
- State Health Resource Centre, Chhattisgarh, Raipur India
| | - Tomas Zapata
- WHO, South East Asia Regional Office, New Delhi, India
| | | | | | - C. Krishnendhu
- State Health Resource Centre, Chhattisgarh, Raipur India
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Lukewich J, Asghari S, Marshall EG, Mathews M, Swab M, Tranmer J, Bryant-Lukosius D, Martin-Misener R, Norful AA, Ryan D, Poitras ME. Effectiveness of registered nurses on system outcomes in primary care: a systematic review. BMC Health Serv Res 2022; 22:440. [PMID: 35379241 PMCID: PMC8981870 DOI: 10.1186/s12913-022-07662-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internationally, policy-makers and health administrators are seeking evidence to inform further integration and optimal utilization of registered nurses (RNs) within primary care teams. Although existing literature provides some information regarding RN contributions, further evidence on the impact of RNs towards quality and cost of care is necessary to demonstrate the contribution of this role on health system outcomes. In this study we synthesize international evidence on the effectiveness of RNs on care delivery and system-level outcomes in primary care. METHODS A systematic review was conducted in accordance with Joanna Briggs Institute methodology. Searches were conducted in CINAHL, MEDLINE Complete, PsycINFO, and Embase for published literature and ProQuest Dissertations and Theses and MedNar for unpublished literature between 2019 and 2022 using relevant subject headings and keywords. Additional literature was identified through Google Scholar, websites, and reference lists of included articles. Studies were included if they measured effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN within the context of an independent or interdependent role) and reported outcomes of these interventions. Included studies were published in English; no date or location restrictions were applied. Risk of bias was assessed using the Integrated Quality Criteria for Review of Multiple Study Designs tool. Due to the heterogeneity of included studies, a narrative synthesis was undertaken. RESULTS Seventeen articles were eligible for inclusion, with 11 examining system outcomes (e.g., cost, workload) and 15 reporting on outcomes related to care delivery (e.g., illness management, quality of smoking cessation support). The studies suggest that RN-led care may have an impact on outcomes, specifically in relation to the provision of medication management, patient triage, chronic disease management, sexual health, routine preventative care, health promotion/education, and self-management interventions (e.g. smoking cessation support). CONCLUSIONS The findings suggest that primary care RNs impact the delivery of quality primary care, and that RN-led care may complement and potentially enhance primary care delivered by other primary care providers. Ongoing evaluation in this area is important to further refine nursing scope of practice policy, determine the impact of RN-led care on outcomes, and inform improvements to primary care infrastructure and systems management to meet care needs. PROTOCOL REGISTRATION ID PROSPERO: International prospective register of systematic reviews. 2018. ID= CRD42018090767 .
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Affiliation(s)
- Julia Lukewich
- Faculty of Nursing, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada.
| | - Shabnam Asghari
- Department of Family Medicine, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western, Ontario 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Michelle Swab
- Health Sciences Library, Faculty of Medicine, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | | | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, 5869 University Ave. St, Halifax, NS, B3H 4R2, Canada
| | - Allison A Norful
- School of Nursing, Columbia University, 630 West 168th Street, New York, NY, 10032, USA
| | - Dana Ryan
- Faculty of Nursing, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada
| | - Marie-Eve Poitras
- Département de médecine de famille et médecine d'urgence, Université de Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC, J1K 2R1, Canada
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Lillo-Crespo M, Riquelme-Galindo J, De Baetselier E, Van Rompaey B, Dilles T. Understanding pharmaceutical care and nurse prescribing in Spain: A grounded theory approach through healthcare professionals' views and expectations. PLoS One 2022; 17:e0260445. [PMID: 35073326 PMCID: PMC8786147 DOI: 10.1371/journal.pone.0260445] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pharmaceutical care has been implemented and regulated differently across Europe with no consensus among countries in relation with professional competencies and especially on nurse prescribing. Demophac Project funded by the European Commission aims to develop a Pan-European Pharmaceutical Care Model with collaboration of 14 partner teams across Europe including Spain where nurse prescribing is starting its implementation at regional level. The aim of the study was to increase understanding of the role of nurses in Pharmaceutical care in Spain after the Nurse Prescribing Regulation approved in 2018 throughout exploring the views and expectations of health professionals involved in the representative settings. METHODS AND FINDINGS In depth interviews were conducted in a structure previously agreed by the European Demophac partnership around four topics associated with the Nursing ideal role in pharmaceutical care and the ideal interaction with other healthcare professionals. A grounded-theory approach based on Corbin & Strauss was conducted to interpret collected data from the Spanish most representative settings (primary care, specialized care and residential care for older population). Participants were health professionals involved in pharmaceutical care that accepted to participate (nurses (n = 7), physicians (n = 8) and pharmacists (n = 9)). A pharmaceutical care comprehensive model for the Spanish context considering the recently approved Nurse Prescribing role and the interprofessional collaboration and communication was developed towards facilitating the understanding in such context and the contribution to the unified European Demophac Framework. CONCLUSIONS Nurses are primarily responsible for population's Pharmaceutical Care while other professionals pivot on them to provide quality healthcare on a multidisciplinary level. Nurse prescribing may contribute efficiently to the Spanish Health System though more consensus in terms of nurses' training nationwide and enhancement in communication among different professionals within healthcare organizations is required to achieve adequate integrated care into practice.
