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Rushworth GF, Forsyth P, Radley A, Duggan C, Sampson R, Cunningham S, Maguire B. A Pharmacist Clinician Model as part of a collaborative clinical workforce: A philosophical critique. Res Social Adm Pharm 2024; 20:918-925. [PMID: 38902135 DOI: 10.1016/j.sapharm.2024.06.006] [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: 03/27/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
The term 'clinician' is not reserved for any healthcare professional group. However, there is a general acceptance that a clinician would have the knowledge, skills and behaviours to enable them to clinically assess and manage a patient autonomously. The expectation, in a modern collaborative healthcare system, is that this work would be completed as a part of a planned and integrated multi-disciplinary care delivery structure, where any given clinician delivers a devolved element of that patient's care. Forthcoming changes to regulation and professional development pathways in the UK will have a profound impact on pharmacist professional identity and practice. From 2026, all new UK pharmacist registrants will have full independent prescribing rights. A paradigm shift is expected to enable the development of a Pharmacist Clinician Model, incorporating pharmaceutical care needs with wider clinical assessment, diagnostic, and clinical management responsibilities. Consideration is given to this model and its implications. Changes to regulation, policy, education, and the governance required to deliver safe and effective pharmacist clinicians are outlined. A philosophical critique on the nature of being a clinician, and the differentiation of pharmacist clinician roles compared to other healthcare professions, is given. A further examination of the projected risks and expected benefits of this transformative practice model are then explored.
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Affiliation(s)
- Gordon F Rushworth
- School of Pharmacy & Life Sciences, Robert Gordon University, Aberdeen, AB10 7GJ, UK; Highland & Islands Pharmacy Education & Research (HIPER), NHS Highland, Inverness, IV2 3UJ, UK.
| | - Paul Forsyth
- Clinical Cardiology, Pharmacy, NHS Greater Glasgow & Clyde, Clarkston Court, 56 Busby Road, Glasgow, G76 7AT, UK.
| | - Andrew Radley
- Public Health Pharmacy, NHS Tayside, UK; School of Population Health and Genomics, University of Dundee Medical School, Ninewells Hospital, James Arrott Dr, Dundee, DD2 1SG, UK.
| | | | - Rod Sampson
- Cairn Medical Practice, Culduthel Road, Inverness, IV2 4AG, UK.
| | - Scott Cunningham
- School of Pharmacy & Life Sciences, Robert Gordon University, Aberdeen, AB10 7GJ, UK.
| | - Barry Maguire
- Philosophy, Psychology, and Language Sciences, The University of Edinburgh, 40 George St, Edinburgh, EH8 9JX, UK.
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Zhao J, Aoki Y, Zisman-Ilani Y. Nurse prescribers as key players in shared decision making in psychiatry. Lancet Psychiatry 2024; 11:580-581. [PMID: 38697178 DOI: 10.1016/s2215-0366(24)00113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 05/04/2024]
Affiliation(s)
- Junqiang Zhao
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada; Clinical Public Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Yumi Aoki
- Psychiatric and Mental Health Nursing, Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA 19122, USA; Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK.
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Dostanova Z, Yermukhanova L, Blaževičienė A, Baigozhina Z, Taushanova M, Abdikadirova I, Sultanova G. Perception and Experience of Independent Consultations in Primary Healthcare among Registered Nurses in Kazakhstan: A Qualitative Study. Healthcare (Basel) 2024; 12:1461. [PMID: 39120167 PMCID: PMC11311573 DOI: 10.3390/healthcare12151461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
(1) Background: The nursing profession has undergone a significant transformation not only in a formal context but also in terms of the increased educational competencies required of nurses and their preparedness to adapt to evolving roles and statuses. The aim of our study was to examine the experience of advanced practice nurses who conduct independent consultations on patients and to identify the main challenges they face in their practice. (2) Methods: We carried out 22 semi-structured interviews with nurses responsible for conducting independent consultations across three urban polyclinics located in Aktobe, Almaty, and Astana. All interviews were audio-recorded, transcribed verbatim, and subjected to qualitative content analysis. (3) Results: The content analysis revealed three main themes: "People awareness of the role of an independent nursing appointment", "Adaptation of the work environment", and "Confidence of nurses to provide independent services". (4) Conclusions: Limited competency among nurses and the absence of quality metrics for autonomous nursing consultations present substantial obstacles to assessing and enhancing the quality of care delivered by nurses in their independent roles. Developing and implementing quality indicators for independent nursing appointment, as well as additional training within the framework of interprofessional continuous education for nurses, are important steps toward enhancing the effectiveness, safety, and accessibility of nursing care.
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Affiliation(s)
- Zhanar Dostanova
- Department of Public Health and Health Care, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan; (L.Y.); (M.T.); (I.A.); (G.S.)
| | - Lyudmila Yermukhanova
- Department of Public Health and Health Care, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan; (L.Y.); (M.T.); (I.A.); (G.S.)
| | - Aurelija Blaževičienė
- Department of Nursing, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Zaure Baigozhina
- School of Nursing, Astana Medical University, Astana 010000, Kazakhstan;
| | - Maiya Taushanova
- Department of Public Health and Health Care, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan; (L.Y.); (M.T.); (I.A.); (G.S.)
| | - Indira Abdikadirova
- Department of Public Health and Health Care, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan; (L.Y.); (M.T.); (I.A.); (G.S.)
| | - Gulnar Sultanova
- Department of Public Health and Health Care, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan; (L.Y.); (M.T.); (I.A.); (G.S.)
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MacVicar S. Nurse independent prescribing: exploring the opportunities and challenges. Nurs Stand 2024; 39:40-45. [PMID: 38736365 DOI: 10.7748/ns.2024.e12304] [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] [Accepted: 01/11/2024] [Indexed: 05/14/2024]
Abstract
The Nursing and Midwifery Council states that nurses should be able to demonstrate competence in prescribing practice at the point of registration to be 'prescribing ready'. The aim is to increase the number of nurse independent prescribers and improve access to pharmacological treatments for patients. However, while this policy presents opportunities for nurses to develop their prescribing knowledge and skills, there are also challenges involved in integrating prescribing theory into nurse education and ensuring there are enough suitable mentors available in practice. This article details how the policy of prescribing readiness is being addressed in preregistration nurse education and explores the supervision of nurse prescribing in clinical practice. The author also discusses how best to support the professional development of nurse independent prescribers beyond their initial training.
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Affiliation(s)
- Sonya MacVicar
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
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Baig S, Mughal S, Murad Y, Virdee M, Jalal Z. Exploring the Perceptions and Behaviours of UK Prescribers Concerning Novel Lipid-Lowering Agent Prescriptions: A Qualitative Study. PHARMACY 2024; 12:104. [PMID: 39051388 PMCID: PMC11270282 DOI: 10.3390/pharmacy12040104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/24/2024] [Accepted: 06/29/2024] [Indexed: 07/27/2024] Open
Abstract
Reducing low-density lipoprotein cholesterol levels lowers the risk of atherosclerotic cardiovascular disease. With the current and future portfolios of emerging lipid-lowering therapies included in various national and international guidelines, the objectives of this study were (i) to investigate the perceptions of UK prescribers', including doctors, pharmacists, and nurses, on current lipid management for cardiovascular diseases and prescriptions of novel lipid-lowering therapies, and (ii) to explore the challenges and facilitating factors of prescribing novel lipid-lowering therapies through qualitative interviews. Qualitative semi-structured interviews with twelve medical and non-medical prescribers were conducted, around 20-30 min in length. The interviews were audio-recorded and transcribed on an online platform. A thematic analysis was deployed. Four major themes emerged from the analysis: (1) prescribing barriers; (2) prescribing enablers; (3) inter-profession variability; and (4) health literacy. These themes highlighted the contrast between the need for optimal shared decision making and the various constraints in practice. Participants expressed their inexperience with novel lipid-lowering therapies and acknowledged the requirement and importance of these agents for primary cardiovascular disease prevention. Participants recognised confidence and competence as key drivers for prescribing therapies and welcomed further education and training to enhance their skillset. Patients' misconceptions towards current lipid-lowering therapies contributed to their refusal of newer agents, highlighting a requirement to improve patient education. Targeting communities through awareness campaigns was identified as a viable solution.
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Affiliation(s)
- Sarah Baig
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, Birmingham B15 2TT, UK (Z.J.)
| | - Shahrauz Mughal
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, Birmingham B15 2TT, UK (Z.J.)
| | - Yousuf Murad
- Worcestershire Acute Hospital Trust Woodrow Drive, Redditch B98 7UB, UK;
| | - Mandeep Virdee
- Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK;
| | - Zahraa Jalal
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, Birmingham B15 2TT, UK (Z.J.)
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Bayot i Escardívol R, Mateo-Viladomat E, Galbany-Estragués P, Vilar-Pont M, Calderó i Solé MA, Mora-López G, Flores-Montoya R, Vicente-Belis M, Escoda-Geli N, Molina-Nadal A, Canet-Vélez O, Jodar-Solà G. Implementation of Nurse Prescriptions throughout the Public Health System in Catalonia (2021-2022). Healthcare (Basel) 2024; 12:1232. [PMID: 38921348 PMCID: PMC11204069 DOI: 10.3390/healthcare12121232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Nurses in Catalonia have always prescribed health advice, health products, and medication in line with the professional competency of the discipline. Legislation about nurse prescriptions and the implementation of nurse prescribing varies widely among different countries. This article reports data regarding nurse prescribing in Catalonia in 2021 and 2022. METHODS This retrospective longitudinal study analyzed data from all care-providing units in Catalonia's integrated public health system. RESULTS The number of nurse prescriptions increased from 139,435 in 2021 to 573,822 in 2022, and the number of nurses issuing prescriptions increased from 3604 in 2021 to 5563 in 2022. The proportion of prescriptions for different products was similar in the two years analyzed. Prescriptions for medication increased by 7.5% in 2022. CONCLUSIONS Nurse prescribing is a recent advance in Catalonia. Despite some difficulties in rollout, the data indicate that this practice is becoming consolidated, as in other European countries.
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Affiliation(s)
- Rosa Bayot i Escardívol
- Official College of Nurses of Barcelona, 08019 Barcelona, Spain; (R.B.i.E.); (E.M.-V.); (P.G.-E.); (G.J.-S.)
| | - Enric Mateo-Viladomat
- Official College of Nurses of Barcelona, 08019 Barcelona, Spain; (R.B.i.E.); (E.M.-V.); (P.G.-E.); (G.J.-S.)
| | - Paola Galbany-Estragués
- Official College of Nurses of Barcelona, 08019 Barcelona, Spain; (R.B.i.E.); (E.M.-V.); (P.G.-E.); (G.J.-S.)
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, 08907 L’Hospitalet de Llobregat, Spain
| | | | | | | | - Raquel Flores-Montoya
- Catalan Health Service (CatSalut), Catalan Department of Health, 08028 Barcelona, Spain; (R.F.-M.); (M.V.-B.); (N.E.-G.); (A.M.-N.)
| | - Montse Vicente-Belis
- Catalan Health Service (CatSalut), Catalan Department of Health, 08028 Barcelona, Spain; (R.F.-M.); (M.V.-B.); (N.E.-G.); (A.M.-N.)
| | - Núria Escoda-Geli
- Catalan Health Service (CatSalut), Catalan Department of Health, 08028 Barcelona, Spain; (R.F.-M.); (M.V.-B.); (N.E.-G.); (A.M.-N.)
| | - Andrea Molina-Nadal
- Catalan Health Service (CatSalut), Catalan Department of Health, 08028 Barcelona, Spain; (R.F.-M.); (M.V.-B.); (N.E.-G.); (A.M.-N.)
| | - Olga Canet-Vélez
- Official College of Nurses of Barcelona, 08019 Barcelona, Spain; (R.B.i.E.); (E.M.-V.); (P.G.-E.); (G.J.-S.)
