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

Pharmacists' perspectives on potential pharmacist prescribing: a nationwide survey in the Netherlands

BACKGROUND

Pharmacist prescribing legislation aims to enhance healthcare quality and accessibility. However, in many countries, like the Netherlands, it has not yet been legally established.

AIM

To investigate pharmacists' perspectives on potential pharmacist prescribing in the Netherlands.

METHOD

An online survey using a questionnaire that was distributed via e-mail and electronic newsletters to most practicing pharmacists in the Netherlands during October and November 2023. The questionnaire was based on previous literature, further developed during an international conference with pharmacists and piloted with Dutch pharmacists. Agreement with statements about potential prescribing models, settings, preconditions, and perceived benefits and risks was measured using a 4-point Likert scale. Data were analysed descriptively.

RESULTS

In total, 625 participants from community pharmacy (n = 432; 69.1%), hospital pharmacy (n = 149; 23.8%), or other/combined settings (n = 44; 7.0%) completed the questionnaire. Most pharmacists (somewhat) agreed with the introduction of an independent prescribing model with limitations (n = 538; 86.1%) or a model dependent on collaborative agreements with physicians (n = 471; 75.4%). A minority (n = 245; 39.2%) supported independent prescribing with diagnostic authority. The precondition that participants most frequently (somewhat) agreed with was access to health records (n = 607; 97.1%). The most (somewhat) agreed-upon benefits were enhanced professional position of pharmacists (n = 574; 91.8%) and reduced workload for other prescribers (n = 573; 91.7%). Increased workload for pharmacists (n = 495; 79.2%) was the most (somewhat) agreed-upon identified risk.

CONCLUSION

Pharmacists in the Netherlands are generally supportive of an independent but limited or collaborative pharmacist prescribing model. These findings support further investigations into the potential introduction of pharmacist prescribing legislation.

A qualitative, theory-based exploration of facilitators and barriers for implementation of pharmacist prescribing in chronic kidney disease

BACKGROUND

While there is an accumulation of evidence that pharmacist prescribing is safe and effective, there is a lack of research on processes of implementation into practice, particularly for patients with complex clinical conditions such as chronic kidney disease (CKD).

AIM

The aim was to explore the facilitators and barriers to the implementation of pharmacist prescribing for patients with CKD in the United Kingdom (UK).

METHOD

Semi-structured interviews were conducted with UK Renal Pharmacy Group members who were independent prescribers. The Consolidated Framework for Implementation Research (CFIR) underpinned the interview schedule. Interviews were recorded, transcribed, and independently coded by two researchers. A thematic approach was used for analysis, with data generation continuing until saturation of themes. Ethical approval was granted.

RESULTS

Data saturation was achieved following 14 interviews. Most interviewees were female (n = 11), all had secondary care as their main practice setting, and were highly experienced prescribers with 8 having 11 or more years of prescribing practice. Interviewees were positive regarding the development of their prescribing practice. Facilitators and barriers emerged across all 5 of the CFIR domains. Key facilitators were aspects of inner setting (e.g., organisational support and communication) while key barriers were also related to inner setting, specifically the need for adequate structural and financial resources.

CONCLUSION

This theory-based study has illuminated the facilitators and barriers for the implementation of pharmacist prescribing in CKD. There is a need to consider the resources required for implementation of prescribing practice at an early stage of planning and development.

Why is it so hard to reduce harm from medicines?

Pharmacotherapy is the most common therapeutic intervention in healthcare, but more than 200 million medication errors occur every year in England alone. This may in part reflect greater awareness and better reporting; however, the incidence of patient harm from medication has remained broadly unchanged for decades, despite concerted national campaigns and global safety initiatives. Rapid technological and therapeutic advances together with the complexity of modern healthcare make reducing harm from medicines more challenging than ever. This opinion piece will provide a perspective on some of those challenges, as well as highlighting areas of best practice and emerging work. While system and process improvements are required, individual clinicians need to remain vigilant and reflect on medications at each patient interaction.

The community pharmacist as an independent prescriber: A scoping review

BACKGROUND

Due to the shortage of professionals and the ever-increasing need for and demand for appointments, consultation with physicians is becoming increasingly difficult, and delays are increasing. To limit this issue, several countries have experimented with different models of independent prescribing through pharmacies.

AIM

This study aimed to analyze the contribution of independent prescribing by community pharmacists in primary care using a micro, meso, and macrolevel framework.