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Affiliation(s)
- Manuel Lillo-Crespo
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - Jorge Riquelme-Galindo
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - Elyne De Baetselier
- Department of Nursing and Pharmaceutical Care, University of Antwerp, Antwerp, Belgium
| | - Bart Van Rompaey
- Department of Nursing and Pharmaceutical Care, University of Antwerp, Antwerp, Belgium
| | - Tinne Dilles
- Department of Nursing and Pharmaceutical Care, University of Antwerp, Antwerp, Belgium
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Groenewegen PP, Boerma WGW, Spreeuwenberg P, Seifert B, Schäfer W, Batenburg R, van Tuyl L. Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries. Prim Health Care Res Dev 2021; 22:e66. [PMID: 34753532 PMCID: PMC8581458 DOI: 10.1017/s1463423621000657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/02/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022] Open
Abstract
AIM To describe variation in task shifting from general practitioners (GPs) to practice assistants/nurses in 34 countries, and to explain differences by analysing associations with characteristics of the GPs, their practices and features of the health care systems. BACKGROUND Redistribution of tasks and responsibilities in primary care are driven by changes in demand for care, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill mix of primary care teams. However, these developments are hampered by barriers between professional domains, which can be rigid as a result of strict regulation, traditional attitudes and lack of trust. METHODS Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7200 GPs in 34 countries. The dependent variable 'task shifting' is measured through a composite score of GPs' self-reported shifting of tasks. Independent variables at GP and practice level are: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are: institutional development of primary care; demand for and supply of care; nurse prescribing as an indicator for professional boundaries; professionalisation of practice assistants/nurses (indicated by professional training, professional associations and journals). Multilevel analysis is used to account for the clustering of GPs in countries. FINDINGS Countries vary in the degree of task shifting by GPs. Regarding GP and practice characteristics, use of electronic health record applications (as an indicator for innovativeness) and age of the GPs are significantly related to task shifting. These variables explain only little variance at the level of GPs. Two country variables are positively related to task shifting: nurse prescribing and professionalisation of primary care nursing. Professionalisation has the strongest relationship, explaining 21% of the country variation.