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain
| | - Glòria Jodar-Solà
- Official College of Nurses of Barcelona, 08019 Barcelona, Spain; (R.B.i.E.); (E.M.-V.); (P.G.-E.); (G.J.-S.)
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McCauley S, Stothers S, Semple C. Evaluation of patient satisfaction of receiving Systemic Anti-Cancer Therapy prescribed by nurse Non-Medical Prescribers. Eur J Oncol Nurs 2024; 70:102597. [PMID: 38795439 DOI: 10.1016/j.ejon.2024.102597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE To evaluate patient satisfaction of patients receiving Systemic Anti-Cancer Treatment prescribed by nurse Non-Medical Prescribers as a new model of care at a Cancer Unit in Northern Ireland, United Kingdom. METHODS A cross-sectional survey design, with a convenience sample of patients from five tumour groups who received Systemic Anti-Cancer Therapy by nurse Non-Medical Prescribers, across a 3-month period in 2022 was employed. Anonymised data were collected via postal survey, which incorporated a minimally modified version of the 45-item Leeds Satisfaction Questionnaire (LSQ). RESULTS One-hundred and sixteen surveys were returned, yielding a 36% response rate. Overall patients' satisfaction levels with nurse non-medical prescribing of systemic anti-cancer therapy were high across all six subscales of the modified LSQ corroborated by qualitative free-text comments. Eighty-five percent of participants indicated they were happy to continue being prescribed systemic anti-cancer therapy by the nurse non-medical prescribers. CONCLUSION Overall patient satisfaction of Systemic Anti-Cancer Treatment prescribed by nurse Non-Medical Prescribers was positively rated; with high standards of compassionate, person-centred care reported, demonstrating an acceptable transformation in care delivery from a consultant-led model. Nonetheless, there was scope for improved health literacy to enhance patients' understanding and compliance with treatment.
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Affiliation(s)
- Sarah McCauley
- Cancer Services, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast, Northern Ireland, BT16 1RH, UK.
| | - Sheena Stothers
- Cancer Services, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast, Northern Ireland, BT16 1RH, UK; Institute of Nursing and Health Research, Ulster University, York Street, Belfast, Northern Ireland, BT15 1AP, UK
| | - Cherith Semple
- Cancer Services, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast, Northern Ireland, BT16 1RH, UK; Institute of Nursing and Health Research, Ulster University, York Street, Belfast, Northern Ireland, BT15 1AP, UK
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Karampatakis GD, Patel N, Stretch G, Ryan K. Integration and impact of pharmacists in general practice internationally: A rapid review. J Health Serv Res Policy 2024; 29:56-67. [PMID: 37329256 PMCID: PMC10729538 DOI: 10.1177/13558196231179831] [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] [Indexed: 06/19/2023]
Abstract
OBJECTIVE English general practices have been facing ongoing pressures, arising from complicated health care needs and the recent pandemic. To overcome these pressures and reduce the workload of general practitioners, there have been extensive attempts to integrate pharmacists into general practices. A number of literature reviews, often systematic, have partially explored the topic of general practice-based pharmacists (GPBPs) internationally. Our aim was to further explore the employment/integration models of GPBPs and their actual activities and impact, concepts that have not been thoroughly investigated by previous reviews. METHODS Two databases were searched from inception to June 2021 for studies published in the English language. Results were independently screened by two reviewers to establish eligibility for inclusion. Original research studies, or protocols where results had not been released at the time of search, that reported on services provided by pharmacists with some sort of integration into general practices were included. The studies were analysed using narrative synthesis. RESULTS Searches identified 3206 studies in total, of which 75 met the inclusion criteria. The included studies were highly heterogeneous in terms of participants involved and methodologies employed. Integration of pharmacists into general practices has occurred in several countries, with funds originating from multiple sources. Several employment models for GPBPs were described - for example, part-time and full-time work and/or coverage of multiple or single practices. GPBP activities, with some exceptions, were comparable between different countries, with medication reviews being the most common task globally. GPBP impact was identified through both observational and/or interventional research methods, by pursuing a large variety of measures (e.g. activity volume, contact with patients, perceptions/experiences, and patient outcomes). Independent, quantifiable outcomes from GPBP activities were all positive but were of varying statistical significance. CONCLUSIONS Our findings suggest that GPBP services can lead to positive, quantifiable outcomes, mainly in relation to medication use. This shows the usefulness of GPBP services. The findings of this review can help policy makers decide how best to implement and fund GPBP services, and how to identify and measure GPBP impact.
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Affiliation(s)
- Georgios Dimitrios Karampatakis
- Postdoctoral Researcher-Health Services, Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nilesh Patel
- Associate Professor in Pharmacy, University of Reading School of Pharmacy, Reading, UK
| | | | - Kath Ryan
- Professor Emerita, University of Reading School of Pharmacy, Reading, UK
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Owczarek A, Marciniak DM, Jezior R, Karolewicz B. Assessment of the Prescribing Pharmacist's Role in Supporting Access to Prescription-Only Medicines-Metadata Analysis in Poland. Healthcare (Basel) 2023; 11:3106. [PMID: 38131996 PMCID: PMC10743265 DOI: 10.3390/healthcare11243106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
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.
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Affiliation(s)
- Artur Owczarek
- Department of Drug Form Technology, Wroclaw Medical University, Borowska 211 A, 50-556 Wroclaw, Poland; (D.M.M.); (B.K.)
| | - Dominik M. Marciniak
- Department of Drug Form Technology, Wroclaw Medical University, Borowska 211 A, 50-556 Wroclaw, Poland; (D.M.M.); (B.K.)
| | - Rafał Jezior
- Department of Data Processing Centers, Wroclaw IT Service Center, Namysłowska 8, 50-304 Wroclaw, Poland;
| | - Bożena Karolewicz
- Department of Drug Form Technology, Wroclaw Medical University, Borowska 211 A, 50-556 Wroclaw, Poland; (D.M.M.); (B.K.)
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Tan W, Hu Q, Wang C, Li Y, Jiang Y. Outline of nurse prescribing education programs: A scoping review. NURSE EDUCATION TODAY 2023; 131:105941. [PMID: 37690439 DOI: 10.1016/j.nedt.2023.105941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/04/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The role of nurse prescribers is developing rapidly to meet rising health care demands worldwide. However, prescribing is a complex process that requires nurses to receive the proper education. OBJECTIVES To identify what is known in the research field on nurse prescribing education. DESIGN Arksey and O'Malley's five-stage methodological framework was used to guide this scoping review. DATA SOURCES PubMed, Web of Science, CINAHL, Embase, and the Cochrane Library. REVIEW METHODS Databases were searched from inception to December 31, 2022. Data were extracted from papers meeting the inclusion criteria using the data chart and synthesized using a narrative method. RESULTS Seventy-one studies were included in the scoping review. Five education content themes and four education modes were identified. In addition, positive effects of nurse prescribing education and the learning needs of nurses were also found. CONCLUSIONS There is considerable heterogeneity in nurse prescribing education content and mode. This scoping review highlights the benefits of implementing education programs to prepare nurses for prescribing. However, nurses still have some unmet needs for prescribing education. More longitudinal studies and evaluation tools are needed to determine long-term effects. Future nurse prescribing education programs could consider the dual mentorship system, interactive educational activities, and specialized courses to improve the motivation of nurses and the quality of education.
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Affiliation(s)
- Wei Tan
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Qin Hu
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Cong Wang
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yijing Li
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yan Jiang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China.
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Dunn J, Pryor C. Non-medical prescribing in nursing: the history and evolution of independent and supplementary prescribing. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:1004-1008. [PMID: 37938995 DOI: 10.12968/bjon.2023.32.20.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Non-medical prescribing has been shown to be beneficial to both service users and practitioners spanning all care sectors. Nurse prescribing has developed significantly in its short existence, and is set to continue to push the boundaries of practice as the role and education of nurses changes and adapts to current population healthcare needs. This article details the origins and evolution of non-medical prescribing, the variety of annotations found on the Nursing and Midwifery Council (NMC) register involved and how these affect nursing practice, as well as the expansion of roles. It also discusses supervision and assessment requirements in line with the NMC standards for prescribing programmes, and the Royal Pharmaceutical Society competence framework.
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Affiliation(s)
- Joanne Dunn
- Lecturer, Non-Medical Prescribing Module Lead, Northumbria University
| | - Claire Pryor
- Lecturer, Non-Medical Prescribing Module Lead, Northumbria University
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Martin SE, Graham K, Banwell HA, Johnson JL. Continuing professional development opportunities for Australian endorsed for scheduled medicines podiatrists-What's out there and is it accessible, relevant, and meaningful? A cross-sectional survey. PLoS One 2023; 18:e0289217. [PMID: 37733657 PMCID: PMC10513227 DOI: 10.1371/journal.pone.0289217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/14/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Non-medical prescribing is a valuable strategy to enable equitable access to medications in the context of the increasing demands on health services globally. Australian podiatrists have been able to seek endorsement for scheduled medicines (ESM) for over a decade. This project investigates the perceptions and habits of ESM podiatrists in meeting the extra continuing professional development (CPD) requirements associated with their ESM status. METHODS Australian ESM podiatrists completed an anonymous, online survey capturing demographics; CPD engagement; and self-reflections of CPD activities. RESULTS Twenty percent (n = 33) of Australian ESM registered podiatrists (N = 167) responded to the survey (18 female; median ESM status 2.5 years, (IQR 1.0, 9.0)). For the previous registration period, 88% (n = 29) completed the mandatory CPD hours, with only 35% (n = 11) completing a CPD learning goal plan. Over 80% identified their last ESM CPD activity as accessible, affordable, and could recommend to colleagues. Conversely, 50% or less agreed the activity increased confidence; changed their practice; improved communication skills; or enabled networking. Most respondents (81%, n = 27) indicated improvements should be made to the content, relevance, accessibility, and meaningfulness of CPD. These findings were supported by responses to the open-ended questions. CONCLUSIONS Our findings suggest ESM podiatrists engage in CPD that is accessible rather than learning goal driven. Concerningly, CPD activities resulted in low translation of learnings to practice. This brings in to question the value of mandatory CPD systems based on minimum hours, rather than meaningfulness.
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Affiliation(s)
- Saraid E. Martin
- Allied Health & Human Performance, The University of South Australia, Adelaide, South Australia, Australia
- Podiatry Department, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Kristin Graham
- Allied Health & Human Performance, The University of South Australia, Adelaide, South Australia, Australia
| | - Helen A. Banwell
- Allied Health & Human Performance, The University of South Australia, Adelaide, South Australia, Australia
| | - Jacinta L. Johnson
- Clinical & Health Sciences, The University of South Australia, Adelaide, South Australia, Australia
- SA Pharmacy, Statewide Clinical Support Services, SA Health, Adelaide, South Australia, Australia
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Roberts J, Jaam M, Paudyal V, Hadi MA. Minimizing prescribing errors: A phenomenological exploration of the views and experiences of independent prescribing pharmacists. Br J Clin Pharmacol 2023; 89:2747-2756. [PMID: 37105534 DOI: 10.1111/bcp.15758] [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: 11/02/2022] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 04/29/2023] Open
Abstract
AIMS This study aims to explore the views and experiences of independent prescribing (IP) pharmacists regarding prescribing errors and strategies to mitigate errors in practice. METHODS One-to-one online semi-structured interviews were conducted with IP pharmacists across the United Kingdom. Verbatim transcripts of the interview were generated and coded using NVivo® 12 software for thematic analysis. A mixed inductive and deductive approach was used to generate themes and sub-themes which were then mapped onto the framework of factors that influence clinical practice proposed by Vincent et al. RESULTS: A total of 14 interviews were conducted. Participants linked the risk-averse nature of a pharmacist, self-perception of their roles as medicines experts, and previous experience of keeping checks on doctors' prescriptions as a dispenser often made them feel confident in prescribing. However, lacking adequate diagnostic skills, inadequate prescribing training programmes, and dealing with complex patients often made them feel vulnerable to committing errors. Organizational and system-related factors such as work interruptions and increased workload were identified as other factors linked to prescribing errors. CONCLUSIONS Independent prescribing pharmacists use a variety of strategies to reduce the risk of prescribing errors. Promoting diagnostic competency in their area of practice, strengthening undergraduate and prescribing curricula, and addressing known organizational and system-related factors linked to prescribing errors can minimize errors and promote patient safety.