METHOD

This was a scoping review of 3 different databases: Medline, Scopus, and Embase. The search (all databases) was executed on May 14, 2024. To be selected for the review, articles needed to be published after 2000, written in English or French, and focused on independent prescribing by community pharmacists. The articles had to investigate the pharmacist-independent prescribing (PIP) efficacy, effectiveness, or efficiency. Only original research was included. The bibliographies of the included papers were reviewed for additional studies. The articles were imported into Covidence to perform the review.

RESULTS

The search yielded 2802 articles, and 1062 remained after removing duplicates. Finally, 13 studies were included in the scoping review. As an independent prescriber, the community pharmacist can improve patient access to primary care, reducing treatment delays (microlevel). In addition, patient safety is maintained, and patients' quality of life is increased. Giving the community pharmacist an extra role helps reduce the workload on physicians, and thus facilitates access to care (mesolevel). The PIP model seems to be cost-effective for society and avoid medical consultations (macrolevel).

CONCLUSION

This review highlights the potential value and relevance of pharmacist-independent prescribers. Minor ailment services were frequently described, but PIP has also been implemented for chronic conditions. The benefits to society are felt at all levels: micro, meso, and macro. Its effectiveness and efficacy have been established, but additional studies are needed, particularly on its efficiency.

Views and experiences of non-medical prescribing: a national survey of prescribing physiotherapists

BACKGROUND

Physiotherapy non-medical prescribing (NMP) is a contemporary development whereby physiotherapists can prescribe medications within their scope of practice. Despite institutional and professional support for its implementation, data regarding physiotherapists' views and experiences of NMP is limited.

OBJECTIVES

To explore the views and experiences of NMP for UK prescribing physiotherapists.

DESIGN

Cross-sectional study, using an anonymous, online survey.

METHODS

Recruitment involved non-probability sampling targeting UK physiotherapists with a NMP qualification. Data was gathered about the role, scope, and activity of prescribing physiotherapists via closed and open-ended questions. Descriptive statistics and inductive content analysis were undertaken.

RESULTS

Of the 552 respondents, most worked in FCP roles (122/552, 22%) and 82% (450/552) prescribed medication. NSAIDs were the most prescribed drug class (267/450, 59%). Perceived benefits were enhanced patient care, reduced burden on other prescribers, and improved medication access. Challenges included restrictions on prescribing or deprescribing controlled drugs (CDs), limited scope of practice, and inadequate CPD. Themes identified to improve physiotherapy NMP were increasing the CDs that physiotherapists can independently prescribe and deprescribe, improving CPD and supervision, and increasing awareness amongst the public and healthcare professionals.

CONCLUSIONS

This study provides novel findings of the perceived benefits, challenges, and development areas for physiotherapy prescribing. There is a need to review and potentially expand the drug formulary for physiotherapists. Improving education and supervision is crucial for the sustainable growth of physiotherapy NMP. Increasing the awareness amongst the public and healthcare professionals may enhance the acceptance of physiotherapy prescribing. CONTRIBUTION OF THE PAPER.

Interventions and impact of pharmacist-delivered services in perioperative setting on clinically important outcomes: a systematic review and meta-analysis

Background

The perioperative arena is a unique and challenging environment that requires coordination of the complex processes and involvement of the entire care team. Pharmacists' scope of practice has been evolving to be patient-centered and to expand to variety of settings including perioperative settings.

Objectives

To critically appraise, synthesize, and present the available evidence of the characteristics and impact of pharmacist-led interventions on clinically important outcomes in the perioperative settings.

Design

A systematic review and meta-analysis.

Methods

We searched PubMed, Embase, and CINAHL from index inception to September 2023. Included studies compared the effectiveness of pharmacist-led interventions on clinically important outcomes (e.g. length of stay, readmission) compared to usual care in perioperative settings. Two independent reviewers extracted the data using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) and undertook quality assessment using the Crowe Critical Appraisal (CCAT). A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and standard mean difference (SMD) for continuous data] with 95% confidence intervals (CIs).