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Affiliation(s)
- Peter P. Groenewegen
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
- Department of Sociology and Department of Human Geography, Utrecht University, PO Box 80.115, 3508 TCUtrecht, The Netherlands
| | - Wienke G. W. Boerma
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
| | - Bohumil Seifert
- Institute of General Practice, Charles University, Prague, Czechia
| | - Willemijn Schäfer
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
- Northwestern University, Feinberg School of Medicine, Department of Surgery, Chicago, IL60611, USA
| | - Ronald Batenburg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
- Department of Sociology, Radboud University, Nijmegen, The Netherlands
| | - Lilian van Tuyl
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
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Aponte-González J, Brown P, Eslava-Schmalbach J. Preferences based interventions to address the use of antibiotics without prescription: A discrete choice experiment. Pharm Pract (Granada) 2021; 19:2401. [PMID: 34621451 PMCID: PMC8455123 DOI: 10.18549/pharmpract.2021.3.2401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/05/2021] [Indexed: 11/14/2022] Open
Abstract
Background In many countries, concerns have arisen over the population using antibiotics without consulting a physician. This practice can place patients at risk and increase antibiotic resistance in the community. Objective To evaluate individuals' preferences regarding the use of antibiotics. The study also assessed the likely effectiveness of interventions aimed at reducing inappropriate use of antibiotics. Methods A discrete choice experiment (DCE) was conducted in Bogotá, Colombia. The attributes were determined by a systematic literature review and four focus group sessions. The DCE included nine factors - cost, time to get attention, level of symptoms, efficacy, safety, among others- and one label -using or not antibiotics. Data analysis was carried out using a generalized multinomial logit (GMNL) model. Marginal probabilities of different sets of attributes' levels were compared to estimate the likely effectiveness of interventions. Results The survey was administered to 222 participants from diverse socioeconomic backgrounds. The results suggest that participants preferred not taking antibiotics and having a physician as an advisor, but the probability of inappropriate antibiotic use increased as the waiting time or the cost of receiving advice rose. The pharmacy was the preferred source of antibiotics, and participants chose the pharmacy worker (nonprofessional) as an advisor over the nurse on the phone. In the absence of any interventions aimed at reducing the use of antibiotics, approximately 47.3% of people would misuse antibiotics. This reduces to 26.5% when people perceive the efficacy of the antibiotics as low and the potential risks of self-medicating as high. An alternative model using a nursing service would likely lower inappropriate use of antibiotics. Conclusions Even though people prefer not using antibiotics or visiting a physician in case of disease rather than self-medicating, current access conditions might discourage them from appropriately use antibiotics. The results suggest that interventions that informing people about the risks of self-medication and the low efficacy might significantly reduce inappropriate use of antibiotics. Our results also suggest that programs that empower other health professionals to provide access to antibiotics would likely further lower inappropriate use.
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Affiliation(s)
- Johanna Aponte-González
- Pharm, PhD. Professor. Pharmacy Department, School of Sciences, National University of Colombia. Bogotá (Colombia).
| | - Paul Brown
- PhD. Professor Public Health and Health Economics. University of California, Merced. Merced, CA (United States).
| | - Javier Eslava-Schmalbach
- MD, PhD. Professor. University Hospital, Faculty of Medicine, National University of Colombia. Bogotá (Colombia).
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Fox A, Joseph R, Cardiff L, Thoms D, Yates P, Nissen L, Chan RJ. Evidence-informed implementation of nurse prescribing under supervision: An integrative review. J Adv Nurs 2021; 78:301-313. [PMID: 34477229 DOI: 10.1111/jan.14992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/10/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022]
Abstract
AIM To explore evidence reporting facilitators and barriers to implementation of nurse prescribing and provide practical recommendations for evidence-informed implementation and adoption of nurse prescribing under a supervision model. BACKGROUND As demand for access to quality health care services increases, health professional roles are expanding to meet population needs. Nurse prescribing has been effective in some countries and is being considered globally to address growing health care demand. Successful implementation of health service models requires careful planning and consideration. No existing reviews have examined implementation factors in the literature. DESIGN Integrative review. DATA SOURCES CINAHL, MEDLINE, PubMed and EMBASE databases were searched from inception to 15 April 2020. REVIEW METHODS This integrative review is guided by Whittemore and Knafl and adheres to PRISMA reporting guidelines. The sustainability of innovation framework was used to synthesize data concerning implementation and sustainability factors (i.e. innovation, organizational, political, workforce and financial) for nurse prescribing. RESULTS A total of 39 articles were reviewed with literature predominantly reporting findings related to non-medical and nurse prescribing under various models. Variable evidence was found to inform nurse prescribing across five implementation and sustainability factors identifying several areas that require in-depth consideration. Very little evidence is available on nurse prescribing under supervision. CONCLUSION Introduction of service reform is often costly. This review highlights gaps in the literature and raises areas for consideration prior to implementation of this new service delivery model. The introduction of nurse prescribing must be planned and informed by available evidence to support effective adoption, practice and patient outcomes. IMPACT There are significant gaps in evidence related to nurse prescribing under a supervision model. Based on the evidence synthesized in this review, this paper provides practical recommendations for health service providers, managers, clinicians, educators and researchers to support implementation and adoption of nurse prescribing.