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Affiliation(s)
- Joshua Roberts
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Myriam Jaam
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Vibhu Paudyal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Muhammad Abdul Hadi
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
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14
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Pryor C, Hand A, Dunn J. Influences on paramedic prescribing: student and prescriber perspectives. Br Paramed J 2023; 8:10-17. [PMID: 37674919 PMCID: PMC10477823 DOI: 10.29045/14784726.2023.9.8.2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Background Paramedic prescribing has been permitted in legislation from 2018. In 2019 one of the first cohorts of paramedic prescribers in the country was invited to share their experiences, thoughts and perceptions around the new and evolving role of paramedic prescribing practice. Aim To explore the opinions of student and newly qualified paramedic prescribers regarding the impact and effectiveness of paramedic independent prescribing on their clinical practice. Design and setting A qualitative study was undertaken within the North East of England with a group of experienced paramedics undertaking non-medical prescribing education. Methods A focus group and dyad interview were undertaken with a purposive sample of paramedics recruited from a higher education institution providing V300 independent and supplementary prescribing education. The focus group was undertaken with paramedics on the non-medical prescribing (NMP) programme of study. The dyad interview was undertaken with participants once qualified as prescribers, and actively prescribing. The focus group and interview were audio recorded, transcribed verbatim and subjected to thematic analysis to identify key themes. Results A total of n = 7 and n = 2 paramedics undertook the focus group and dyad interview, respectively. Paramedics in this sample represented a range of paramedic practice areas. Paramedic NMP students noted four key themes around role, expectations, governance and opportunities and challenges in relation to prescribing practice. The returning sample of paramedics, now practising as prescribers, noted themes of organisational and infrastructure challenges, monitoring of prescribing practice and the evolution of paramedic roles. Conclusion Paramedic prescribing is rapidly expanding and evolving into new clinical areas. As such, careful consideration should be given to not only the resourcing of prescribers as individuals, but also the wider organisational and technological support and structures needed to be in place to allow paramedic prescribers to fulfil their roles and utilise their advanced practice skills.
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Affiliation(s)
- Claire Pryor
- Northumbria University ORCID iD: https://orcid.org/0000-0003-0766-1357
| | - Annette Hand
- Northumbria University ORCID iD: https://orcid.org/0000-0002-9364-757X
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15
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Babashahi S, Carey N, Jani Y, Hart K, Hounsome N. Costs, consequences and value for money in non-medical prescribing: a scoping review. BMJ Open 2023; 13:e067907. [PMID: 37130673 PMCID: PMC10163523 DOI: 10.1136/bmjopen-2022-067907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Non-medical prescribing (NMP) is a key feature of the UK healthcare system that refers to the legal prescribing rights granted to nurses, pharmacists and other non-medical healthcare professionals who have completed an approved training programme. NMP is deemed to facilitate better patient care and timely access to medicine. The aim of this scoping review is to identify, synthesise and report the evidence on the costs, consequences and value for money of NMP provided by non-medical healthcare professionals. DESIGN Scoping review DATA SOURCES: MEDLINE, Cochrane Library, Scopus, PubMed, ISI Web of Science and Google Scholar were systematically searched from 1999 to 2021. ELIGIBILITY CRITERIA Peer-reviewed and grey literature written in English were included. The research was limited to original studies evaluating economic values only or both consequences and costs of NMP. DATA EXTRACTION AND SYNTHESIS The identified studies were screened independently by two reviewers for final inclusion. The results were reported in tabular form and descriptively. RESULTS A total of 420 records were identified. Of these, nine studies evaluating and comparing NMP with patient group discussions, general practitioner-led usual care or services provided by non-prescribing colleagues were included. All studies evaluated the costs and economic values of prescribing services by non-medical prescribers, and eight assessed patient, health or clinical outcomes. Three studies showed pharmacist prescribing was superior in all outcomes and cost saving at a large scale. Others reported similar results in most health and patient outcomes across other non-medical prescribers and control groups. NMP was deemed resource intensive for both providers and other groups of non-medical prescribers (eg, nurses, physiotherapists, podiatrists). CONCLUSIONS The review demonstrated the need for quality evidence from more rigorous methodological studies examining all relevant costs and consequences to show value for money in NMP and inform the commissioning of NMP for different groups of healthcare professionals.
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Affiliation(s)
- Saeideh Babashahi
- Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Nicola Carey
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
| | - Yogini Jani
- Centre for Medicines Optimisation Research and Education, UCLH NHS Foundation Trust and UCL School of Pharmacy, London, UK
| | - Kath Hart
- Department of Nutritional Sciences, School of Biosciences & Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Natalia Hounsome
- Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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16
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Plowright C, Ross Deveau S, Fazzini B, Ringer J, Cooper H, Dawson D. BACCN
position statement on non‐medical prescribing in critical care. Nurs Crit Care 2022. [DOI: 10.1111/nicc.12866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | - Jo Ringer
- East Kent Hospitals University NHS Foundation Trust Canterbury United Kingdom
| | | | - Deborah Dawson
- St George's University Hospitals NHS Foundation Trust London United Kingdom
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17
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Williams L, Adhiyaman V. What do physician associates think about independent prescribing? Future Healthc J 2022; 9:282-285. [PMID: 36561821 PMCID: PMC9761445 DOI: 10.7861/fhj.2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Physician associates (PAs) are currently unable to prescribe in the UK due to the absence of statutory regulation and prescribing legislation. This is likely to change with the introduction of regulation by the General Medical Council (GMC) set to start from 2023. Currently, there are working groups looking into what needs to be done to enable them to prescribe. In this paper, we explored the views of PAs that qualified in the UK on prescribing and ordering investigations via an online questionnaire. Almost all PAs would prefer to be able to prescribe and request radiological investigations. Inability to perform these basic duties has a negative impact on patient care, patient flow, PAs' contribution to healthcare and career progression.
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Affiliation(s)
- Llinos Williams
- AGlan Clwyd Hospital, Rhyl, UK,Address for correspondence: Llinos Williams, Ward 7, Glan Clwyd Hospital, Rhyl, Denbighshire LL18 5UJ, UK. Twitter: @LlinosWilliams5
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18
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McCarthy C, Pericin I, Smith SM, Kiely B, Moriarty F, Wallace E, Clyne B. Patient and general practitioner experiences of implementing a medication review intervention in older people with multimorbidity: Process evaluation of the SPPiRE trial. Health Expect 2022; 25:3225-3237. [PMID: 36245339 DOI: 10.1111/hex.13630] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The SPPiRE cluster randomized controlled trial found that a general practitioner (GP)-delivered medication review that incorporated screening for potentially inappropriate prescriptions (PIP), a brown bag review and a patient priority assessment, resulted in a significant but small reduction in the number of medicines and no significant reduction in PIP. This process evaluation aims to explore the experiences of GPs and patients and the potential for system-wide implementation. METHODS The trial included 51 general practices and 404 participants with multimorbidity aged ≥65 years, prescribed ≥15 medicines. The process evaluation used mixed methods and ran parallel to the trial. Quantitative data was collected from the SPPiRE intervention website and analysed descriptively. Qualitative data on medication changes were collected from intervention GPs (18/26) and a purposive sample of intervention patients (27/208) via semi-structured telephone interviews. All interviews were transcribed verbatim and analysed using a thematic analysis. Qualitative and quantitative data were integrated using a triangulation protocol. RESULTS The analysis generated two themes, intervention implementation and mechanisms of action, and both were underpinned by the theme of context. Intervention delivery varied among practices and 45 patients (28%) had no review, primarily due to insufficient GP time. 80% of reviewed patients had ≥1 PIP identified, 59% had ≥1 problem identified during the brown bag review and 79% had ≥1 priority recorded. The brown bag review resulted in the most deprescription of medications. GPs and patients responded positively to the intervention but most GPs did not engage with the patient priority-setting process. GPs identified a lack of integration into practice software and resources as barriers to future implementation. CONCLUSION The SPPiRE intervention had a small effect in reducing the number of medicines and this was primarily mediated through the brown bag review. The context of resource shortages and deep-seated views around medical decision-making influenced intervention implementation. PATIENT OR PUBLIC CONTRIBUTION Qualitative data on the implementation of the medication review and their wider views on their medicines was collected from older people with multimorbidity through semi-structured telephone interviews. CLINICAL TRIAL REGISTRATION The SPPiRE trial was registered prospectively on the ISRCTN registry (ISRCTN12752680).
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Affiliation(s)
- Caroline McCarthy
- Department of General Practice, HRB Centre for Primary Care Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ivana Pericin
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, HRB Centre for Primary Care Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Department of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - Bridget Kiely
- Department of General Practice, HRB Centre for Primary Care Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Moriarty
- Department of General Practice, HRB Centre for Primary Care Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Emma Wallace
- Department of General Practice, HRB Centre for Primary Care Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, HRB Centre for Primary Care Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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19
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Chadwick SE. The use of leg elevation in the treatment of chronic peripheral oedema. Br J Community Nurs 2022; 27:S28-S32. [PMID: 36205412 DOI: 10.12968/bjcn.2022.27.sup10.s28] [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] [Indexed: 06/16/2023]
Abstract
Chronic peripheral oedema is a common long-term condition, with conflicting evidence on how it is best managed. It is crucial to establish the cause of the oedema to decide on the most appropriate intervention for its management. If the oedema is not managed, it can lead to unwanted complications for the service user. The District Nurse (DN) is pivotal in the management of patients with long-term conditions, both directly and indirectly. It is important that a multi-disciplinary approach is used, although nurses are now more autonomous due to advances in practice. The present study focuses on leg elevation as a form of intervention in the treatment of chronic peripheral oedema. As with any intervention, there are some risks with leg elevation that must be considered. This should be disseminated and monitored effectively.
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20
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Advances in Pharmacy Practice: A Look towards the Future. PHARMACY 2022; 10:pharmacy10050125. [PMID: 36287446 PMCID: PMC9608826 DOI: 10.3390/pharmacy10050125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
This review looks at the factors that may influence practice in the future. Transformation could occur at 3 levels. Firstly, the traditional profession of the pharmacist as a dispenser of medicines is expanding. Secondly, the pharmacist’s activities are progressing into new healthcare fields. Thirdly, other changes are stimulated by global developments. This review may be helpful for pharmacy and healthcare leaders looking at the future configuration and aims of their pharmacy services.
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21
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Ramos DC, Ferreira L, Santos Júnior GAD, Ayres LR, Esposti CDD. Pharmacist prescribing: a review of perceptions and attitudes of patients, pharmacists and other interested professionals. CIENCIA & SAUDE COLETIVA 2022; 27:3531-3546. [PMID: 36000642 DOI: 10.1590/1413-81232022279.19972021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/26/2022] [Indexed: 11/22/2022] Open
Abstract
Pharmacist prescribing is a growing reality in some developed counties, with varied health systems. Understanding the contribution that this activity can offer in the healthcare process, and investigating its acceptance is of utmost importance for the countries that implement and regulate this type of system. This literature review aimed to design a state-of-the-art academic investigation on the perception, opinions, and attitudes in the context of pharmacist prescribing practices in countries that have adopted this system. To achieve this, the present study conducted an investigation of the Medline, Scopus, Embase, SciELO, and Lilacs databases, resulting in the selection of 17 studies. From the analysis of the articles, three categories of discussion arose: "understanding of the practice and perceived benefits", "acceptance and adherence to the practice, and "hindrances to the practice". The results showed varied acceptance and perceptions among the different publics, depending, among other questions, on the level of knowledge and experience of the patients and health professionals, on the profile of the pharmacists, or on the prescribing modality. This study highlights some challenges involved in the practice of pharmacist prescribing, and its findings can be useful in suggesting a means through which to strengthen the practice.