Results

Twenty-five studies were eligible, 20 (80%) had uncontrolled study design. Most interventions were multicomponent and continuous over the perioperative period. The intervention components included clinical pharmacy services (e.g. medication management/optimization, medication reconciliation, discharge counseling) and education of healthcare professionals. While some studies provided a minor description in regards to the intervention development and processes, only one study reported a theoretical underpinning to intervention development. Pooled analyses showed a significant impact of pharmacist care compared to usual care on length of stay (11 studies; SMD -0.09; 95% CI -0.49 to -0.15) and all-cause readmissions (8 studies; OR 0.60; 95% CI 0.39-0.91). The majority of included studies (n = 21; 84%) were of moderate quality.

Conclusion

Pharmacist-led interventions are effective at improving clinically important outcomes in the perioperative setting; however, most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions; therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. Future research should prioritize the development and evaluation of multifaceted theory-informed pharmacist interventions that target the whole surgical care pathway.

Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review

OBJECTIVES

Research indicates that people with lower socioeconomic status (SES) receive inferior healthcare and experience poorer health outcomes compared with those with higher SES, in part due to health professional (HP) bias. We conducted a scoping review of the impact of HP bias about SES on clinical decision-making and its effect on the care of adults with lower SES.

DESIGN

JBI scoping review methods were used to perform a systematic comprehensive search for literature. The scoping review protocol has been published in BMJ Open.

DATA SOURCES

Medline, Embase, ASSIA, Scopus and CINAHL were searched, from the first available start date of the individual database to March 2023. Two independent reviewers filtered and screened papers.

ELIGIBILITY CRITERIA

Studies of all designs were included in this review to provide a comprehensive map of the existing evidence of the impact of HP bias of SES on clinical decision-making and its effect on the care for people with lower SES.

DATA EXTRACTION AND SYNTHESIS

Data were gathered using an adapted JBI data extraction tool for systematic scoping reviews.

RESULTS

Sixty-seven papers were included from 1975 to 2023. 35 (73%) of the included primary research studies reported an association between HP SES bias and decision-making. Thirteen (27%) of the included primary research studies did not find an association between HP SES bias and decision-making. Stereotyping and bias can adversely affect decision-making when the HP is fatigued or has a high cognitive load. There is evidence of intersectionality which can have a powerful cumulative effect on HP assessment and subsequent decision-making. HP implicit bias may be mitigated through the assertiveness of the patient with low SES.

CONCLUSION

HP decision-making is at times influenced by non-medical factors for people of low SES, and assumptions are made based on implicit bias and stereotyping, which compound or exacerbate health inequalities. Research that focuses on decision-making when the HP has a high cognitive load, would help the health community to better understand this potential influence.

Assisted teleconsultation in an outpatient pharmacy: Results of a pilot study in Geneva, Switzerland

INTRODUCTION

Assisted teleconsultation (ATC) is the act of telemedicine involving on one side a patient in the presence of a healthcare professional, and an expert on the other side. ATC in outpatient pharmacies may be an alternative to the emergency room for patients with a semi-urgent medical problem. This project aimed at pilot testing the ATC in an outpatient pharmacy to assess its feasibility and to collect initial real-world data.

METHODS

After initial evaluation and triage by the pharmacist, ATC was proposed to patients consulting at one outpatient pharmacy for semi-urgent medical problems. Prospective data on patients, consultation reasons, teleconsultation duration, patient's orientation and pharmacist' satisfaction were prospectively collected.

RESULTS

Between December 2020 and June 2021, 39 consultations took place, 12 with video and 27 with telephone. Patients' median age was 37 years (IQR 26-50), 59% were women. Near half of the consultations (19) happened during the weekend. Mean ATC duration was 22 min (IC95% 18.6-26.1). Twenty-nine (74%) consultations ended with a prescription, 8 (21%) with medical recommendations and 2 (5%) with an emergency care referral. Without teleconsultation, 34 (87%) patients would have consulted a physician for their problem, and 24 (62%) would have been to the emergency room (self-reported). Fourteen (36%) consultations involved ENT, ophthalmologic and dermatologic complaints.

CONCLUSION

A young population with semi-urgent medical problems can be managed in the pharmacy using ATC with a primary care physician. Financial, technical and training aspects should be developed and optimized in the future.

Managing common ambulatory conditions: Exploring clinical decision making performance between pharmacists and family physicians

Background

Prescribing is part of the expanded scope of practice for pharmacists in Alberta, Canada. Given these responsibilities, clinical decision making (the outcome from the diagnostic and therapeutic decision making process) is an essential skill for pharmacists. The current study compared diagnostic and therapeutic decision-making between Additional Prescribing Authority (APA) pharmacists and family physicians using a set of common ambulatory clinical cases that both practitioners could encounter in the community as part of their daily practice.