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Affiliation(s)
- Amanda Fox
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ria Joseph
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lynda Cardiff
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Debra Thoms
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Patsy Yates
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lisa Nissen
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Raymond Javan Chan
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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16
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Peiffer-Smadja N, Poda A, Ouedraogo AS, Guiard-Schmid JB, Delory T, Le Bel J, Bouvet E, Lariven S, Jeanmougin P, Ahmad R, Lescure FX. Paving the Way for the Implementation of a Decision Support System for Antibiotic Prescribing in Primary Care in West Africa: Preimplementation and Co-Design Workshop With Physicians. J Med Internet Res 2020; 22:e17940. [PMID: 32442155 PMCID: PMC7400049 DOI: 10.2196/17940] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/13/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Background Suboptimal use of antibiotics is a driver of antimicrobial resistance (AMR). Clinical decision support systems (CDSS) can assist prescribers with rapid access to up-to-date information. In low- and middle-income countries (LMIC), the introduction of CDSS for antibiotic prescribing could have a measurable impact. However, interventions to implement them are challenging because of cultural and structural constraints, and their adoption and sustainability in routine clinical care are often limited. Preimplementation research is needed to ensure relevant adaptation and fit within the context of primary care in West Africa. Objective This study examined the requirements for a CDSS adapted to the context of primary care in West Africa, to analyze the barriers and facilitators of its implementation and adaptation, and to ensure co-designed solutions for its adaptation and sustainable use. Methods We organized a workshop in Burkina Faso in June 2019 with 47 health care professionals representing 9 West African countries and 6 medical specialties. The workshop began with a presentation of Antibioclic, a publicly funded CDSS for antibiotic prescribing in primary care that provides personalized antibiotic recommendations for 37 infectious diseases. Antibioclic is freely available on the web and as a smartphone app (iOS, Android). The presentation was followed by a roundtable discussion and completion of a questionnaire with open-ended questions by participants. Qualitative data were analyzed using thematic analysis. Results Most of the participants had access to a smartphone during their clinical consultations (35/47, 74%), but only 49% (23/47) had access to a computer and none used CDSS for antibiotic prescribing. The participants considered that CDSS could have a number of benefits including updating the knowledge of practitioners on antibiotic prescribing, improving clinical care and reducing AMR, encouraging the establishment of national guidelines, and developing surveillance capabilities in primary care. The most frequently mentioned contextual barrier to implementing a CDSS was the potential risk of increasing self-medication in West Africa, where antibiotics can be bought without a prescription. The need for the CDSS to be tailored to the local epidemiology of infectious diseases and AMR was highlighted along with the availability of diagnostic tests and antibiotics using national guidelines where available. Participants endorsed co-design involving all stakeholders, including nurses, midwives, and pharmacists, as central to any introduction of CDSS. A phased approach was suggested by initiating and evaluating CDSS at a pilot site, followed by dissemination using professional networks and social media. The lack of widespread internet access and computers could be circumvented by a mobile app with an offline mode. Conclusions Our study provides valuable information for the development and implementation of a CDSS for antibiotic prescribing among primary care prescribers in LMICs and may, in turn, contribute to improving antibiotic use, clinical outcomes and decreasing AMR.
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Affiliation(s)
- Nathan Peiffer-Smadja
- Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University of Paris, French Institute for Medical Research (INSERM), Paris, France.,National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom.,Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.,Sorbonne Université, Paris, France
| | - Armel Poda
- Department of Infectious Diseases, University Hospital Souro Sanou, Bobo-Dioulasso, Burkina Faso.,Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Abdoul-Salam Ouedraogo
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso.,Service de Bactériologie Virologie, University Hospital Souro Sanou, Bobo-Dioulasso, Burkina Faso
| | | | - Tristan Delory
- Antibioclic, Paris, France.,Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, French Institute for Medical Research (INSERM), Paris, France.,Innovation and Clinical Research Unit, Annecy-Genevois Hospital, Épagny Metz-Tessy, France
| | - Josselin Le Bel
- Antibioclic, Paris, France.,Department of General Practice, Université Paris Diderot, Université de Paris, Paris, France
| | - Elisabeth Bouvet
- Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.,Antibioclic, Paris, France
| | - Sylvie Lariven
- Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.,Antibioclic, Paris, France
| | | | - Raheelah Ahmad
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom.,School of Health Sciences, City, University of London, London, United Kingdom
| | - François-Xavier Lescure
- Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University of Paris, French Institute for Medical Research (INSERM), Paris, France.,Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.,Antibioclic, Paris, France
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Abstract
Nursing and midwifery practice has evolved, with many nurses and midwives now holding prescriptive authority. This paper reports on findings in relation to care which formed part of a broader qualitative study which aimed to explore the experiences of nurse and midwife prescribers in the maternity setting in Ireland. Following research ethics approval, 16 nurse/midwife prescribers participated in one-to-one audio recorded semi-structured interviews. Prescriptive authority both enhances the caring role of the nurse/midwife and supports safer care. The ways in which this happened have been illuminated though barriers have also been identified. In order for the full potential of nurses/midwives with prescriptive authority to be realised, measures such as increasing the number of prescribers and the provision on non-interruption zones need to be considered.