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Affiliation(s)
- Diego Carneiro Ramos
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo. Av. Marechal Campos 1468, Maruípe. 29047-105 Vitória ES Brasil. .,Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia. Barreiras BA Brasil
| | - Lorena Ferreira
- Instituto Capixaba de Ensino, Pesquisa e Inovação em Saúde, Secretaria Estadual de Saúde do Espírito Santo. Vitória ES Brasil
| | | | - Lorena Rocha Ayres
- Instituto de Biotecnologia, Universidade Federal de Catalão. Catalão GO Brasil
| | - Carolina Dutra Degli Esposti
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo. Av. Marechal Campos 1468, Maruípe. 29047-105 Vitória ES Brasil.
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22
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Ramos DC, Ferreira L, Santos Júnior GAD, Ayres LR, Esposti CDD. Pharmacist prescribing: a review of perceptions and attitudes of patients, pharmacists and other interested professionals. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022279.19972021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Pharmacist prescribing is a growing reality in some developed counties, with varied health systems. Understanding the contribution that this activity can offer in the healthcare process, and investigating its acceptance is of utmost importance for the countries that implement and regulate this type of system. This literature review aimed to design a state-of-the-art academic investigation on the perception, opinions, and attitudes in the context of pharmacist prescribing practices in countries that have adopted this system. To achieve this, the present study conducted an investigation of the Medline, Scopus, Embase, SciELO, and Lilacs databases, resulting in the selection of 17 studies. From the analysis of the articles, three categories of discussion arose: “understanding of the practice and perceived benefits”, “acceptance and adherence to the practice, and “hindrances to the practice”. The results showed varied acceptance and perceptions among the different publics, depending, among other questions, on the level of knowledge and experience of the patients and health professionals, on the profile of the pharmacists, or on the prescribing modality. This study highlights some challenges involved in the practice of pharmacist prescribing, and its findings can be useful in suggesting a means through which to strengthen the practice.
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Affiliation(s)
- Diego Carneiro Ramos
- Universidade Federal do Espírito Santo, Brazil; Universidade Federal do Oeste da Bahia, Brasil
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23
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Jebara T, McIntosh T, Stewart F, Osprey A, Bruce R, Cunningham S. Designated prescribing practitioners: a theory-based cross-sectional study of stakeholders' views on implementation of a novel pharmacy regulator mandated preceptorship model. Int J Clin Pharm 2022; 44:1195-1204. [PMID: 35951218 DOI: 10.1007/s11096-022-01467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/02/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Scottish Government is increasing independent prescribers (IP) in community pharmacy (CP). A new preceptorship model using IPs as Designated Prescribing Practitioners (DPPs) has been introduced. AIM To investigate stakeholder views of implementation of a novel regulator mandated IP course preceptorship model. METHOD A theory-based online pre-piloted survey of stakeholders including e.g. directors of pharmacy, prescribing, education leads, policy & strategy leads and CPs. Questionnaire development used Consolidated Framework for Implementation Research (CFIR) and a DPP Competency Framework. Data were analysed descriptively and presented with mapping to CFIR constructs. RESULTS Of ninety-nine responses 82.5% (80/97) responded 'yes' to '..abilities in reporting concerns..' and 53.1% (51/96) indicating 'no' to '..anticipated issues with clinical and diagnostic skills'. CFIR related facilitators included agreement that; there was tension for change with 84 (85%) indicating '….urgent need to implement role …', that incentives are likely to help (6566%) and small pilots would help (8588%). Barriers were evident related to 'unsure' responses about sufficiency of; DPP capacity (39/97, 40.2%), time (48/96, 50%) and support and resources (4445%) to undertake the role. Concerns were expressed with 81 (83%) in agreement or unsure that leadership commitment may be lacking and 48 (48.9%) were 'unsure' about availability of good training for the DPP role. CONCLUSION There was DPP role positivity but expressed barriers and facilitators at policy, organisational and individual practitioner levels needing further consideration. Further research is warranted on uptake and embedding of the role.
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Affiliation(s)
- Tesnime Jebara
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Trudi McIntosh
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | | | | | - Rachel Bruce
- NHS Education for Scotland, Glasgow, UK.,NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Scott Cunningham
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK.
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24
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Birt L, Dalgarno L, Bond CM, Holland R, Alldred DP, Hughes C, Blyth A, Watts L, Wright DJ. Evaluation of a training programme for Pharmacist Independent Prescribers in a care home medicine management intervention. BMC MEDICAL EDUCATION 2022; 22:551. [PMID: 35840960 PMCID: PMC9287970 DOI: 10.1186/s12909-022-03575-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The provision of independent prescribing rights for United Kingdom (UK) pharmacists has enabled them to prescribe within their area of competence. The aim of this study was to evaluate an evidence-based training programme designed to prepare Pharmacist Independent Prescribers (PIPs) to safely and effectively assume responsibility for pharmaceutical care of older people in care homes in the UK, within a randomised controlled trial. METHODS The training and competency assessment process included two training days, professional development planning against a bespoke competency framework, mentor support, and a viva with an independent General Practitioner (GP). Data on the PIPs' perceptions of the training were collected through evaluation forms immediately after the training days and through online questionnaires and interviews after delivery of the 6-month intervention. Using a mixed method approach each data set was analysed separately then triangulated providing a detailed evaluation of the process. Kaufman's Model of Learning Evaluation guided interpretations. RESULTS All 25 PIPs who received the training completed an evaluation form (N = 25). Post-intervention questionnaires were completed by 16 PIPs and 14 PIPs took part in interviews. PIPs reported the training days and mentorship enabled them to develop a personalised portfolio of competence in preparation for discussion during a viva with an independent GP. Contact with the mentor reduced as PIPs gained confidence in their role. PIPs applied their new learning throughout the delivery of the intervention leading to perceived improvements in residents' quality of life and medicines management. A few PIPs reported that developing a portfolio of competence was time intensive, and that further training on leadership skills would have been beneficial. CONCLUSIONS The bespoke training programme was fit for purpose. Mentorship and competency assessment were resource intensive but appropriate. An additional benefit was that many PIPs reported professional growth beyond the requirement of the study. TRIAL REGISTRATION The definitive RCT was registered with the ISRCTN registry (registration number ISRCTN 17,847,169 ).
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Affiliation(s)
- L Birt
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
- School of Allied Health Professions, University of Leicester, Leicester, UK.
| | - L Dalgarno
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - C M Bond
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - R Holland
- Leicester Medical School, University of Leicester, Leicester, UK
| | - D P Alldred
- School of Healthcare, University of Leeds, Leeds, UK
| | - C Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - A Blyth
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - L Watts
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - D J Wright
- School of Allied Health Professions, University of Leicester, Leicester, UK
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
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25
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Elnour AA, Raja NS, Abdi F, Mostafiz F, Elmubarak RI, Khalil AM, Hait KA, Alqahtani MM, Dabbagh N, Abdulnasser Z, Albek D, Amer A, Damook NOA, Shayeb A, Alblooshi S, Samir M, Hajal AA, Barakani NA, Balbahaith R, Mazrouie HA, Ali RA. Protocol for systematic review and meta-analysis of randomized controlled trials, cost-benefit analysis and interrupted time-series interventions on pharmacist's prescribing. Pharm Pract (Granada) 2022; 20:2713. [PMID: 36733516 PMCID: PMC9851817 DOI: 10.18549/pharmpract.2022.3.2713] [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: 07/19/2022] [Accepted: 08/11/2022] [Indexed: 02/05/2023] Open
Abstract
Background Shortening the process of prescribing via permitting the pharmacist to select the most appropriate pharmaceuticals for each particular patient may provide great opportunities for pharmacists to develop suitable pharmaceutical care plan, monitor and follow up prescribed medications, communicate and consult physicians for more confirmations. Objective The objective of the current protocol for the systematic review and meta-analysis of pharmacists prescribing interventions was to explore, investigate the evidence, assess and compare PICO in patients with medical conditions (population), receiving pharmacist's prescribing care services (interventions) versus non-pharmacist's prescribing (comparators), and identify how it will impact the clinical, humanistic, and economic patient's outcomes (outcomes). Methods The necessary elements of PRISMA will be strictly followed to report the systematic review. The meta-analysis will be reported in line with the Cochrane guidelines for synthesis of trials and all forms will be based on quality measures as per the validated Cochrane templates. We will present the results of the systematic review and the meta-analysis based on PICO comparison between the included trials. Results We have identified four models of pharmacist prescribing interventions (independent, dependent [collaborative], supplementary, and emergency prescribing). The results will contain a systematic critical evaluation of the included trials in terms of the sample number of the population (characteristics), the type of interventions and the comparators, and the main outcome measures. Conclusion This protocol will report the evidence and explore the magnitude of impact of pharmacist prescribing interventions, on clinical, humanistic, and economic outcomes. .
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Affiliation(s)
- Asim Ahmed Elnour
- PhD, MSc. Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates. AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates. ;
| | - Nadia Sarfaraz Raja
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Fatemeh Abdi
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Fariha Mostafiz
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Razan Isam Elmubarak
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Alaa Mohsen Khalil
- Intern student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi- United Arab Emirates.
| | - Khawla Abou Hait
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Mariam Mohamed Alqahtani
- Intern student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Nour Dabbagh
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Zainab Abdulnasser
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Danah Albek
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Abdelfattah Amer
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Nosayba Othman Al Damook
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Aya Shayeb
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Sara Alblooshi
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Mohammed Samir
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Abdallah Abou Hajal
- Post-graduate MSc student, BSc, Pharmaceutical Sciences, College of Pharmacy, Al Ain University (AAU), Abu Dhabi campus, Abu Dhabi- United Arab Emirates. AAU Health and Biomedical Research Centre, Al Ain University, Abu Dhabi, UAE.
| | - Nora Al Barakani
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Rahf Balbahaith
- Fourth year student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Hamda Al Mazrouie
- Intern student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
| | - Rahaf Ahmed Ali
- Intern student, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi-United Arab Emirates.
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Kennedy M, Dickinson R, Alldred D, Bradbury H, Easthall C, Greer D, Shaffiq S, Strickland‐Hodge B. Virtual Objective Structured Clinical Examinations for Independent and Supplementary Prescribing Trainees: redeveloping a high‐stakes assessment. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mary‐Claire Kennedy
- School of Healthcare Faculty of Medicine and Health University of Leeds Leeds UK
| | - Rebecca Dickinson
- School of Healthcare Faculty of Medicine and Health University of Leeds Leeds UK
| | - David Alldred
- School of Healthcare Faculty of Medicine and Health University of Leeds Leeds UK
| | - Helen Bradbury
- School of Healthcare Faculty of Medicine and Health University of Leeds Leeds UK
| | - Claire Easthall
- School of Healthcare Faculty of Medicine and Health University of Leeds Leeds UK
| | - Dan Greer
- School of Healthcare Faculty of Medicine and Health University of Leeds Leeds UK
| | - Sumrah Shaffiq
- School of Healthcare Faculty of Medicine and Health University of Leeds Leeds UK
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Brimblecombe N, Dobel‐Ober D. The development of nurse prescribing in mental health services: outcomes from five national surveys 2004‐19. J Nurs Manag 2022; 30:1018-1026. [PMID: 35278007 PMCID: PMC9314713 DOI: 10.1111/jonm.13588] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Neil Brimblecombe
- Professor of Mental Health, Institute of Health and Social Care London South Bank University
| | - David Dobel‐Ober
- Evaluation Lead, Research and Innovations, Midlands Partnership NHS Foundation Trust
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Guest BN, Chandrakanthan C, Bascombe K, Watkins J. Preparing physician associates to prescribe: evidence, educational frameworks and pathways. Future Healthc J 2022; 9:21-24. [PMID: 35372767 PMCID: PMC8966800 DOI: 10.7861/fhj.2021-0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There are approximately 2,850 physician associates (PAs) in the UK, and this number is growing. PAs are unable to prescribe due to an absence of statutory regulation and necessary prescribing legislation. While PAs cannot prescribe, they must have an adequate level of pharmacology knowledge to safely manage patients. There is an expectation that this is taught as part of the core syllabus on PA programmes. The Department of Health and Social Care (DHSC) recently announced the introduction of statutory regulation of Medical Associate Professionals (MAPs) that include PAs under the General Medical Council. With the introduction of regulation, PAs may be able to prescribe as part of their role. A working group is considering how this might be achieved in terms of education and supervision requirements, delivery of the training and scope of practice. This paper explores the current approach to delivering pharmacology across UK PA programmes. We evaluate what constitutes acceptable training and assessment, and determine if programmes have the capacity to prepare students for prescribing rights. We compare UK PA programmes with those in the USA, with the V300 Independent/Supplementary Prescribing course and with the Prescribing Safety Assessment examination.