Objectives

To explore clinical decision making performance and behaviors between APA pharmacists and family physicians during the assessment and prescribing of common ambulatory conditions.

Methods

Eight written ambulatory clinical cases were developed by a panel of experts in both family medicine and pharmacy that were commonly encountered in both professions' daily practice. Participating APA pharmacists and family physicians reviewed the cases and responded with likely diagnoses, recommended treatments, and reported confidence in therapeutic choices. The responses of 18 APA pharmacists and 9 family physicians in community practices were analyzed.

Results

There were no significant differences in diagnostic accuracy, therapeutic accuracy, confidence in diagnostic choices, and confidence in therapeutic choices between APA pharmacists and family physicians to these common ambulatory presentations.

Conclusions

This study provides preliminary insights regarding the capabilities of pharmacists in the assessment of common ambulatory community conditions and suggests that APA pharmacists are making similar diagnostic and therapeutic decisions to family physicians. Future research could focus on examining the performance of pharmacists trained in different pharmacy education models, as well as their ability to provide clinical assessment in other specialties, or in more uncommon clinical scenarios.

Pharmacist roles in the medication use process: Perceptions of patients, physicians, and pharmacists

OBJECTIVES

It is uncertain whether stakeholder perceptions of pharmacist roles in the medication use process (MUP) have evolved alongside pharmacist advanced scope of practice. This study aimed to examine patient, pharmacist, and physician perceptions of pharmacist roles in the MUP.

DESIGN

This IRB-approved study used a cross-sectional design with online panels of patients, pharmacists, and physicians.

SETTING AND PARTICIPANTS

A Qualtrics panel of 1,004 patients, 205 pharmacists, and 200 physicians completed the surveys between August-November 2021.

OUTCOME MEASURES

Using role theory as framework, 12-item surveys were developed to examine perceptions regarding effectiveness of and best choice for improving each MUP step. Data analysis included descriptive statistics, correlations, and comparisons.

RESULTS

Majority of the physician, pharmacist, and patient samples believed that physicians prescribe the best possible medications (93.5%, 83.4%, 89.0% respectively), prescriptions are filled accurately (59.0%, 61.4%, 92.6% respectively) and timely (86.0%, 68.8, 90.2% respectively). Majority of physicians (78.5%) opined prescriptions are generally error free and patients are monitored (71%); fewer pharmacists agreed (42.9%, 51%; p<0.05). Most patients (92.4%) reported taking medications as directed; only 60% professionals agreed (p<0.05). Physicians selected 'pharmacists' as top choice for reducing dispensing errors, providing counseling, and helping patients take medications as directed. Patients wanted pharmacists to help manage their medications (87.0%) and 'someone' to periodically check on their health (100%). All 3 groups agreed physician-pharmacist collaboration was important to improve patient care and outcomes (90.0%-97.1%); however, 24% of physicians were uninterested in collaboration. Both professionals reported lack of time, appropriate setup, and interprofessional communication as challenges to collaboration.

CONCLUSION

Pharmacists believe their roles have evolved to align with expanded opportunities. Patients perceived pharmacists play comprehensive roles in medication management through counseling and monitoring. Physicians recognized pharmacist roles in dispensing and counseling, but not in prescribing or monitoring. Clarity in role expectations amongst these stakeholders is critical to optimizing pharmacist roles and patient outcomes.

Totally devoted to you: A qualitative study examining the experiences of sacrifice among pharmacists in rural and regional areas

BACKGROUND

The health of rural and regional communities is routinely identified as poor and access to healthcare services is often limited. Rural and regional pharmacists are well placed to deliver a variety of high-quality services to their community, however there is a limited examination of the complexities of their role in rural contexts. This study seeks to examine the types of personal sacrifices and what impact these may have among pharmacists working in rural and regional communities of Australia.

METHOD

A qualitative approach was adopted to examine the experiences of pharmacists working in public health service and private community pharmacies across 13 rural communities in Australia. Purposive sampling was used to recruit pharmacists as part of a larger study examining the efficacy of a workforce recruitment tool (PharmCAQ). As part of the development of the tool, a one-on-one interview were conducted.