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Affiliation(s)
- Chanel Watson
- Health Professions Education School of Nursing and Midwifery, Royal College of Surgeons in Ireland
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18
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Zimmermann A, Cieplikiewicz E, Wąż P, Gaworska-Krzemińska A, Olczyk P. The Implementation Process of Nurse Prescribing in Poland-A Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072417. [PMID: 32252355 PMCID: PMC7177755 DOI: 10.3390/ijerph17072417] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022]
Abstract
The study aimed to investigate the situation of nurse prescribing, introduced in Poland in 2016, by analyzing the opinions of nurses, expected to be influential on nurses' actual practices, in response to legislative change to enable nurses to prescribe and comparing this with actual nurse prescribing behaviours during the early years of the legislation. The paper fills a knowledge gap and provides baseline data analysis for subsequent research. Nurses' opinions were collected during the period they were preparing themselves for prescribing. That data was compared with data on the character and extent of nurses' actual prescribing practices over the first two years of implementation. The study showed the number of nurse prescriptions increased. Comparing the first and second years of nurse prescribing, the number of nurse independent prescriptions more than doubled. Over the same period, the number of nurse supplementary prescriptions increased almost six-fold. The implementation of nurse prescribing has increased the scope of nursing care, especially in the treatment of the infections, pain and chronic conditions in the elderly.
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Affiliation(s)
- Agnieszka Zimmermann
- Department of Medical and Pharmaceutical Law, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
- Correspondence:
| | - Ewa Cieplikiewicz
- Department of Medical and Pharmaceutical Law, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Piotr Wąż
- Department of Nuclear Medicine, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Aleksandra Gaworska-Krzemińska
- Department of Nursing Management, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Paweł Olczyk
- Department of Clinical Chemistry and Laboratory Diagnostics, School of Pharmacy and Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, 41-200 Katowice, Poland;
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Ewertowski H, Hesse AK, Schneider N, Stiel S. [Primary palliative care provision by general practitioners: Development of strategies to improve structural, legal and financial framework conditions]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 149:32-39. [PMID: 32059833 DOI: 10.1016/j.zefq.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/29/2019] [Accepted: 12/22/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION General practitioners (GPs) make a major contribution to outpatient palliative care (AAPV). In 2013, new fee rates for AAPV were included in the uniform assessment standard, which strengthens the financial framework conditions for outpatient palliative care by GPs. The aim of the ALLPRAX project is to improve the framework conditions for AAPV. This contribution focusses on ideas for changing structural, legal, and financial framework conditions for an optimised AAPV. METHODS In April 2018, 28 healthcare professionals (10 GPs, 3 medical assistants, 3 hospital doctors, and 12 representatives of the nursing professions) from hospice and palliative care providers in Lower Saxony were invited to participate in nine group discussions at Hannover Medical School. During these group discussions, inhibitory factors for AAPV and possible solutions were discussed. The analysis of the group discussions was carried out using a summarizing content analysis according to Mayring. RESULTS In order to optimise palliative care by GPs in Germany, it is proposed that a) additional palliative care specialists for care coordination and round-the-clock availability for patients and relatives in GP practices should be provided (structural solution), b) nursing staff should be permitted to prescribe aids (legal solution), and c) higher remuneration for medical consultations should be provided (financial solution). These approaches could increase feasibility in day-to-day practice and create incentives for caregivers to provide more high-quality general outpatient palliative care. DISCUSSION The described high expenditure in general outpatient palliative care, which is hardly inferior to specialised outpatient palliative care from the caregivers' point of view, is not reflected accordingly, neither structurally nor financially. CONCLUSION In order to optimise general outpatient palliative care, structural, legal and financial framework conditions need to be correspondingly adapted.