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Deslandes P, Blowers H, Haines K, Hodson K, Deslandes R. Medicines prescribed by non-medical independent prescribers in primary care in Wales: a 10-year longitudinal study April 2011-March 2021. BMJ Open 2022; 12:e059204. [PMID: 35210350 PMCID: PMC8883253 DOI: 10.1136/bmjopen-2021-059204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The therapeutic classes of medicines prescribed by non-medical independent prescribers (NMIPs) working in primary care in Wales has not been studied in detail. The aim of this study was to conduct a 10-year longitudinal analysis of NMIP prescribing in Wales from April 2011 to March 2021. The study examined the British National Formulary (BNF) chapters from which medicines were prescribed by NMIPs, whether this changed over time, and whether there was variation in prescribing across the geographic regions of Wales. DESIGN Retrospective secondary data analysis of primary care prescribing data. Monthly prescribing data for the 10 National Health Service financial years (April to March) from April 2011 to March 2021 were obtained from the Comparative Analysis System for Prescribing Audit software. Data were analysed according to BNF chapter, to identify in which therapeutic areas NMIPs were prescribing, and whether this changed over the study period. RESULTS The number of items prescribed by NMIPs increased during the study period. From April 2011 to March 2021 prescribing in seven BNF chapters equated to approximately 80% of total items, with cardiovascular system medicines most prescribed. In the financial year 2011-2012 the BNF chapters with the greatest proportion of items prescribed were infection (18%) and respiratory system (13%), while in 2020-2021, these had changed to cardiovascular (23%) and nervous system (19%). The number of items prescribed in each health board in Wales varied, however, the BNF chapters contributing the largest percentages of items to the health board totals were broadly comparable. CONCLUSIONS The BNF chapter with the most prescribed items changed from infection to cardiovascular during the study period, suggesting an increase in chronic disease management by NMIPs. The impact of this on the delivery of primary care services and patient outcomes is a focus for future work.
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Affiliation(s)
- Paul Deslandes
- All Wales Therapeutics and Toxicology Centre, Academic Centre, University Hospital Llandough, Llandough, UK
- School of Care Sciences, University of South Wales, Treforest, UK
| | - Hannah Blowers
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Kath Haines
- All Wales Therapeutics and Toxicology Centre, Academic Centre, University Hospital Llandough, Llandough, UK
| | - Karen Hodson
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Rhian Deslandes
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
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Santos-Willshere J, Pizarro N. Introducing nurse prescribing in Gibraltar: the impact on palliative care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:162-168. [PMID: 35152752 DOI: 10.12968/bjon.2022.31.3.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article critically explores the impact of the introduction of nurse prescribing on palliative care in Gibraltar. A preliminary audit review of the prescriptions issued by the two palliative independent nurse prescribers over their first full calendar year of prescribing (2020) revealed two primary areas of impact: facilitating end-of-life care at home and improving anticipatory prescribing for end-of-life symptom management. These initial findings will be discussed in the context of the challenges and facilitators encountered during the first year of prescribing practice. Challenges were primarily related to the introduction of an advanced nursing role into an existing medical paradigm. Identified facilitators included comprehensive record keeping, collaborative working and the development of local guidelines, as well as the support of management and peers. The article concludes with a recommendation for further audits of prescribing data as a way to measure the impact of the new role and to inform future palliative service development.
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Affiliation(s)
| | - Nicole Pizarro
- Specialist Palliative Nurse, Gibraltar Health Authority, Gibraltar
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OUP accepted manuscript. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kilańska D, Lipert A, Guzek M, Engelseth P, Marczak M, Sienkiewicz K, Kozłowski R. Increased Accessibility to Primary Healthcare Due to Nurse Prescribing of Medicines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010292. [PMID: 35010551 PMCID: PMC8751194 DOI: 10.3390/ijerph19010292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 06/04/2023]
Abstract
Since January 2016, nurses and midwives in Poland have had the right, with some restrictions, to prescribe medicines. Consequently, Polish patients received the same opportunity as in other countries worldwide: easier access to certain health services, i.e., medical prescribing. The aim of this study was to assess the impact of structural changes which increased the nurses' competences on the accessibility to prescription visits for patients receiving primary healthcare on the example of Medical and Diagnostic Centre (MDC), and to discuss the general trend of legal changes in nursing profession regulations. We performed a detailed analysis of the data on the MDC patient population in Siedlce who received at least one prescription written by a general practitioner and/or a nurse/midwife in the years 2017-2019.The largest number of prescription visits made by nurses concerned patients aged 50-70 years, as this age range includes the largest number of patients with chronic diseases who need continued pharmacological treatment originally administered by doctors. An increasing tendency for prescription visits made by nurses was recorded, with a simultaneous downward trend in the same type of visits undertaken by doctors at MDC. Nurses' involvement in prescribing medications as a continued pharmacotherapy during holiday seasons results in patients having continuous access to medication. An upward trend was also observed in the number of medications prescribed by nurses per patient. Structural changes in the legal regulations of the nursing profession improve patients' access to prescription visits under primary healthcare. Further research is recommended to evaluate the dynamics of these trends and the impact of newly introduced nursing competences on the accessibility of prescription visits for patients.
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Affiliation(s)
- Dorota Kilańska
- Department of Coordinated Care, Medical University of Lodz, 90-131 Lodz, Poland;
| | - Anna Lipert
- Department of Sports Medicine, Medical University of Lodz, 92-213 Lodz, Poland
| | - Marika Guzek
- Medical and Diagnostic Center (MCM), 08-110 Siedlce, Poland;
| | - Per Engelseth
- Narvik Campus, Tromsø School of Business and Economics, The Arctic University of Norway, 8505 Narvik, Norway;
| | - Michał Marczak
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-131 Lodz, Poland; (M.M.); (K.S.)
| | - Kamila Sienkiewicz
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-131 Lodz, Poland; (M.M.); (K.S.)
| | - Remigiusz Kozłowski
- Center of Security Technologies in Logistics, Faculty of Management, University of Lodz, 90-237 Lodz, Poland;
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Ukaegbu O, Smith J, Hall D, Frain T, Abbasian C. Staff awareness of the use of cannabidiol (CBD): a trust-wide survey study in the UK. J Cannabis Res 2021; 3:51. [PMID: 34906259 PMCID: PMC8672615 DOI: 10.1186/s42238-021-00104-x] [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: 08/21/2020] [Accepted: 10/31/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Cannabidiol (CBD) is now a legal substance in Europe and is available in 'high street shops', usually as CBD oil. However, in the United Kingdom (UK), there is no clear consensus among healthcare professionals and organisations over how to manage CBD use in their patients. This is an important issue as CBD is a constituent of 'medicinal and recreational cannabis' and is gaining support in the scientific literature and lay media for use in physical and mental health problems. Given the aforementioned, this study is an exploration of healthcare professionals' beliefs and attitudes with regard to CBD. METHODS In July 2018, we sent requests by email to approximately 2000 clinical staff (including 319 physicians) at a mental health trust in South West London to answer 8 questions in a single survey using Surveyplanet.com , about their beliefs regarding CBD. There was no specific method of choosing the staff, and the aim was to get the email request sent to as many staff as possible on each service line. We did an analysis to see how the attitudes and beliefs of different staff member groups compared. We also gave them space to offer free text responses to illustrate their ideas and concerns. We used chi-squared tests for comparison across groups and used odds ratio for pairwise group comparisons. RESULTS One hundred ninety surveys were received in response, and of these, 180 were included in the final sample. The physician response rate was 17.2% (55/319); the response rate for non-physicians could not be estimated as their total number was not known at outset. 32.2% of the responders had the right to prescribe (58/180) and 52.8% had an experience of working in addiction services (95/180). We found that staff members who can prescribe were 1.99 times as likely to believe CBD has potential therapeutic properties compared to those who do not (OR = 1.99, CI = 1.03, 3.82; p = 0.038) and 2.94 times less likely to think it had dangerous side effects (OR = 0.34, CI = 0.15, 0.75; p = 0.006). Prescribing healthcare professionals were 2.3 times as likely to believe that CBD reduces the likelihood of psychosis (OR = 2.30, CI = 1.10, 4.78; p = 0.024). However, prescribing healthcare professionals with the ability to prescribe were 2.12 times as likely to believe that CBD should be prescription only (OR = 2.12, CI = 1.12, 4.01; p = 0.02). Individuals experienced in addiction services were 2.22 times as likely to be associated with a belief that CBD has therapeutic properties (OR = 2.22, CI = 1.22, 4.04; p = 0.009). Staff in general reported a lack of knowledge about CBD in their free text responses. CONCLUSIONS With almost 95% of prescribers being physicians, they appear to demonstrate awareness of potential therapeutic benefit, reduced likelihood of psychosis and seeming lack of dangerous side effects with CBD. However, their higher stringency about the need for prescription implies an attitude of caution. There was also a suggestion that biases about cannabis were influencing responses to questions as well. The external validity of this study could be diminished by sampling bias and limitation to a single mental health trust. Nonetheless, some of the results drew a reasonable comparison with similar studies.
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Affiliation(s)
- Obioha Ukaegbu
- East Wandsworth Community Mental Health Team, Springfield Hospital, South West London and St George’s Mental Health NHS Trust, 61 Glenburnie Road, London, SW17 7DJ UK
| | - Jared Smith
- Population Health Research Institute, St George’s, University of London, Cranmer Terrace, Tooting, London, SW17 0RE UK
| | - David Hall
- East Wandsworth Community Mental Health Team, Springfield Hospital, South West London and St George’s Mental Health NHS Trust, 61 Glenburnie Road, London, SW17 7DJ UK
| | - Thomas Frain
- East Wandsworth Community Mental Health Team, Springfield Hospital, South West London and St George’s Mental Health NHS Trust, 61 Glenburnie Road, London, SW17 7DJ UK
| | - Cyrus Abbasian
- East Wandsworth Community Mental Health Team, Springfield Hospital, South West London and St George’s Mental Health NHS Trust, 61 Glenburnie Road, London, SW17 7DJ UK
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Noblet T, Heneghan NR, Hindle J, Rushton A. Accreditation of advanced clinical practice of musculoskeletal physiotherapy in England: a qualitative two-phase study to inform implementation. Physiotherapy 2021; 113:217-244. [PMID: 34579951 DOI: 10.1016/j.physio.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To establish whether international musculoskeletal physiotherapy educational standards and associated governance framework align with advanced clinical practice (ACP) frameworks in England; and to evaluate physiotherapy stakeholders' perceptions about potential accreditation and governance of ACP for musculoskeletal physiotherapists. DESIGN A qualitative two-phase study. 1] An explicit documentary mapping process of established international educational musculoskeletal standards to the ACP frameworks for England, in terms of domains, standards and competencies by two independent reviewers. Results were evaluated by a third reviewer and focus group participants. 2] Focus groups enabled maximal insight into perceptions of musculoskeletal stakeholders through the interactive process facilitated by a topic guide. Groups were recorded and transcribed verbatim; data were analysed using thematic coding. SETTING Three focus groups in London, Birmingham and Manchester facilitated recruitment from all regions of England. PARTICIPANTS Purposive sampling (n=26) ensured representation of stakeholders for ACP (e.g. Professional Networks, patients). RESULTS International educational standards fully mapped to both ACP frameworks, with 100% saturation of defined capabilities, and agreement across reviewers and focus groups. Four themes were identified from focus groups: musculoskeletal physiotherapy specific professional factors; fit for purpose, innovative educational opportunities; advocated recognition of musculoskeletal physiotherapy ACP as a discrete professional practice field; and advocating a potential vehicle for musculoskeletal physiotherapy ACP. CONCLUSIONS This study identifies the importance of musculoskeletal ACP specific to the physiotherapy profession. Fit-for-purpose innovative educational opportunities for musculoskeletal physiotherapists are required at Masters level to support preparation for ACP roles. The established national and international musculoskeletal frameworks afford an opportunity.