RESULTS

A total of 20 participants were recruited. Two major themes emerged: Above all the community and More than just a script monkey that embodies the experiences of pharmacists. Centred around self-sacrifice, the first theme captures the tension that is experienced by these professionals as they tread an unsustainable path for the benefit of the community. The second theme provides some insights into the complex nature of the rural and regional context that is juxtaposed with that of their urban counterparts.

CONCLUSION

Pharmacist in rural and regional areas offer a highly skilled and accessible resource to better address the growing needs of those living in rural and regional areas. Despite the opportunities that exist to expand the role of pharmacists in these areas and to capitalise on their expertise, there is a growing need to find ever better ways to support those who support others.

Community pharmacists' acceptance of prescribing pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV)

BACKGROUND

Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is highly effective. Pharmacists can increase PrEP accessibility through pharmacist prescribing. This study aimed to determine pharmacists' acceptance of a pharmacist PrEP prescribing service in Nova Scotia.

METHODS

A triangulation mixed methods study consisting of an online survey and qualitative interviews was conducted with Nova Scotia community pharmacists. The survey questionnaire and qualitative interview guide were underpinned by the 7 constructs of the Theoretical Framework of Acceptability (affective attitude, burden, ethicality, opportunity costs, intervention coherence, perceived effectiveness and self-efficacy). Survey data were analyzed descriptively and with ordinal logistic regression to determine associations between variables. Interview transcripts were deductively coded according to the same constructs and then inductively coded to identify themes within each construct.

RESULTS

A total of 214 community pharmacists completed the survey, and 19 completed the interview. Pharmacists were positive about PrEP prescribing in the constructs of affective attitude (improved access), ethicality (benefits communities), intervention coherence (practice alignment) and self-efficacy (role). Pharmacists expressed concerns about burden (increased workload), opportunity costs (time to provide the service) and perceived effectiveness (education/training, public awareness, laboratory test ordering and reimbursement).

CONCLUSION

A PrEP prescribing service has mixed acceptability to Nova Scotia pharmacists yet represents a model of service delivery to increase PrEP access to underserved populations. Future service development must consider pharmacists' workload, education and training as well as factors relating to laboratory test ordering and reimbursement.

Uptake of community pharmacist prescribing over a three-year period

Objectives

Pharmacists in Nova Scotia have had legislated authority to prescribe since 2011. This study aimed to describe the prescribing activities of pharmacists and the characteristics of patients who used pharmacist prescribing services.

Methods

Using provincial health administrative databases we identified all community pharmacists who prescribed during the study period (October 2016 to March 2020) and correspondingly patients who had medications prescribed by a pharmacist during this period. Differences in, and predictors of the quantity of pharmacist prescribing over three fiscal years (April 2017 to March 2020) were described. Pharmacist prescribing activity was compared across the fiscal years of the study period with One-way Analysis of Variance. Negative binomial regression examined patient factors associated with use of pharmacist prescribing services. Analysis was carried out using SAS ENTERPRISE GUIDE v.8.2 (SAS Institute Cary, NC, USA).

Key findings

A total of 1182 pharmacist prescribers were identified, who on average prescribed 24.6, 26.3, and 32.5 (p < 0.001) times per month in fiscal years 2018, 2019, 2020, respectively. The patient cohort contained 372,203 Nova Scotians over the 3-year period. For approved common and minor ailment prescribing in Nova Scotia, gastroesophageal reflux disease, vaccines (non-travel), contraceptive management, herpes zoster treatment, and allergic rhinitis had the highest number of prescriptions over the study period. Patient factors most strongly related to receiving more prescribing services by a pharmacist included receiving income assistance without copay (Incidence rate ratio (IRR) = 1.70), having >2 comorbidities (IRR = 1.51), male sex (IRR = 1.03), and greater age (IRR = 1.01). Those from an urban area (IRR = 0.92) or having a higher income (IRR = 0.95) received fewer pharmacist prescribing services (all p < 0.0001).

Conclusions

Pharmacist prescribing increased over the 3-year period. Patients who were older and those with multiple comorbidities used pharmacist prescribing services most often. Prescribing activities represent an increasingly utilized role for pharmacists in primary care.

