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Walpola RL, Issakhany D, Gisev N, Hopkins RE. The accessibility of pharmacist prescribing and impacts on medicines access: A systematic review. Res Social Adm Pharm 2024; 20:475-486. [PMID: 38326207 DOI: 10.1016/j.sapharm.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Pharmacist prescribing has been introduced in several countries as a strategy to improve access to health care and medicines. However, the direct impacts of pharmacist prescribing on medicines access, and the overall accessibility of pharmacist prescribing services, are not well known. OBJECTIVES This systematic review aimed to assess the direct impacts of pharmacist prescribing on medicines access, and the accessibility of pharmacist prescribing services, in community and primary care settings. METHODS PubMed, Embase, and CINAHL were searched for studies published in English between 01 January 2003 to 15 June 2023. Both quantitative and qualitative primary studies were included if they described pharmacist prescribing in a primary care setting. Outcomes included findings related to access to medicines as a result of pharmacist prescribing (primary outcome), and access to pharmacist prescribing services overall (secondary outcome). Narrative synthesis of outcomes was undertaken. RESULTS A total of 47 studies were included from four countries (United States, United Kingdom, Canada, New Zealand). Thirteen studies provided evidence that pharmacist prescribing may improve medicines access in several ways, including: increasing the proportion of eligible people receiving medicines, increasing the number of overall dispensed prescriptions, or reducing time to receipt of treatment. The remainder of the included studies reported on the accessibility of pharmacist prescribing services. Published studies highlight that pharmacist prescribers practicing in community settings are generally accessible, with pharmacist prescribers viewed by patients as easy and convenient to consult. There was limited evidence about the affordability of pharmacy prescribing services, and a number of potential equity issues were observed, including reduced access to pharmacist prescribers in more socioeconomically disadvantaged areas and those with greater proportions of populations at risk of health inequities, such as culturally and linguistically diverse communities. CONCLUSIONS This systematic review found that pharmacist prescribing services were both highly accessible and beneficial in improving access to medicines. However, measures of medicines access varied, and few studies included direct measures of medicines access as an outcome of pharmacist prescribing, highlighting a need for future studies to incorporate direct measures of medicines access when assessing the impact of pharmacist prescribing services.
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Affiliation(s)
- Ramesh L Walpola
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia; School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
| | - Dabrina Issakhany
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Ria E Hopkins
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Berry J, Hilts KE, Thoma L, Corelli RL, Stump TE, Monahan PO, Hudmon KS. Patient awareness, perceptions, and attitudes towards pharmacists prescribing tobacco cessation medications. Res Social Adm Pharm 2023; 19:1531-1542. [PMID: 37777388 PMCID: PMC10625477 DOI: 10.1016/j.sapharm.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Recent legislative advances now permit pharmacists to prescribe tobacco cessation medications in 17 states. While national initiatives are underway to prepare the pharmacy profession for this expanded role, patient perceptions of this role have not been explored. OBJECTIVE The objective of this study was to characterize patient perceptions, attitudes, and awareness of pharmacists prescribing for tobacco cessation medications. METHODS A cross-sectional survey of English and Spanish-speaking patients was conducted at 12 locations of a federally-qualified health center in Northwest Indiana. Survey measures assessed sociodemographics, tobacco use history and interest in quitting, prior interactions with pharmacists and awareness of pharmacists' ability to prescribe tobacco cessation medications, and perceptions of pharmacists assisting with cessation. The Theory of Planned Behavior (TPB) served as a framework for item development. Multivariable logistic regression was used for modeling. RESULTS A total of 2082 individuals (1878 English, 204 Spanish) completed the survey (42.4%). Among current users (n = 592; 28.4%), 46.2% had made a quit attempt in the past year, and 41.0% reported having used a tobacco cessation medication in the past. Over half (60.5%) of current users would be comfortable talking with a pharmacist about quitting, 31.9% intended to talk with a pharmacist about quitting, and 31.7% intended to ask a pharmacist to prescribe a medicine to help with quitting. In multivariable modeling, intention to (a) talk with a pharmacist about quitting and (b) ask a pharmacist to prescribe a medication were significantly associated with TPB constructs. Current tobacco users were receptive to pharmacist-facilitated assistance with quitting, including prescribing of tobacco cessation medications. CONCLUSIONS Patients' attitudes, subjective norms, and perceived behavioral control, from the Theory of Planned Behavior, were important predictors of intention to engage with pharmacists for quitting and intention to ask a pharmacist to prescribe a cessation medication.