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Affiliation(s)
- Timothy Noblet
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Jacqueline Hindle
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; School of Physical Therapy, Western University, Elborn College, London, Ontario, N6G 1H1, Canada.
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Mitchell A, Pearce R. Prescribing practice: an overview of the principles. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:1016-1022. [PMID: 34605262 DOI: 10.12968/bjon.2021.30.17.1016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Nurse prescribing has become a well-established aspect of advanced clinical practice working alongside key NHS principles and drivers to address the increasing complexities in patient care and the demands on the health service. Prescribing practice is governed by ethical and legal principles to ensure a holistic patient-centred approach. It has been recognised as a valuable resource that could effectively transform healthcare services to reduce hospital admissions and long hospital stays and improve the quality of life for patients with long-term conditions and multiple comorbidities. This article will provide an overview of prescribing practice.
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Affiliation(s)
- Aby Mitchell
- Professional Lead for Simulation and Immersive Technologies, University of West London
| | - Reuben Pearce
- Nurse Consultant Crisis Resolution and Home Treatment Services, Berkshire Healthcare NHS Foundation Trust
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Naderi A, Janatolmakan M, Jalali R, Andayeshgar B, Khatony A. Iranian nurses' attitudes towards the necessity and barriers to developing nurse prescribing roles. BMC Nurs 2021; 20:178. [PMID: 34556102 PMCID: PMC8459540 DOI: 10.1186/s12912-021-00700-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background Prescribing medication by nurses as an approach to rational drug prescription has been proposed in many countries. Nursing prescribing is an effective measure in the management of critically ill patients admitted to intensive care units (ICU). This study investigated the attitude of ICU nurses towards the necessity and the barriers to developing nursing prescribing. Materials and methods In this cross-sectional study, 136 ICU nurses were included by stratified random sampling. The data collection tool was the researcher-made questionnaire. Cronbach’s alpha method was used to evaluate the reliability of the instrument. The validity of the instrument was also verified by the content validity method. To collect the data, the researcher referred to the nurses’ workplace and provided them with a questionnaire and collected it after completion.The collected data were analyzed by IBM SPSS 16 using descriptive and inferential statistics. Results It was revealed that 58.8 % of nurses were familiar with the term ‘nursing prescribing’; a majority (92.1 %) of whom considered it vital to develop this role in the ICU. Moreover, 86 % (n = 98) of the nurses assumed that it is possible to implement this role in ICU. The most potential barriers to its implementation were lack of legitimacy, disapproval of physicians, and the reluctance of nursing managers. Conclusions Most nurses maintained a positive attitude towards nursing prescribing; hence, its legitimacy seems vital in ICUs. For the development of the ‘nurse prescribing’ role, the Nursing System Organization may be helpful.
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Affiliation(s)
- Azam Naderi
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Janatolmakan
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bahare Andayeshgar
- School of Health, kermanshah University of Medical Sciences, kermanshah, Iran
| | - Alireza Khatony
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran. .,Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. .,Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. .,Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Power A, Stewart D, Craig G, Boyter A, Reid F, Stewart F, Cunningham S, Maxwell S. Student and pre-registration pharmacist performance in a UK Prescribing Assessment. Int J Clin Pharm 2021; 44:100-109. [PMID: 34495454 DOI: 10.1007/s11096-021-01317-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
Abstract
Student and pre-registration pharmacist performance in a UK Prescribing Assessment': room for improvement and need for curricular change Background Increasingly the global policy direction is for patient-facing pharmacist prescribers. The 'UK Prescribing Safety Assessment' (PSA) was developed for medical graduates to demonstrate prescribing competencies in relation to the safe and effective use of medicines. Objectives To determine PSA performance of final year undergraduate student pharmacists (year 4) and pre-registration pharmacy graduates (year 5) and explore their opinions on its suitability. Setting Scotland, UK Methods Final year undergraduates (n = 238) and pre-registration pharmacists (n = 167) were briefed and undertook the PSA. PSA questions were mapped to specific thematic areas with 30 questions over 60 min. Data was analysed using descriptive statistics. A questionnaire was completed to gauge opinions on appropriateness of the PSA. Main Outcome Measure PSA scores Results Mean total PSA score for pre-registration pharmacists (64.4, SD 10) was significantly higher than for undergraduates (51.2, SD 12.0,) (p < 0.001). Pre-registration pharmacists performed significantly better across all question areas (all p < 0.001 other than 'adverse drug reactions', p < 0.01). Hospital pre-registration pharmacists performed statistically significantly better than community with higher overall scores (67.4, SD 9.8 v 63.2, SD 9.8, p < 0.05). Positive views on the appropriateness of the approach and the usability of the online interface were obtained from participants. Conclusion Hospital pre-registration pharmacists performed better than the undergraduates, but there is a need to improve prescribing skills in all, most notably in diagnostic skills. The PSA is acceptable to the participants. These results will help inform pharmacy curricula development and provides a cross-disciplinary method of assessment of prescribing competence.
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Affiliation(s)
- Ailsa Power
- Pharmacy NHS Education for Scotland, 2 Central Quay, Glasgow, G38BW, Scotland.
| | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | - Gail Craig
- Pharmacy NHS Education for Scotland, 2 Central Quay, Glasgow, G38BW, Scotland
| | - Anne Boyter
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, 161 Cathedral St, Glasgow, G4 0RE, Scotland
| | - Fiona Reid
- Retired, Formerly of NHS Education for Scotland, 2 Central Quay, Glasgow, G38BW, Scotland
| | - Fiona Stewart
- Pharmacy NHS Education for Scotland, 2 Central Quay, Glasgow, G38BW, Scotland
| | - Scott Cunningham
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, AB10 7GJ, Scotland
| | - Simon Maxwell
- Clinical Pharmacology Unit, Edinburgh Medical School, Medical Education Centre, Western General Hospital, Edinburgh, EH14 2XU, Scotland
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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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Occomore-Kent LC, Hatch E, Cruice M. Scoping opinion: Speech and language therapists' views on extending their role to the urgent ear, nose and throat pathway. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:975-988. [PMID: 34309979 DOI: 10.1111/1460-6984.12650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In the UK, there is increasing pressure on ear, nose and throat (ENT) clinicians and departments, which is anticipated to amplify in the coming months and years due to the coronavirus disease 2019 pandemic and other workforce pressures. In the context of a national drive to advance practice of Allied Health Professionals to address some key challenges facing the National Health Service, we explored whether UK speech and language therapists (SLTs) felt it is possible to utilize and extend their existing skills to patients on the urgent 2-week wait (2ww) ENT pathway. AIMS To explore SLTs' views of extending their role to work with patients referred on the ENT 2ww pathway. METHODS & PROCEDURES Two separate focus groups were conducted using nominal group technique to generate and rank benefits and challenges of the proposed extension of role. Participants were invited to take part through Clinical Excellence Networks relevant to head and neck cancer and voice sub-specialties. Participants were competent in performing nasendscopy in at least a highly specialist role in voice or head and neck subspecialties. OUTCOMES & RESULTS Nine SLTs from England, Wales and Northern Ireland attended two focus groups. All were employed in band 8 roles in head and neck and/or voice. Eight were competent to Royal College of Speech and Language Therapists' scoping level 3. Important benefits of the proposed novel service delivery model were generated and ranked by participants, with both groups identifying improved quality and efficiency of service for patients among the most important. Disadvantages were then generated and ranked across the two groups with potential for misdiagnosis ranked as the most important by both. CONCLUSIONS & IMPLICATIONS Participants responded that extending the SLT role into assessment of 2ww patients would provide benefits for quality of care, healthcare efficiency and the SLT workforce. The identified disadvantages require addressing if the proposed SLT-led model of service delivery is piloted in the UK. These include practical matters such as referral and prescribing rights, alongside wider implications such as support, governance, indemnity, acknowledgement and remuneration for the extended role. Nationally agreed competencies and training for the role are required if this model is to be successful. WHAT THIS PAPER ADDS What is already known on this subject? International studies have shown that SLTs provide safe and effective assessment for routine ENT referrals with dysphonia and dysphagia, reducing ENT waiting lists in the process (Payten et al., 2020; Seabrook et al., 2019). The current study is the first, to the authors' knowledge, to explore views of the profession regarding SLTs' involvement in assessing patients on the more urgent ENT 2ww pathway in the UK, particularly in the primary care setting. What this study adds The greatest benefits of SLTs assessing patients with dysphonia and dysphagia in the 2ww wait clinic were felt to be for patients through prompt, holistic consultation from a clinician with expert knowledge in their disorder. The greatest disadvantages were posed for the workforce such as potential to miss diagnoses, risk of litigation and the increased burden of responsibility. While advantages are clear for service users, the disadvantages must be addressed if such a model is to be implemented. Clinical implications of this study Expert SLTs communicated strongly that SLTs would be a beneficial addition to the 2ww assessment clinic for patients with dysphonia and dysphagia. For this role to be piloted and implemented successfully, their concerns around increased responsibility, potential for litigation and missed diagnoses need to be addressed. If the SLT role is to be extended to the 2ww clinic, robust training, competencies, supervision, guidance and recognition are necessary to support clinicians in this role and protect patients. Some practical matters such as referral and prescription rights also require exploration.
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Affiliation(s)
- Louise C Occomore-Kent
- Division of Language and Communication Science, School of Health Sciences, City, University of London, Northampton Square, Clerkenwell, London, UK
| | - Ellie Hatch
- Division of Language and Communication Science, School of Health Sciences, City, University of London, Northampton Square, Clerkenwell, London, UK
| | - Madeline Cruice
- Division of Language and Communication Science, School of Health Sciences, City, University of London, Northampton Square, Clerkenwell, London, UK
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De Baetselier E, Van Rompaey B, Dijkstra NE, Sino CG, Akerman K, Batalha LM, Fernandez MID, Filov I, Grøndahl VA, Heczkova J, Helgesen AK, Keeley S, Kolovos P, Langer G, Ličen S, Lillo-Crespo M, Malara A, Padyšáková H, Prosen M, Pusztai D, Raposa B, Riquelme-Galindo J, Rottková J, Talarico F, Tziaferi S, Dilles T. The NUPHAC-EU Framework for Nurses' Role in Interprofessional Pharmaceutical Care: Cross-Sectional Evaluation in Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157862. [PMID: 34360162 PMCID: PMC8345454 DOI: 10.3390/ijerph18157862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022]
Abstract
Clear role descriptions promote the quality of interprofessional collaboration. Currently, it is unclear to what extent healthcare professionals consider pharmaceutical care (PC) activities to be nurses’ responsibility in order to obtain best care quality. This study aimed to create and evaluate a framework describing potential nursing tasks in PC and to investigate nurses’ level of responsibility. A framework of PC tasks and contextual factors was developed based on literature review and previous DeMoPhaC project results. Tasks and context were cross-sectionally evaluated using an online survey in 14 European countries. A total of 923 nurses, 240 physicians and 199 pharmacists responded. The majority would consider nurses responsible for tasks within: medication self-management (86–97%), patient education (85–96%), medication safety (83–95%), monitoring adherence (82–97%), care coordination (82–95%), and drug monitoring (78–96%). The most prevalent level of responsibility was ‘with shared responsibility’. Prescription management tasks were considered to be nurses’ responsibility by 48–81% of the professionals. All contextual factors were indicated as being relevant for nurses’ role in PC by at least 74% of the participants. No task nor contextual factor was removed from the framework after evaluation. This framework can be used to enable healthcare professionals to openly discuss allocation of specific (shared) responsibilities and tasks.