Integration of pharmacist independent prescribers into general practice: a mixed-methods study of pharmacists' and patients' views

BACKGROUND

Since 2015, the National Health Service (NHS) has funded pharmacists to work in general practice (GP practice) to ease workload pressures. This requires pharmacists to work in new roles and be integrated effectively in GPs. Independent prescribing is a key part of the GP pharmacist role, but little is known about pharmacists' integration into GP practice as well as patients' perceptions and experiences of the care provided by GP pharmacists. This study aims to explore the perceptions of pharmacist independent prescribers (PIPs) about their integration into GP practice and gain insight into patients' perceptions about the care provided to them by pharmacists.

METHODS

A mixed-methods study comprising semi-structured interviews with PIPs (n = 13) followed by questionnaire-based assessment of patients' (n = 77) evaluation of pharmacists' care was conducted between December 2019 and March 2020. Quantitative data were analysed using descriptive statistics. Interviews and open comments of the survey were thematically analysed.

RESULTS

Pharmacist independent prescribers reported undertaking a range of patient-facing and non-clinical roles. Lack of understanding about PIPs' clinical role and working beyond their clinical area of competence were some of the barriers to their integration into GP practice. Most patients were satisfied with the consultations they received from pharmacists and reported confidence in the pharmacist's recommendations about their health conditions. However, a few patients (14%) felt they would still need to consult a general practitioner after their appointment and 11% were not sure if a further consultation was needed.

CONCLUSIONS

Pharmacist independent prescribers provide a range of clinical services for the management of long-term conditions which appear to be recognised by patients. However, there is a need to address the barriers to PIPs' integration into GP practice to optimise their skill-mix and patient-centred care.

Feasibility of a collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: a preliminary study

BACKGROUND

Pharmacists working in general practices provide medication reviews with recommendations to general practitioners (GPs) to optimise medications. We describe a model where the pharmacist is empowered with increased responsibility to implement agreed recommendations through collaborative prescribing.

AIM

To assess a collaborative pharmacist prescribing model incorporating increased pharmacist responsibility, for patients with chronic diseases in general practice.

METHOD

This was a pre-test-post-test quasi experimental pilot study using a pharmacist embedded in three Australian general practices. A pharmaceutical care plan was developed with patients and their GP to identify drug related problems (DRPs). The pharmacist discussed recommendations to manage DRPs with the GP and implemented recommendations agreed by the GP and patient over the six-month study period. Outcome measures included acceptance and implementation rate of recommendations made by the pharmacist.

RESULTS

The pharmacist made 135 recommendations to optimise medicine use of which 126 (93.3%) were accepted by the GP. There were 105 (83.3%) implemented by the end of the study of which the pharmacist implemented 62 (49.3%).

CONCLUSION

Compared to other Australian studies using a general practice pharmacist model, this study suggested increased pharmacist responsibility through collaborative prescribing led to high acceptance and implementation rates of recommendations to manage DRPs.

Optometry independent prescribing during COVID lockdown in Wales

INTRODUCTION

During the COVID-19 lockdown, primary care optometry services in Wales moved to a hub model of provision. Three independent prescribing models were available in different areas: a commissioned Independent Prescribing Optometry Service (IPOS), independent prescribers that were not commissioned and no independent prescribers available. This allowed a unique opportunity for comparison.

METHOD

Optometry practices completed an online survey for each patient episode. Analysis of the data gave insight into patient presentation to urgent eye services and the drugs prescribed by optometrists. Medicines prescribed, sold or given and onward referral were compared between areas with an IPOS service (n = 2), those with prescribers but no commissioned service (n = 2) and those with no prescribers (n = 2).

RESULTS

Data from 22,434 reported patient episodes from 81 optometry practices in six health boards between 14 April 2020 and 30 June 2020 were analysed. Urgent care accounted for 10,997 (49.02%) first appointments and 1777 (7.92%) follow-ups. Most (18,006, 80.26%) patients self-referred. The most common presenting symptom was 'Eye pain/discomfort' (4818, 43.81% of urgent attendances). Anterior segment pathology was the most reported finding at first (6078, 55.27%) and follow-up (1316, 74.06%) urgent care appointments. Topical steroids (373, 25.99% of prescriptions) were the most prescribed medications. More medications were prescribed in areas with an IPOS service (1136, 79.16% of prescriptions) than areas with prescribers but no commissioned service. There were more follow-up appointments in optometric practice and fewer urgent referrals to ophthalmology in IPOS areas.