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Affiliation(s)
- Jonathan Berry
- Pharmacy Department, HealthLinc, Valparaiso, IN, 46383, USA.
| | - Katy Ellis Hilts
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, USA.
| | - Lynn Thoma
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, 47902, USA.
| | - Robin L Corelli
- Department of Clinical Pharmacy, School of Pharmacy, University of California-San Francisco, San Francisco, CA, 94143, USA.
| | - Timothy E Stump
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN, 46202, USA.
| | - Patrick O Monahan
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN, 46202, USA.
| | - Karen Suchanek Hudmon
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, 47902, USA; Department of Clinical Pharmacy, School of Pharmacy, University of California-San Francisco, San Francisco, CA, 94143, USA.
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Abrams LM, Look KA. Community pharmacists and improving contraception access: Relationships between contraceptive counseling and dispensing contraceptives. Res Social Adm Pharm 2023; 19:1602-1605. [PMID: 37709642 DOI: 10.1016/j.sapharm.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/08/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Experiences of contraceptive counseling and obtaining contraceptives vary for women of childbearing age based on education level, race, ethnicity, and health insurance. Community pharmacists are an important resource for improving access to contraceptive care in states with over-the-counter access to and pharmacist prescribing of contraceptives. OBJECTIVES We first aimed to determine how patient education level, race, ethnicity, insurance, and patient-provider race concordance influenced the likelihood of receiving contraceptive counseling. The second aim was to determine how receiving contraceptive counseling influenced the likelihood of being dispensed contraceptives by a pharmacist. METHODS Pearson chi-square tests and logistic regression were used to address study aims. RESULTS Older women and those with Medicaid were less likely to receive contraceptive counseling. Race concordance had no influence on counseling. Counseling and education level were strong predictors of being dispensed contraceptives. Race, ethnicity, Medicaid, and marital status were negatively associated with being dispensed contraceptives. CONCLUSIONS Inequities exist in access to contraceptive care for women of diverse backgrounds as well as those insured through Medicaid. State-level policy advancements and over the counter access to oral contraceptives may provide pharmacists a unique opportunity to provide contraceptive care for women without access to a primary care provider.
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Affiliation(s)
- Lucille M Abrams
- University of Wisconsin-Madison, School of Pharmacy, Rennebohm Hall, 777 Highland Ave, Madison, WI, 53705, USA.
| | - Kevin A Look
- University of Wisconsin-Madison, School of Pharmacy, Rennebohm Hall, 777 Highland Ave, Madison, WI, 53705, USA.
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Adams AJ, Eid DD. Federal pharmacist Paxlovid prescribing authority: A model policy or impediment to optimal care? Explor Res Clin Soc Pharm 2023; 9:100244. [PMID: 36945228 PMCID: PMC10011027 DOI: 10.1016/j.rcsop.2023.100244] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
The U.S federal government leveraged emergency authority to allow pharmacists to prescribe Paxlovid (nirmatrelvir and ritonavir) during the COVID-19 pandemic. While heralded by pharmacy associations, the FDA framework included restrictions that arguably ran counter to clinical guidelines and evidence-based research and recommendations. These restrictions will limit the utility of pharmacist prescriptive authority for Paxlovid in practice. The experience of Paxlovid prescribing and a similar recent federal action illustrate the challenges inherent in federal oversight of pharmacist prescriptive authority. While initially more difficult to navigate for stakeholders, working with state legislatures and state boards of pharmacy has much stronger long-term potential to enable broad pharmacist prescriptive authority and benefit patient care. This commentary uses Idaho's pharmacist prescribing regulations as a comparison to the federal actions.