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Affiliation(s)
- Elyne De Baetselier
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing and Midwifery Science, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (B.V.R.); (T.D.)
- Correspondence:
| | - Bart Van Rompaey
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing and Midwifery Science, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (B.V.R.); (T.D.)
| | - Nienke E. Dijkstra
- Research Group Care for the Chronically III, University of Applied Sciences Utrecht, 3584 CH Utrecht, The Netherlands; (N.E.D.); (C.G.S.)
| | - Carolien G. Sino
- Research Group Care for the Chronically III, University of Applied Sciences Utrecht, 3584 CH Utrecht, The Netherlands; (N.E.D.); (C.G.S.)
| | - Kevin Akerman
- Department of Nursing, Swansea University, Swansea SA2 8PP, UK;
| | - Luis M. Batalha
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3046851 Coimbra, Portugal; (L.M.B.); (M.I.D.F.)
| | - Maria I. D. Fernandez
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3046851 Coimbra, Portugal; (L.M.B.); (M.I.D.F.)
| | - Izabela Filov
- Higer Medical School, University “St. Kliment Ohridski”, 7000 Bitola, North Macedonia;
| | - Vigdis A. Grøndahl
- Faculty of Health and Welfare, Østfold University College, 1757 Halden, Norway; (V.A.G.); (A.K.H.)
| | - Jana Heczkova
- First Faculty of Medicine, Institute of Nursing Theory and Practice, Charles University, 11000 Prague, Czech Republic;
| | - Ann Karin Helgesen
- Faculty of Health and Welfare, Østfold University College, 1757 Halden, Norway; (V.A.G.); (A.K.H.)
| | - Sarah Keeley
- Department of Nursing and Clinical Science, Bournemouth University, Bournemouth BH12 5BB, UK;
| | - Petros Kolovos
- Department of Nursing, University of Peloponnese, 22100 Tripolis, Greece; (P.K.); (S.T.)
| | - Gero Langer
- Medical Faculty, Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, 06108 Halle/Saale, Germany;
| | - Sabina Ličen
- Department of Nursing, Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia; (S.L.); (M.P.)
| | - Manuel Lillo-Crespo
- Department of Nursing, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain; (M.L.-C.); (J.R.-G.)
| | - Alba Malara
- ANASTE-Humanitas Foundation, 00192 Rome, Italy; (A.M.); (F.T.)
| | - Hana Padyšáková
- Faculty of Nursing and Professional Health Studies, Slovak Medical University in Bratislava, 83101 Bratislava, Slovakia; (H.P.); (J.R.)
| | - Mirko Prosen
- Department of Nursing, Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia; (S.L.); (M.P.)
| | - Dorina Pusztai
- Institute of Nursing Sciences, Basic Health Sciences and Health Visiting, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (D.P.); (B.R.)
| | - Bence Raposa
- Institute of Nursing Sciences, Basic Health Sciences and Health Visiting, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (D.P.); (B.R.)
| | - Jorge Riquelme-Galindo
- Department of Nursing, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain; (M.L.-C.); (J.R.-G.)
| | - Jana Rottková
- Faculty of Nursing and Professional Health Studies, Slovak Medical University in Bratislava, 83101 Bratislava, Slovakia; (H.P.); (J.R.)
| | | | - Styliani Tziaferi
- Department of Nursing, University of Peloponnese, 22100 Tripolis, Greece; (P.K.); (S.T.)
| | - Tinne Dilles
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing and Midwifery Science, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (B.V.R.); (T.D.)
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Jonuscheit S, Geue C, Laidlaw R, Fischbacher C, Melia B, Lewsey J, King C. Towards transforming community eye care: an observational study and time-series analysis of optometrists' prescribing for eye disorders. Public Health 2021; 196:107-113. [PMID: 34182255 DOI: 10.1016/j.puhe.2021.04.029] [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: 08/13/2020] [Revised: 03/29/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to provide evidence on the therapeutic prescribing activity by community optometrists in Scotland and to determine its impact on workload in general practice and ophthalmology clinics. STUDY DESIGN Scottish administrative healthcare data for a 53-month period (November 2013-April 2018) were used to analyse non-medical prescribing practice by optometrists. METHODS Using interrupted time-series regression (Autoregressive Integrated Moving Average), we assessed the impact of optometrist prescribing on ophthalmology outpatient attendances and general practice prescribing for eye disorders. RESULTS A total of 54,246 items were prescribed by 205 optometrists over the study period. Since the commencement of data recording, optometrist prescribing activity increased steadily from a baseline of zero to 1.2% of all ophthalmic items prescribed. Neither the monthly number of items prescribed nor the size of optometric workforce were associated with a reduction in ophthalmology outpatient appointments over time. CONCLUSIONS Optometrists increasingly contribute to community ophthalmic prescribing in Scotland, releasing capacity and lessening general practice, but not secondary care workload. There appears to be an underutilisation of optometrists related to the management of dry eye, which represents an opportunity to release further capacity.
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Affiliation(s)
- S Jonuscheit
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - C Geue
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, G12 8RZ, UK
| | - R Laidlaw
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - C Fischbacher
- Information Services Division, Public Health Scotland, Edinburgh, UK
| | - B Melia
- Information Services Division, Public Health Scotland, Edinburgh, UK
| | - J Lewsey
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, G12 8RZ, UK
| | - C King
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
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Stewart D, Pallivalapila A, Thomas B, Hanssens Y, El Kassem W, Nazar Z, Al Hail M. A theoretically informed, mixed-methods study of pharmacists' aspirations and readiness to implement pharmacist prescribing. Int J Clin Pharm 2021; 43:1638-1650. [PMID: 34125372 PMCID: PMC8642360 DOI: 10.1007/s11096-021-01296-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/04/2021] [Indexed: 12/03/2022]
Abstract
Background Studies have highlighted advancing clinical pharmacy practice in Qatar. Objective To explore pharmacists’ aspirations and readiness to implement pharmacist prescribing. Setting Hamad Medical Corporation (HMC), the main provider of secondary and tertiary care. Method A sequential explanatory mixed-methods design. Questionnaire items were derived from the Consolidated Framework of Implementation Research (CFIR), in domains of: awareness/support; readiness; implementation; and facilitators and barriers. Following piloting, all pharmacists (n = 554) were invited to participate. Questionnaire data were analysed using descriptive and inferential statistics with principal component analysis of attitudinal items. Focus groups were recorded, transcribed and analysed using the Framework Approach. Main outcome measure Aspirations and readiness to implement pharmacist prescribing. Results The response rate was 62.8% (n = 348), with respondents highly supportive of implementation in Qatar (median 4, scale 0–5, extremely supportive). The majority (64.9%, n = 226) considered themselves ready, particularly those more senior (p < 0.05) and classifying themselves innovative (p < 0.01). Outpatient (72.9%, n = 221 agreeing) and inpatient (71.1%, n = 218 agreeing) HMC settings were those perceived as being most ready. PCA identified 2 components, with ‘personal attributes’ being more positive than ‘prescribing support’. Facilitators were access to records, organizational/management support and the practice environment, with physician resistance and scope of practice as barriers. Focus groups provided explanation, with themes in CFIR domains of innovation characteristics, characteristics of individuals and the inner setting. Conclusion HMC pharmacists largely aspire, and consider themselves ready, to be prescribers with inpatient and outpatient settings most ready. CFIR domains and constructs identified as facilitators and barriers should be focus for implementation.
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Affiliation(s)
- Derek Stewart
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | - Binny Thomas
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Yolande Hanssens
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Wessam El Kassem
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Zachariah Nazar
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - Moza Al Hail
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
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Raghunandan R, Howard K, Marra CA, Tordoff J, Smith A. Identifying New Zealand Public Preferences for Pharmacist Prescribers in Primary Care: A Discrete Choice Experiment. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 15:77-92. [PMID: 34109570 DOI: 10.1007/s40271-021-00529-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Given increasing patient populations, general practitioner workforce constraints and the growing demand for health services in New Zealand (NZ), the development and provision of pharmacist prescribing services could be used to improve people's access to medicines. A discrete choice experiment (DCE) was utilised to determine NZ public preferences for pharmacist prescribing services in primary care in NZ. METHODS A D-efficient DCE design generated 20 choice questions in four blocks of five questions with three labelled alternatives per choice question. The online DCE used a NZ general public online research panel administered by an external organisation (SurveyEngine). The DCE included six attributes with two attributes each with two levels (location of consultation and consultation type), three levels (type of service and operating hours) and four levels (waiting time and cost). RESULTS Nine hundred and twenty-four respondents completed the survey with 4620 observations available for analyses. Respondents preferred pharmacist prescribing services with the following characteristics: optimisation of medicines and changes to only current medicine service types (relative to repeat prescribing); lower consultation costs, shorter waiting times, longer operating hours and consultation by appointment (relative to walk-in and wait clinic). CONCLUSIONS Prescribing policy could incorporate these public preferences to help develop accessible and effective primary care prescribing services utilising the skills of pharmacist prescribers to improve and reduce inequities in access to medicines in NZ. These results suggest the NZ public see pharmacists as part of the primary care prescribing team and are willing to utilise them if these services are implemented.
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Affiliation(s)
- Rakhee Raghunandan
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, Otago, 9054, New Zealand.
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Carlo A Marra
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, Otago, 9054, New Zealand
| | - June Tordoff
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, Otago, 9054, New Zealand
| | - Alesha Smith
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, Otago, 9054, New Zealand
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Osborne J, Kerr H. Role of the clinical nurse specialist as a non-medical prescriber in managing the palliative care needs of individuals with advanced lung cancer. Int J Palliat Nurs 2021; 27:205-212. [PMID: 34169745 DOI: 10.12968/ijpn.2021.27.4.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Rapid identification of the palliative care needs of individuals with a diagnosis of advanced lung cancer is crucial to maximise the patient's quality of life by upholding exemplary standards of patient-centred holistic care. The clinical nurse specialist is in an ideal position to contribute to the identification and management of the palliative care needs of individuals with advanced lung cancer through the assessment and timely prescribing of medications to manage distressing symptoms. AIM This paper reviews and critiques the role of the clinical nurse specialist as an independent non-medical prescriber in the management of palliative symptoms in end-of-life care for patients with advanced lung cancer. RESULTS Published literature highlights the positive impact the clinical nurse specialist has as a non-medical prescriber in addressing the palliative needs of individuals with lung cancer. However, there are barriers and challenges, and to overcome these, maximising resources and the availability of support is required to ensure the delivery of timely, person-centred care. CONCLUSION The clinical nurse specialist as a non-medical prescriber is an evolving role. There are a range of factors that may influence the clinical nurse specialist to confidently and competently undertake this role. These include the perception that there will be an escalation in the workload, concerns about increased accountability and inadequate mentoring for this new role. To incentivise this role, multidisciplinary support is essential in promoting the clinical nurse specialist's confidence for developing this service to individuals with advanced lung cancer.
