Pharmacists as independent prescribers in community pharmacy: A scoping review

BACKGROUND

There has been a growing interest in granting prescribing rights to pharmacists as a strategy to improve healthcare access. Researchers continue to explore the impact and implementation of pharmacist prescribing. Given the recent international changes in this field, an overview of current territories allowing pharmacist independent prescribing would provide a comprehensive understanding for researchers and policymakers.

AIM

This scoping review aims to summarize the countries and specific jurisdictions where pharmacists can prescribe independently in community pharmacy, and map the conditions they can prescribe for, required training, and reimbursement policies.

METHOD

This scoping review was conducted in October 2024 and has been reported following the PRISMA-ScR guidelines. Searches were performed in Scopus, Web of Science, CINAHL, PubMed, and Cochrane databases, along with grey literature searches using Google.

RESULTS

A total of 88 studies and reports were identified. The countries where pharmacist can prescribe independently include the United Kingdom, the United States, Canada, Australia, Poland, Switzerland, and Denmark. Pharmacists authorized as independent prescribers generally require post-registration training and are authorized to initiate, adapt, renew, or substitute prescriptions. For the payment and reimbursement, this service is publicly funded only in Canada, Denmark, France, and the United Kingdom.

CONCLUSION

Pharmacist prescribing practices vary significantly worldwide, with differences in terminology, legislation, and training requirements. This scoping review provides the necessary information to visualize and conceptualize the current scope of pharmacist independent prescribers, offering a foundation for advancing this practice in new jurisdictions. Further research should address current models in under-studied regions, explore the scope for pharmacists to prescribe for undiagnosed conditions, and analyze payment structures in non-funded jurisdictions.

Bridging the gap: Enhancing pharmacist-physiscian collaboration through the provision of comprehensive medication reviews in community pharmacy

Background

Collaborative practice between physicians and pharmacists is particularly important in the provision of pharmacy services, such as Comprehensive Medication Reviews (CMR), which often require a close coordination between these professionals. Understanding the level and nature of this collaboration can assist in the development of strategies to enhance integrated care.

Objectives

(1) To evaluate the changes in level of collaborative practice between community pharmacists and physicians in the context of a CMR service compared to usual practice, from the perspective of community pharmacists, and (2) to explore the determinants of such collaborative practice.

Design

This research was conducted alongside a 12-months prospective longitudinal observational study.

Methods

Community pharmacists providing CMR and pharmacists providing usual care (nCMR) from six provinces in Spain participated in the study. To measure the level of collaborative practice from the perspective of the community pharmacist, a previously validated tool was used. Collaborative practice was assessed at baseline, 6 months and 12 months. A multiple regression analysis was undertaken.

Results

323 pharmacists participated in the study. At the 12-month time point there were statistical differences between CMR and nCMR groups for all factors considered in the level of collaborative practice. Determinants which showed positive significant differences between groups included: rural location of the pharmacy, pharmacists being a pharmacy owner, and female gender of the physician. The age of the pharmacist was negatively associated with higher levels of collaborative practice.

Conclusion

The study provides novel evidence on the level and nature of the collaborative practice between community pharmacists and physicians.

Strategic interventions and a novel model for the integration of community pharmacy and primary care in Spain: qualitative insights

OBJECTIVES

To explore the opinions and perceptions of key stakeholders on the integration between community pharmacy and primary care, within the Valencian Autonomous Community. Specific objectives include identifying strategic interventions to facilitate this integration. Additionally, the manuscript discusses the formulation of a novel model for the integration of community pharmacy and primary care.

DESIGN

Qualitative, with data from five virtual focus groups (FG) and 12 semistructured interviews analysed thematically using NVivo and interventions prioritised through a virtual nominal group technique.

SETTING

Valencian Autonomous Community (Spain).

PARTICIPANTS

FG involved community pharmacists (CP) and primary care stakeholders including general practitioners, primary care nurses, general practitioner pharmacists, social services managers and administrators. Interviewees were government representatives and professionals from organisations. Selection was through snowball sampling and invitations by Official Colleges of Pharmacists.

RESULTS

Five themes emerged, revealing the multifaceted nature of integrating community pharmacies and primary care. 'Integration' was identified as an ambitious target, anchored in collaboration and communication efforts. The role of CP was particularly noted for their direct patient interaction and trust, vital in fostering medication adherence. Barriers like role ambiguity and regulatory environment were highlighted. Seven interventions were identified to enable integration, with three of them prioritised: 'bidirectional communication', 'protocol standardisation' and 'multidisciplinary team strengthening'. These interventions, linked with prior components of health system integration, led to a pioneer integration model.

CONCLUSIONS

Recognising stakeholder insights is essential in shaping workable, practical and adaptable models for integration. Tailoring these temporal models to stakeholders' immediate needs and strategic priorities may serve as effective starting points for integration. Support from professional bodies and proactive stakeholders' engagement will optimise the integration success and its acceptance across healthcare levels.