CONCLUSION

Urgent care services were most utilised by patients with discomfort caused by anterior eye conditions. IPOS services enabled optometrists to manage conditions to resolution without referral and without reduction in medications sold or given. Commissioners should recognise the value in reducing burden in urgent ophthalmology and the need for follow-up as part of a commissioned independent prescribing service.

Designated prescribing practitioners: a theory-based cross-sectional study of stakeholders' views on implementation of a novel pharmacy regulator mandated preceptorship model

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.

Time trends in contraceptive prescribing in UK primary care 2000-2018: a repeated cross-sectional study

BACKGROUND

Over the last 20 years, new contraceptive methods became available and incentives to increase contraceptive uptake were introduced. We aimed to describe temporal trends in non-barrier contraceptive prescribing in UK primary care for the period 2000-2018.

METHODS

A repeated cross-sectional study using patient data from the IQVIA Medical Research Data (IMRD) database. The proportion (95% CI) of women prescribed non-barrier contraception per year was captured.

RESULTS

A total of 2 705 638 women aged 15-49 years were included. Between 2000 and 2018, the proportion of women prescribed combined hormonal contraception (CHC) fell from 26.2% (26.0%-26.3%) to 14.3% (14.2%-14.3%). Prescriptions for progestogen-only pills (POPs) and long-acting reversible contraception (LARC) rose from 4.3% (4.3%-4.4%) to 10.8% (10.7%-10.9%) and 4.2% (4.1%-4.2%) to 6.5% (6.5%-6.6%), respectively. Comparing 2018 data for most deprived versus least deprived areas, women from the most deprived areas were more likely to be prescribed LARC (7.7% (7.5%-7.9%) vs 5.6% (5.4%-5.8%)) while women from the least deprived areas were more likely to be prescribed contraceptive pills (20.8% (21.1%-21.5%) vs 26.2% (26.5%-26.9%)). In 2009, LARC prescriptions increased irrespective of age and social deprivation in line with a pay-for-performance incentive. However, following the incentive's withdrawal in 2014, LARC prescriptions for adolescents aged 15-19 years fell from 6.8% (6.6%-7.0%) in 2013 to 5.6% (5.4%-5.8%) in 2018.

CONCLUSIONS

CHC prescribing fell by 46% while POP prescribing more than doubled. The type of contraception prescribed was influenced by social deprivation. Withdrawal of a pay-for-performance incentive may have adversely affected adolescent LARC uptake, highlighting the need for further intervention to target this at-risk group.

Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review

OBJECTIVES

To support workforce deficits and rising demand for medicines, independent prescribing (IP) by nurses, pharmacists and allied health professionals is a key component of workforce transformation in UK healthcare. This systematic review of qualitative research studies used a thematic synthesis approach to explore stakeholders' views on IP in primary care and identify barriers and facilitators influencing implementation.

SETTING

UK primary/community care.

PARTICIPANTS

Inclusion criteria were UK qualitative studies of any design, published in the English language. Six electronic databases were searched between January 2010 and September 2021, supplemented by reference list searching. Papers were screened, selected and quality-appraised using the Quality Assessment Tool for Studies with Diverse Designs. Study data were extracted to a bespoke table and two reviewers used NVivo software to code study findings. An inductive thematic synthesis was undertaken to identify descriptive themes and interpret these into higher order analytical themes. The Diffusion of Innovations and Consolidated Framework for Implementation Research were guiding theoretical anchors.

PRIMARY AND SECONDARY OUTCOME MEASURES

N/A.

RESULTS

Twenty-three articles addressing nurse, pharmacist and physiotherapist IP were included. Synthesis identified barriers and facilitators in four key stages of implementation: (1) 'Preparation', (2) 'Training', (3) 'Transition' and 4) 'Sustainment'. Enhancement, substitution and role-specific implementation models reflected three main ways that the IP role was used in primary care.

CONCLUSIONS

In order to address global deficits, there is increasing need to optimise use of IP capability. Although the number of independent prescribers continues to grow, numerous barriers to implementation persist. A more coordinated and targeted approach is key to overcoming barriers identified in the four stages of implementation and would help ensure that IP is recognised as an effective approach to help alleviate workforce shortfalls in the UK, and around the world.

PROSPERO REGISTRATION NUMBER

CRD42019124400.

Medicines prescribed by non-medical independent prescribers in primary care in Wales: a 10-year longitudinal study April 2011-March 2021

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.