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Affiliation(s)
- Jenny Osborne
- Macmillan Lung Cancer Clinical Nurse Specialist, South Eastern Health and Social Care Trust, Belfast, Northern Ireland
| | - Helen Kerr
- Senior Lecturer, School of Nursing and Midwifery, Queen's University, Belfast
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Anderson M, O'Neill C, Macleod Clark J, Street A, Woods M, Johnston-Webber C, Charlesworth A, Whyte M, Foster M, Majeed A, Pitchforth E, Mossialos E, Asaria M, McGuire A. Securing a sustainable and fit-for-purpose UK health and care workforce. Lancet 2021; 397:1992-2011. [PMID: 33965066 PMCID: PMC9634455 DOI: 10.1016/s0140-6736(21)00231-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/30/2020] [Accepted: 01/07/2021] [Indexed: 12/18/2022]
Abstract
Approximately 13% of the total UK workforce is employed in the health and care sector. Despite substantial workforce planning efforts, the effectiveness of this planning has been criticised. Education, training, and workforce plans have typically considered each health-care profession in isolation and have not adequately responded to changing health and care needs. The results are persistent vacancies, poor morale, and low retention. Areas of particular concern highlighted in this Health Policy paper include primary care, mental health, nursing, clinical and non-clinical support, and social care. Responses to workforce shortfalls have included a high reliance on foreign and temporary staff, small-scale changes in skill mix, and enhanced recruitment drives. Impending challenges for the UK health and care workforce include growing multimorbidity, an increasing shortfall in the supply of unpaid carers, and the relative decline of the attractiveness of the National Health Service (NHS) as an employer internationally. We argue that to secure a sustainable and fit-for-purpose health and care workforce, integrated workforce approaches need to be developed alongside reforms to education and training that reflect changes in roles and skill mix, as well as the trend towards multidisciplinary working. Enhancing career development opportunities, promoting staff wellbeing, and tackling discrimination in the NHS are all needed to improve recruitment, retention, and morale of staff. An urgent priority is to offer sufficient aftercare and support to staff who have been exposed to high-risk situations and traumatic experiences during the COVID-19 pandemic. In response to growing calls to recognise and reward health and care staff, growth in pay must at least keep pace with projected rises in average earnings, which in turn will require linking future NHS funding allocations to rises in pay. Through illustrative projections, we show that, to sustain annual growth in the workforce at approximately 2·4%, increases in NHS expenditure of 4% annually in real terms will be required. Above all, a radical long-term strategic vision is needed to ensure that the future NHS workforce is fit for purpose.
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Affiliation(s)
- Michael Anderson
- Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Ciaran O'Neill
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | | | - Andrew Street
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Michael Woods
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Anita Charlesworth
- The Health Foundation, London, UK; College of Social Sciences, Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Moira Whyte
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Emma Pitchforth
- Department of Health Policy, London School of Economics and Political Science, London, UK; College of Medicine and Health, University of Exeter, Exeter, UK
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Miqdad Asaria
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Alistair McGuire
- Department of Health Policy, London School of Economics and Political Science, London, UK
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Raghunandan R, Marra CA, Tordoff J, Smith A. Examining non-medical prescribing trends in New Zealand: 2016-2020. BMC Health Serv Res 2021; 21:418. [PMID: 33941188 PMCID: PMC8094524 DOI: 10.1186/s12913-021-06435-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population growth and general practitioner workforce constraints are creating increasing demand for health services in New Zealand (NZ) and internationally. Non-medical prescribing (NMP) is one strategy that has been introduced to help manage this. Little is known about the NMP practice trends in NZ. The aim of this study was to provide a current overview of the scale, scope, and trends of NMP practice in NZ. METHODS All claims for community dispensed medicines prescribed by a non-medical prescriber were extracted from the NZ Pharmaceutical Collection for the period 2016-2020. Patient demographics were retrieved from the Primary Health Organisation enrolment collection. These national databases contain prescription information for all subsidised community pharmacy medicines dispensed and healthcare enrolment data for 96% of New Zealanders. RESULTS The proportion of prescriptions written by all NMP providers and patients receiving NMP prescriptions increased each year from 1.8% (2016) to 3.6% (2019) and 8.4% (2016) to 14.4% (2019) respectively. From 2016 to 2019, the proportion of NMP patients who had at least one NMP prescription increased from 26% to 39% for nurse prescribers, from 1% to 9% for pharmacist prescribers, from 2% to 3% for dietitian prescribers, and decreased from 47% to 22% for dentists, and from 20% to 12% for midwives. The most commonly prescribed medicines were antibiotics (amoxicillin, amoxicillin with clavulanic acid, and metronidazole), and analgesics (paracetamol, and codeine phosphate). While some NMP providers were prescribing for patients with greater health needs, all NMP providers could be better utilised to reach more of these patients. CONCLUSIONS This study highlights that although the NMP service has been implemented in NZ, it has yet to become mainstream healthcare practice. This work provides a baseline to evaluate the NMP service moving forward and enable policy development. Improved implementation and integration of primary care NMP services can ensure continued access to prescribing services and medicines for our communities.
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Affiliation(s)
- Rakhee Raghunandan
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, Otago, 9054, New Zealand.
| | - Carlo A Marra
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, Otago, 9054, New Zealand
| | - June Tordoff
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, Otago, 9054, New Zealand
| | - Alesha Smith
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, Otago, 9054, New Zealand
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Damiaens A, Fraeyman J, Fakroune S, Hutsebaut C, Roussel S, Van Dyck L, Van Hal G, Van den Broucke S, Foulon V. General Practitioners and Community Pharmacists' Collaboration in Primary Care: Small Steps for a Major Change. Int J Integr Care 2021; 21:10. [PMID: 33976599 PMCID: PMC8064283 DOI: 10.5334/ijic.5612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Healthcare authorities worldwide search for ways to develop integrated care and interprofessional collaboration. In Belgium, Medical-Pharmaceutical Concertation (MPC) was introduced as a format to promote constructive dialogues between GPs and community pharmacists (CPs) with a focus on pharmacotherapy. OBJECTIVE To evaluate the implementation of MPC from the perspective of healthcare authorities and GPs/CPs. METHODS Mixed-methods approach, including semi-structured interviews with stakeholders and service users, observations of MPC meetings and surveys in GPs/CPs. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed inductively. RESULTS The implementation of MPC took a slow start. Parties involved had divergent views on the goals of the MPC: stakeholders focused on measurable results, while service users aimed on improving interprofessional communication. Additionally, service users felt that the lack of local structures hindered consensus building and implementation of agreements in daily practice. Support from professional associations was considered indispensable for the implementation of MPC. In order to organize this efficiently, the establishment of an independent institution, coordinating the MPC initiative, was highly recommended. CONCLUSION The study confirms that a thorough context assessment prior to implementation of a complex project is needed and that a step-wise approach should be respected to achieve effective interprofessional relationships.
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Affiliation(s)
- Amber Damiaens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Jessica Fraeyman
- Association of Community Health Centers, Vooruitgangstraat 333 box 10, B-1030 Brussels
- Department of Epidemiology and Social Medicine, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk
| | - Sarah Fakroune
- Psychological Sciences Research Institute, UCLouvain, Place Cardinal Mercier 10, B-1348, Louvain-La-Neuve, Belgium
| | - Caroline Hutsebaut
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Sandrine Roussel
- Psychological Sciences Research Institute, UCLouvain, Place Cardinal Mercier 10, B-1348, Louvain-La-Neuve, Belgium
| | - Lieve Van Dyck
- Department of Epidemiology and Social Medicine, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk
| | - Guido Van Hal
- Department of Epidemiology and Social Medicine, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, UCLouvain, Place Cardinal Mercier 10, B-1348, Louvain-La-Neuve, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
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Ness V, Currie K, Reilly J, McAloney-Kocaman K, Price L. Factors associated with independent nurse prescribers' antibiotic prescribing practice: a mixed-methods study using the Reasoned Action Approach. J Hosp Infect 2021; 113:22-29. [PMID: 33864894 DOI: 10.1016/j.jhin.2021.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The number of nurse prescribers is increasing, yet little evidence exists about their antibiotic prescribing behaviour. AIM To measure nurse independent prescribers' (NIPs) intention to manage patients, presenting with an upper respiratory tract infection (URTI) for the first time, without prescribing an antibiotic and to examine the determinants of this behaviour. METHODS This was a mixed-method study using the Reasoned Action Approach (RAA). Content analysis of data from 27 telephone interviews with NIPs informed the development of a questionnaire which was tested for validity and reliability and used in a national survey of NIPs across Scotland. Descriptive and inferential statistical analysis was carried out to determine intention to manage patients without prescribing an antibiotic and the significant influences on this intention. FINDINGS From 184 participants it was found that NIPs intended to manage patients, presenting with a URTI for the first time, without prescribing an antibiotic. Key determinants were perceived norm, perceived behavioural control, and moral norm. Significant beliefs were positive social influence from other non-medical prescribers (P = 0.007) and nurse prescribers (P = 0.045), the enablers of prescriber experience and confidence (P ≤ 0.001), and the barrier of pressure from patients/carers (P = 0.010). CONCLUSION The findings provide reassurance that NIPs intend to prescribe appropriately. The identification of nurse-specific barriers and enablers to this intention should be acknowledged and targeted in future interventions to manage this behaviour.
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Affiliation(s)
- V Ness
- Glasgow Caledonian University, Glasgow, UK.
| | - K Currie
- Glasgow Caledonian University, Glasgow, UK
| | - J Reilly
- Glasgow Caledonian University, Glasgow, UK; NHS National Services Scotland, Glasgow, UK
| | | | - L Price
- Glasgow Caledonian University, Glasgow, UK
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Raghunandan R, Howard K, Marra CA, Tordoff J, Smith A. Identifying Community Pharmacist Preferences For Prescribing Services in Primary Care in New Zealand: A Discrete Choice Experiment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:253-266. [PMID: 33073328 DOI: 10.1007/s40258-020-00615-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Given increasing patient populations, general practitioner (GP) workforce constraints and increasing demand for health services in New Zealand (NZ), the development and provision of pharmacist prescribing services may need to increase to improve people's access to medicines. A discrete choice experiment (DCE) was utilised to determine community pharmacist preferences for prescribing services in primary care in NZ, and to understand how these factors could improve the provision of pharmacist prescribing services. METHODS A D-efficient design generated 30 labelled choice questions in three blocks of ten, and three alternatives per choice question. The online DCE was emailed to practising community pharmacists in NZ. The DCE included two attributes with five levels (prescribing model, educational requirements) and three attributes with three levels (location, professional fee, change in income). A mixed multinomial logit model was used to estimate preferences. RESULTS A total of 264 respondents completed the survey with 2640 observations for analyses. This DCE found pharmacists preferred pharmacy services with the following characteristics: ability to prescribe using minor ailments and independent prescribing models relative to the pharmacist-only medicines prescribing model; prescribing education by accredited learning modules relative to PGDipClinPharm + PGCertPharmPres; remuneration via a professional fee; and pharmacist prescribing services located in community pharmacies rather than in GP practices. CONCLUSIONS Prescribing policy could incorporate these pharmacist preferences to help develop accessible and effective pharmacist prescribing services that not only improve access to medicines, but also address inequity of access to medicines in NZ. These DCE results are encouraging as they signal that the community pharmacists also see themselves and their pharmacies as part of the prescribing team in primary care in NZ.
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Affiliation(s)
- Rakhee Raghunandan
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, Otago, New Zealand.
| | - Kirsten Howard
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Carlo A Marra
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, Otago, New Zealand
| | - June Tordoff
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, Otago, New Zealand
| | - Alesha Smith
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, Otago, New Zealand
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50
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Mills T, Patel N, Ryan K. Pharmacist non-medical prescribing in primary care. A systematic review of views, opinions, and attitudes. Int J Clin Pract 2021; 75:e13827. [PMID: 33169464 DOI: 10.1111/ijcp.13827] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/05/2020] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Timothy Mills
- Reading School of Pharmacy, University of Reading, Reading, UK
| | - Nilesh Patel
- Reading School of Pharmacy, University of Reading, Reading, UK
| | - Kath Ryan
- Reading School of Pharmacy, University of Reading, Reading, UK
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