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Affiliation(s)
| | | | - Nils Schneider
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover
| | - Stephanie Stiel
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover.
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20
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Martín-Royo J, Villa-García L, Raya-Tena A, Carrera-Alfonso E, Brugués Brugués A, Risco E. Critical analysis of nurse prescribing in primary care: Experience of its use in Catalonia. ENFERMERIA CLINICA 2019; 30:64-66. [PMID: 31694777 DOI: 10.1016/j.enfcli.2019.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/04/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Jaume Martín-Royo
- Grupo de Investigación de la Asociación de Enfermería Familiar y Comunitaria de Cataluña (AIFiCC), CUAP Casernes de Sant Andreu, Institut Català de la Salut, Barcelona, España
| | - Lorena Villa-García
- Grupo de Investigación de la Asociación de Enfermería Familiar y Comunitaria de Cataluña (AIFiCC), Centro de Atención Primaria Can Bou, Consorci Castelldefels Agents de Salut d'Atenció Primària (CASAP), Castelldefels, Barcelona, España.
| | - Antonia Raya-Tena
- Centro de Atención Primaria Raval Nord, Institut Català de la Salut, Barcelona, España
| | - Elisabet Carrera-Alfonso
- Grupo de Investigación de la Asociación de Enfermería Familiar y Comunitaria de Cataluña (AIFiCC), Centro de Atención Primaria La Mina, Institut Català de la Salut, Sant Adrià de Besòs, Barcelona, España
| | - Alba Brugués Brugués
- Asociación de Enfermería Familiar y Comunitaria de Cataluña (AIFiCC), Consorci Castelldefels Agents de Salut d'Atenció Primària (CASAP), Castelldefels, Barcelona, España
| | - Ester Risco
- Grupo de Investigación de la Asociación de Enfermería Familiar y Comunitaria de Cataluña (AIFiCC), Parc Sanitari Pere Virgili, Barcelona, España
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Marcadelli S, Stievano A, Rocco G. Policy proposals for a new welfare: the development of the family and community nurse in Italy as the key to promote social capital and social innovation. Prim Health Care Res Dev 2019; 20:e109. [PMID: 32799972 PMCID: PMC6609921 DOI: 10.1017/s146342361800083x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 07/09/2018] [Accepted: 10/08/2018] [Indexed: 11/11/2022] Open
Abstract
AIM To discuss the development of the family and community health nurse (FCHN) in Italy by focusing on three levels: organisational, political and theoretical. BACKGROUND The role of the FCHN in Italy is not yet embedded evenly across the Italian National Health System (INHS) and does not have formal recognition, either contractually or organisationally. Although complementary post-basic training has been available for over a decade, the FCHN's role in Italy currently exists only in pilot form. In some regions, the FCHN has operated for longer, thanks to which a clearer understanding of the functions and responsibilities required by the FCHN has emerged. Proposals for professional and social policies have emerged, as the FCHN's role may be an answer to health problems and a contributor to the construction of social capital, capable of influencing both individual and collective well-being. METHODS A mixed method investigation via a parallel concurrent design to identify the organisational models for the FCHN was conducted across Italy. In this paper, two profiles are discussed - family and community health nursing and FCHN - but each with its different connotations. The former refers to the practice of nursing and the latter to the nursing practitioners working with family and the community. CONCLUSION We describe the expected future outcomes for FCHNs as elements of social innovation for the development of a new welfare system.
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Affiliation(s)
- Silvia Marcadelli
- Dept of Biomedicine and Prevention - Doctoral Degree in Nursing SciencesTor Vergata University, Rome, Italy
| | - Alessandro Stievano
- Dept of Biomedicine and Prevention - Doctoral Degree in Nursing SciencesTor Vergata University, Rome, Italy
- Research coordinator Centre of Excellence for Nursing Scholarship, OPI, Rome, Italy
| | - Gennaro Rocco
- Dept of Biomedicine and Prevention - Doctoral Degree in Nursing SciencesTor Vergata University, Rome, Italy
- Director Centre of Excellence for Nursing Scholarsip, OPI, Rome, Italy
- Schools of Health Professional, Catholic University Our Lady of Good Counsel, Tirana, Albania
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