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Affiliation(s)
- Alex J Adams
- Idaho Division of Financial Management, Eagle, ID 83616, United States of America
| | - Deeb D Eid
- Ferris State University College of Pharmacy, Affiliate Preceptor, Grand Rapids, MI 49501, United States of America
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Percival M, McMurray A, Freeman C, Cottrell N. A collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: Patient and general practitioner perceptions. Explor Res Clin Soc Pharm 2023; 9:100236. [PMID: 36923064 PMCID: PMC10009526 DOI: 10.1016/j.rcsop.2023.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/01/2023] [Accepted: 02/11/2023] [Indexed: 02/19/2023] Open
Abstract
A collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: patient and general practitioner perceptions. Background Pharmacists working in general practice settings are slowly emerging in Australia, with comprehensive medication reviews forming a large part of their role in optimising pharmaceutical care. In Australia, pharmacists are entirely reliant on general practitioners (GPs) accepting and implementing their recommendations to manage drug related problems (DRPs). The next step is a model where the pharmacist takes on responsibility for implementing some of their recommendations. Aim To investigate patient and general practitioner perceptions of a collaborative model of care where the pharmacist has increased responsibility in assisting the general practitioner manage patients with chronic conditions. Method Semi-structured, phone and face-to-face interviews were conducted with a purposive sample of patients and GPs respectively. Data were transcribed by a professional transcription service, collated using NVivo 12 Plus and analysed using Braun and Clarke's thematic analysis. Provisional codes were generated and clustered into categories, from which themes were identified. Results Eighteen interviews were conducted (12 patients, 6 GPs). Four themes were identified from the patient interview data: pharmacist attributes; acknowledgement of the impact of the pharmacist, understanding of the GP-pharmacist collaborative model; relationships with and attitudes towards medicines and health care providers. Four themes were identified from the general practitioner interview data: pharmacist attributes; relationships with pharmacists; impressions on collaboration; impressions of the pharmacist's recommendations. Patients' and GPs' perceptions of the collaborative model of care overall were positive, acknowledging the advantages of a patient-centred, interdisciplinary approach and the potential benefits to patients. Conclusion The GP-pharmacist collaborative model was viewed favourably by patients and GPs, with some GPs articulating the value in the pharmacist's increased responsibility as they implemented some recommendations to manage DRPs.
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Affiliation(s)
- Matthew Percival
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia.,Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, QLD 4215, Australia
| | - Anne McMurray
- School of Nursing and Midwifery, Griffith University - Gold Coast Campus, Parklands Dr, Southport, Gold Coast, QLD 4222, Australia.,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, QLD 4556, Australia
| | - Christopher Freeman
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Neil Cottrell
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
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Kc B, Alrasheedy AA, Leggat PA, Mohamed Ibrahim MI, Christopher CM, Sapkota B, Shrestha S. Types and outcomes of pharmacist-managed travel health services: A systematic review. Travel Med Infect Dis 2023; 51:102494. [PMID: 36400319 DOI: 10.1016/j.tmaid.2022.102494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM Pharmacists have an important role in providing travel health services and medications to travelers. However, given the limited literature on this topic, the aim of this study is to systematically review the types and outcomes of pharmacist-managed travel health services. METHODS A comprehensive literature search was performed in four electronic databases, namely Scopus, Web of Science, PubMed and ProQuest to identify studies published in English from 1999 to July 2022. The inclusion criteria included the studies that reported an experience of providing dedicated travel health services by pharmacists and reported the outcomes and/or evaluation of these travel health services. RESULTS Nine studies were identified from the literature and included in the review. The pharmacists have provided a wide range of general and specialized travel health services including pre-travel risk assessment, routine and travel-related vaccination service, prescribing or recommending medications for travel-related illnesses, counseling and travel health advice. Overall, 94-100% of the patients were satisfied or very satisfied with pharmacist-managed travel health services. In addition, a good acceptance rate of pharmacist recommendations for vaccines and travel-related mediations was reported with most studies reporting an overall acceptance rate of ≥75% (acceptance rate range: 48%-94.2%). In addition, high rates of acceptance of other nonpharmacological advices were noted. CONCLUSION Pharmacists with training in travel medicine have successfully provided a wide range of general and specialized travel health services. Most travelers were highly satisfied with the pharmacy-based travel health services and accepted the pharmacist recommendations.
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Affiliation(s)
- Bhuvan Kc
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University Parkville Campus Parkville, VIC, 3052, Australia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, QLD, Australia.
| | - Alian A Alrasheedy
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, 51452, Saudi Arabia.
| | - Peter A Leggat
- College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, QLD, Australia; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | | | | | - Binaya Sapkota
- Department of Pharmaceutical Sciences, Nobel College, Affiliated to Pokhara University, Kathmandu, Province Bagmati, Nepal
| | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
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Wash A, Moczygemba LR, Anderson L, Pye T. Using the Theory of Planned Behavior to Assess Oregon community pharmacists' intention to prescribe using the Formulary and Protocol Compendia. Res Social Adm Pharm 2022; 18:4056-4064. [PMID: 35864036 DOI: 10.1016/j.sapharm.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 03/22/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Oregon pharmacists can autonomously prescribe hormonal contraception, naloxone, and various medications and devices from a Formulary and Protocol Compendia (FPC). Prescribing using the FPC has seen limited uptake. OBJECTIVES (1) Assess Oregon community pharmacists' intention to prescribe using the FPC; (2) Determine the impact that attitudes, subjective norms (SN), perceived behavioral control (PBC), perceived obligation, and past prescribing behavior have on pharmacists' intention to prescribe; (3) Examine the relationship between beliefs and pharmacists' attitudes, subjective norms, and perceived behavioral control. METHODS This study was conducted as a cross sectional survey, which was developed based on the results of a previously conducted research project. A modified version of the Theory of Planned Behavior (TPB) was the study framework. All Oregon community pharmacists with a public email address were invited to participate. The questionnaire collected information on TPB constructs as well as demographic and practice information. TPB constructs were measured directly (intention, attitudes, SN, PBC, perceived obligation, and past prescribing behavior) and indirectly (attitudes, SN, and PBC). Descriptive statistics were used for all items. Multiple linear regression was used to assess Objectives 2 and 3. RESULTS There were 175 useable responses included in the analysis of the estimated 1015 community pharmacists that received the survey invitation (17%). Respondents had 16.5 ± 13.3 years in practice, 60% held a PharmD degree, and 69% had prescribed in some manner before. Mean intention to prescribe using the FPC was 5.0 ± 1.5 (7-point scale with 7 indicating higher intention). Attitudes, SN, PBC, and PO were significant predictors of intention to prescribe, while past prescribing behavior was not (Adj R2 = 0.741, p < .0001). Attitudes were explained by beliefs about increasing patient access (p = .0179). PBC was explained by beliefs about having policies and procedures in place (p = .004) and feeling comfortable prescribing (p = .008). CONCLUSIONS Oregon community pharmacists have a positive intention to prescribe using the FPC, but actual uptake remains low. Efforts to increase uptake should focus on the beliefs that contribute most strongly to pharmacist intention.
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Affiliation(s)
- Andrew Wash
- The University of Texas at Austin College of Pharmacy, 2409 University Avenue Stop A1930, Austin, TX, 78712, USA.
| | - Leticia R Moczygemba
- The University of Texas at Austin College of Pharmacy, 2409 University Avenue Stop A1930, Austin, TX, 78712, USA.
| | - Lorinda Anderson
- Oregon State University College of Pharmacy, 1601 SW Jefferson Avenue, Corvallis, OR, 97331, USA.
| | - Tiffanie Pye
- Santiam Memorial Hospital, 1401 North 10th Avenue, Stayton, OR, 97383, USA.
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Adams AJ, Frost TP. Pathways to pharmacist prescriptive authority: Do decentralized models for expanded prescribing work? Res Social Adm Pharm 2021; 18:2695-2699. [PMID: 34321187 DOI: 10.1016/j.sapharm.2021.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Abstract
Scope of practice decisions, such as granting pharmacists independent prescriptive authority, are governed at the state level and are often contentious debates. Five states - Florida (FL), New Mexico (NM), Colorado (CO), Idaho (ID), and Oregon (OR) -- have created structures that can theoretically expand independent prescriptive authority through decentralized approaches rather than needing the legislature to approve each drug that pharmacists may prescribe. These approaches have the potential advantage of allowing the states to expand independent pharmacist prescriptive authority to address public health needs more quickly. Four distinct models have been identified from most to least restrictive in practice: 1) medical veto; 2) interdisciplinary committee; 3) board of pharmacy; and 4) pharmacist-determined. These models have generally focused on postdiagnostic and preventive care by pharmacists. In terms of enabling broad pharmacist prescribing, only two of these models have demonstrated success: board of pharmacy and pharmacist-determined. Pharmacy and public health stakeholders considering similar legislation in their own states should consider the success of these decentralized models prior to enacting legislation.
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Affiliation(s)
- Alex J Adams
- Idaho Division of Financial Management, 4537 N Molly Way, Meridian, ID, 83646, USA.
| | - Timothy P Frost
- Idaho Division of Occupational and Professional Licenses, Boise, ID, 83701, USA
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Wash A, Moczygemba LR, Anderson L, Pye T. Oregon pharmacists' intention to prescribe under HB2397. Res Social Adm Pharm 2021:S1551-7411(21)00234-5. [PMID: 34244074 DOI: 10.1016/j.sapharm.2021.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/23/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In 2017, Oregon passed legislation that authorized pharmacists to autonomously prescribe specified medications or devices that were included on the Formulary and Protocol Compendia (FPC). Factors that impact pharmacists' intention to prescribe from the FPC are not currently known. OBJECTIVES Identify factors that influence pharmacists' intention to prescribe. METHODS The Theory of Planned Behavior (TPB) served as the framework. Three focus groups were conducted with Oregon pharmacists between May and June 2019 to elicit salient beliefs about prescribing related to TPB constructs, including attitudes, subjective norms, perceived behavioral control, and perceived obligation. Two investigators conducted a qualitative content analysis and reached agreement on names of categories during consensus meetings. A codebook was created after analysis of the first focus group and used to guide the remaining analysis. Participants reported background information and awareness of prescribing rules via a questionnaire; descriptive statistics were used to report background information and the prescribing awareness summary score. RESULTS Thirteen participants had 14.1 ± 10.8 years of pharmacist experience. Most earned a Doctor of Pharmacy degree (84.6%) and worked in a community pharmacy setting (61.5%). The mean score on the awareness assessment was 6.3 ± 0.9 (7 = highest awareness). The majority (76.9%) had previous prescribing experience. Attitudes were found to be shaped by behavioral beliefs related to the impact of pharmacist prescribing on patient-centered care and on practice transformation. Normative beliefs were primarily driven by outside groups past experiences with pharmacists and pharmacies. Control beliefs included the following categories: operational readiness; the relationships between comfort, competence, and confidence; and Board of Pharmacy requirements. CONCLUSIONS TPB was useful for exploring pharmacists' beliefs related to their intention to prescribe using the FPC. Determining the relative importance of these factors in a broader population will enable stakeholders to develop interventions to improve uptake of prescribing via the FPC.
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Mantzourani E, Cannings-John R, Evans A, Ahmed H, Meudell A, Hill I, Williams E, Way C, Hood K, Legay B, Houldcroft L, Deslandes R. Understanding the impact of a new pharmacy sore throat test and treat service on patient experience: A survey study. Res Social Adm Pharm 2021; 17:969-77. [PMID: 32912832 DOI: 10.1016/j.sapharm.2020.07.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND A pilot of the first NHS funded Sore Throat Test and Treat (STTT) service in the United Kingdom began in selected community pharmacies in Wales in November 2018. The aim of this research was to explore whether a pharmacist delivering consultation for sore throat that included clinical scoring and point-of-care testing was acceptable to patients and how this might influence future health-seeking behaviour. METHODS A non-experimental design was employed using a survey research tool including a mix of closed and open questions. The patient experience survey was distributed to all patients who had completed a consultation between November 2018 and May 2019. Data from completed surveys were entered in Jisc Online Surveys® and exported to Excel® for descriptive statistics. Free-text comments were analysed using content and inductive thematic analysis. RESULTS A total of 510 surveys were received (n = 2,839 total consultations, response rate 18%). Overall, 501 patients (98%) were satisfied with the service. Patients' confidence in managing their condition and service satisfaction was not dependent on having been supplied antibiotics. After the service, 504 patients (99%) stated that they would return to the pharmacy for subsequent sore throat symptoms. Three themes were constructed after inductive analysis of free-text comments (n = 242): convenience and accessibility; professionalism of pharmacy team; and perceived value of the service. CONCLUSIONS Results confirmed high levels of patient satisfaction with the new service, its delivery and the choice of options offered for sore throat symptom management. Whilst this research can only discuss patients' reported future behaviour, the patient-reported stated intentions signify a potential shift in health-seeking behaviour towards a pharmacist-led service. This has important implications in supporting the long-term plan of the governments in Wales and England to redirect management of uncomplicated conditions from GPs to pharmacies.
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Diab MI, Ibrahim A, Abdallah O, El-Awaisi A, Zolezzi M, Ageeb RA, Elkhalifa WHI, Awaisu A. Perspectives of future pharmacists on the potential for development and implementation of pharmacist prescribing in Qatar. Int J Clin Pharm 2020; 42:110-123. [PMID: 31898166 PMCID: PMC7162834 DOI: 10.1007/s11096-019-00946-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/26/2019] [Indexed: 12/31/2022]
Abstract
Background Pharmacists in many developed countries have been granted prescribing authorities under what is known as "non-medical prescribing" or "pharmacist prescribing". However, such prescribing privileges are not available in many developing countries. Objective The objective of this study was to determine the perspectives of future pharmacists (recent pharmacy graduates and pharmacy students) on pharmacist prescribing and its potential implementation in Qatar. Methods A convergent parallel mixed-methods design was used: (1) a cross-sectional survey using a pre-tested questionnaire and; (2) focus group discussions to allow for an in-depth understanding of the issue, with a focus on pharmacists prescribing competencies as well as barriers for its implementation. Main outcome measures Future pharmacists' perspectives and attitudes towards pharmacist prescribing in Qatar. Results The majority of the respondents (94.4%) indicated awareness of the prescribing competency related to selecting treatment options. Furthermore, the majority (92.4%) believed that pharmacists should undergo prescribing training and accreditation before been legally allowed to prescribe, a point that was reiterated in the focus group discussions. Participants generally expressed support for collaborative and supplementary prescribing models when developing prescribing frameworks for Qatar. Four categories emerged under the theme barriers to implementation of pharmacist prescribing: lack of prescribing competency, pharmacist mindset, lack of accessibility to patient records and counseling rooms, and diversity of education and training background. Conclusion The majority of recent pharmacy graduates and students were in favor of pharmacist prescribing been implemented in Qatar. However, a special training program was deemed necessary to qualify pharmacists to prescribe safely and effectively.
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Affiliation(s)
- Mohammad Issam Diab
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
| | - Angham Ibrahim
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Oraib Abdallah
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Alla El-Awaisi
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Monica Zolezzi
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Rwedah Anwar Ageeb
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | | | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
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Bond CM, Holland R, Alldred DP, Arthur A, Barton G, Blyth A, Desborough J, Ford J, Handford C, Hill H, Hughes CM, Maskrey V, Massey K, Myint PK, Norris N, Poland FM, Shepstone L, Turner D, Zermansky A, Wright D. Protocol for a cluster randomised controlled trial to determine the effectiveness and cost-effectiveness of independent pharmacist prescribing in care homes: the CHIPPS study. Trials 2020; 21:103. [PMID: 31964398 PMCID: PMC6975047 DOI: 10.1186/s13063-019-3827-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prescribing, monitoring and administration of medicines in care homes could be improved. Research has identified the need for one person to assume overall responsibility for the management of medicines within each care home. and shown that a pharmacist independent prescriber service is feasible in this context. AIMS AND OBJECTIVES To conduct a cluster randomised controlled trial to determine the effectiveness and cost-effectiveness of a pharmacist-independent prescribing service in care homes compared to usual general practitioner (GP)-led care. OBJECTIVES To perform a definitive randomised controlled trial (RCT) with an internal pilot to determine the intervention's effectiveness and cost-effectiveness and enable modelling beyond the end of the trial. METHODS This protocol is for a cluster RCT with a 3-month internal pilot to confirm that recruitment is achievable, and there are no safety concerns. The unit of randomisation is a triad comprising a pharmacist-independent prescriber (PIP) based in a GP practice with sufficient registered patients resident in one or more care homes to allow recruitment of an average of 20 participants. In the intervention group, the PIP will, in collaboration with the GP: assume responsibility for prescribing and managing residents' medicines including medication review and pharmaceutical care planning; support systematic ordering and administration in the care home, GP practice and supplying pharmacy; train care home and GP practice staff; communicate with GP practice, care home, supplying community pharmacy and study team. The intervention will last 6 months. The primary outcome will be resident falls at 6 months. Secondary outcomes include resident health-related quality of life, falls at 3 months, medication burden, medication appropriateness, mortality and hospitalisations. A full health economic analysis will be undertaken. The target sample size is 880 residents (440) in each arm) from 44 triads. This number is sufficient to detect a decrease in fall rate from 1.5 per individual to 1.178 (relative reduction of 21%) with 80% power and an ICC of 0.05 or less. DISCUSSION Recruitment is on-going and the trial should complete in early 2020. The trial results will have implications for the future management of residents in care homes and the ongoing implementation of independent pharmacist prescribing. TRIAL REGISTRATION ISRCTN, ID: 17847169. Registered on 15 December 2017.
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Affiliation(s)
- Christine M. Bond
- Institute of Applied Health Sciences, School of Medicine, University of Aberdeen, Foresterhill, Aberdeen, Scotland AB25 2ZD
| | - Richard Holland
- Leicester Medical School, University of Leicester, Leicester, UK
| | - David P. Alldred
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Antony Arthur
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Garry Barton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Annie Blyth
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Joanna Ford
- Consultant Geriatrician, Addenbrookes Hospital Cambridge, Cambridge, UK
| | - Christine Handford
- Norfolk and Suffolk Primary and Community Care Research Office, South Norfolk CCG, Norwich, UK
| | - Helen Hill
- Athena Care Homes, Unit 2 Rima House, A13 Approach, Ripple Road, Barking, Essex, IG11 0RH UK
| | | | | | - Kate Massey
- Norfolk and Suffolk Primary and Community Care Research Office, South Norfolk CCG, Norwich, UK
| | - Phyo K. Myint
- Institute of Applied Health Sciences, School of Medicine, University of Aberdeen, Foresterhill, Aberdeen, Scotland AB25 2ZD
| | - Nigel Norris
- School of Education and Lifelong Learning, University of East Anglia, Norwich, UK
| | - Fiona M. Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - David Wright
- School of Pharmacy, University of East Anglia, Norwich, UK
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Abstract
Canadian pharmacists now have prescribing authority and little is documented about the physicians' perception, experience and relational dynamics evolving around the pharmacists' prescribing practice. The objective of this study was to explore Albertan family physicians' perceptions and experiences of pharmacists' prescribing practice. We used purposeful and maximum variation sampling method and semi-structured face to face or telephone interviews to collect data. From October 2014 to February 2016, we interviewed 12 family physicians in Alberta, having experience with pharmacist prescribing. Interviews were audio recorded and transcribed verbatim for analysis using an interpretive description method, guided by "Relational Coordination" theory. NVivo software was used to manage the data. Three key beliefs (i.e., renewal versus initiate new prescription, community versus team pharmacists, and "I am responsible") about pharmacist prescribing were identified. Trust and communication were prominent themes which shaped participants' collaboration with pharmacist prescribers. Participants were classified as either "collaborative" or "consultative". Participants had greater collaboration with the team pharmacist prescribers compared to community pharmacists due to a higher level of trust and ease of communication. Renewal prescribing by any pharmacist was well accepted but participants showed hesitancy in accepting pharmacist-initiated prescriptions. Our findings provide insight into interprofessional collaboration and communication between physician and pharmacist prescribers.
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Affiliation(s)
- Chowdhury F Faruquee
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Amandeep Sheny Khera
- Faculty of Medicine and Dentistry, Department of Family Medicine, University of Alberta, Alberta, Canada
| | - Lisa M Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
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14
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Lu S, Rafie S, Hamper J, Strauss R, Kroon L. Characterizing pharmacist-prescribed hormonal contraception services and users in California and Oregon pharmacies. Contraception 2018; 99:239-243. [PMID: 30562478 DOI: 10.1016/j.contraception.2018.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study describes hormonal contraception services provided by pharmacists and characterizes patient populations utilizing the service at one supermarket-based pharmacy chain in California and Oregon. STUDY DESIGN This is a descriptive study of 391 pharmacies in California and Oregon within a supermarket-based pharmacy chain providing hormonal contraception services and the patients who utilized those services in a 6.5-month period between August 2016 and February 2017. Data were extracted from pharmacy prescription records and available visit documentation forms to describe services provided and patient characteristics. RESULTS During the study period, 381 trained pharmacists from the pharmacy chain provided hormonal contraception services in 391 pharmacy locations in Oregon and California. A total of 2117 visits were completed and 1970 hormonal contraception prescriptions were issued and dispensed during the study period. Researchers were able to access documentation for 676 visits (32%). Patients from various age groups (range 13-55 years old) and geographical locations (22 states total) utilized the service. Most had health insurance (74%), had seen a primary care provider in the past year (89%) and were previous hormonal contraception users (91%). Contraceptive methods prescribed include pill (n=1886, 95.7%), patch (n=31, 1.6%), vaginal ring (n=51, 2.6%) and injectable (n=2, 0.1%). CONCLUSION Following scope of practice expansion, pharmacists in a community-based pharmacy setting are serving as an access point for women to obtain hormonal contraception services and supplies. IMPLICATIONS This study provides an initial look at California's and Oregon's expansion of hormonal contraception prescribing authority to pharmacists. The service was available across all pharmacy locations of a supermarket-based chain in California and select locations in Oregon and utilized by diverse populations of patients. Pharmacists effectively provided hormonal contraception services and supplies to most patients seeking hormonal contraception.
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Affiliation(s)
- Sunny Lu
- Kaiser Permanente Santa Clara Medical Center, Department of Clinical Pharmacy, 710 Lawrence Expressway, Santa Clara, CA 95051.
| | - Sally Rafie
- Birth Control Pharmacist, 7114 Caminito Quintana, San Diego, CA 92122, USA.
| | - Jeffrey Hamper
- Albertsons Companies, 250 E. Parkcenter Blvd., Boise, ID 83706, USA.
| | - Rebecca Strauss
- Albertsons Companies, 11555 Dublin Canyon Rd., Pleasanton, CA 94588.
| | - Lisa Kroon
- UCSF School of Pharmacy, Department of Clinical Pharmacy, 533 Parnassus Ave., U-503, Box 0622, San Francisco, CA 94143, USA.
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Famiyeh IM, MacKeigan L, Thompson A, Kuluski K, McCarthy LM. Exploring pharmacy service users' support for and willingness to use community pharmacist prescribing services. Res Social Adm Pharm 2019; 15:575-83. [PMID: 30100199 DOI: 10.1016/j.sapharm.2018.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/12/2018] [Accepted: 07/23/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND In 2012, community pharmacists in Ontario, Canada gained regulatory authority to independently prescribe, including renew and adapt prescriptions. Studies have explored views of pharmacists, physicians and policymakers about pharmacist prescribing but less is known about the views of community pharmacy services users. OBJECTIVE To describe Ontario community pharmacy service users' support for and stated willingness to use pharmacist prescribing services. METHODS A qualitative descriptive study was conducted with 19 adults who had filled or refilled prescription(s) at a community pharmacy within the past three months. Participants were recruited through purposive and snowball sampling. Data were collected through one-on-one, semi-structured interviews between May and September 2016. Interview transcripts were coded and thematic analysis conducted. The first two transcripts were independently coded and analyzed by 2 researchers and after consensus was achieved, the lead researcher coded and analyzed the remainder of the data. RESULTS Most community pharmacy service users lacked experience with pharmacist prescribing services but perceived some potential benefits, including personal convenience. The majority of participants supported pharmacist prescribing. Support for and stated willingness to use pharmacist prescribing services varied by the type of service and was contingent upon the clinical purpose of the prescription, pharmacists' access to patient clinical information (e.g. health records), and the extent of pharmacist-physician collaboration during the prescribing process. CONCLUSION Community pharmacy service users in Ontario expressed varying support for and stated willingness to use pharmacist prescribing services. This seemed to be due to their perceptions of the pharmacists' role (compared to physicians) and concerns about risks. Understanding these contributing factors will help implement strategies that address concerns and facilitate use of community pharmacists' prescribing services.
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Wilkinson TA, Miller C, Rafie S, Landau SC, Rafie S. Older teen attitudes toward birth control access in pharmacies: a qualitative study. Contraception 2017; 97:249-255. [PMID: 29223497 DOI: 10.1016/j.contraception.2017.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/19/2017] [Accepted: 11/28/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine adolescent attitudes toward accessing contraception through a new pharmacist prescribing model in the State of California. STUDY DESIGN In-depth telephone interviews were conducted in summer 2015 with 30 females ages 18 to 19 in California. Participants were recruited using a social media advertisement. Semi-structured interviews utilized open-ended questions to understand teens' experiences with pharmacies, experiences obtaining contraception, and views on pharmacist prescribing of contraception. Responses were transcribed and qualitatively analyzed using an independent-coder method to identify salient themes. RESULTS Participants were ethnically diverse and primarily living in suburban areas. All participants had completed high school and many had completed one year of college. