A radical new treatment for the sick health workforce

The process of developing a non-medical (advanced allied health) botulinum toxin A prescribing and injecting model of care in a public rehabilitation setting

Objective The aim of this paper was to describe the process undertaken to develop a non-medical (advanced allied health extended role) botulinum toxin A prescription and injection project for adults with upper and lower limb spasticity secondary to an acquired brain injury. The hypertonicity clinic in the present study was located in a metropolitan public hospital in Queensland where multidisciplinary services are provided by a rehabilitation specialist and an advanced occupational therapist and physiotherapist. Methods The process of developing the model included establishing potential benefits for the role extension project and documentation of a project plan. Results Project outcomes included the development of a relevant governance structure, a research evidence-based project evaluation framework, a draft research ethics application, delineation of the key eligibility criteria and competencies required for physiotherapist and occupational therapist prescribers, and a final project report. Conclusion Non-medical prescribing has the potential to increase patient access to botulinum toxin A injection for the management of focal spasticity. A process that supports early patient engagement, extensive consultation with relevant stakeholders, a strong governance structure, a high-quality research project and a long lead time may maximise the potential for successful completion of advanced allied health role extension projects, including prescription and injection of botulinum toxin A. What is known about the topic? Non-medical prescribing has been recommended as a strategy for facilitating responsive health care and addressing health workforce shortages in Australia and overseas. What does this paper add? A detailed description of the process used to develop a non-medical prescribing and injecting project within a public hospital rehabilitation unit, as well as an analysis of the facilitators and barriers to progression. What are the implications for practitioners? A process that supports early patient engagement, extensive consultation with relevant stakeholders, a strong governance structure, a high-quality research project and a long lead time may maximise the potential for successful completion of advanced allied health role extension projects, including prescription and injection of botulinum toxin A.

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

OBJECTIVES

To evaluate the views of Australian pharmacists on expanded pharmacist prescribing roles and identify important drivers and barriers to its implementation. Setting Pharmacists in Australia.

METHOD

Data were collected using a self-administered questionnaire distributed nationally to a random sample of pharmacists either directly, or in the case of one state, via community pharmacies. One-way ANOVA and ϰ(2) testing were used to identify significant associations. Factor analysis was conducted to pool variables and the derived factors were subjected to regression analysis.

MAIN OUTCOME MEASURES

Perceptions of Australian pharmacists on expanded prescribing and the relationships between variables derived.

RESULTS

A total of 2592 questionnaires were distributed and a response rate of 40.4% was achieved (n = 1049). Of the respondents 83.9% strongly agreed/agreed to an expanded prescribing role for pharmacists and 97.1% reported they would need further training. Of the respondents 896 agreed that pharmacists should engage in supplementary, independent prescribing or both. Of these 69.1% preferred only supplementary prescribing, 3.3% independent prescribing and 27.4% both models. Both models were found to be positive predictors of expanding pharmaceutical services through prescribing (P < 0.001) with supplementary prescribing showing a stronger association (β = 0.52 vs. β = 0.18). Pharmacists' opinion based on their current perceptions of their clients was an important predictor in expanding pharmaceutical services through prescribing (P = 0.005). Inadequate training in patient assessment, diagnosis and monitoring were the strongest barriers to expanded pharmacist prescribing (P < 0.001).

CONCLUSIONS

The majority of Australian pharmacists supported an expanded pharmacist prescribing role. Support for supplementary was stronger than independent prescribing. Pharmacists acknowledged that they would need further training to perform such roles.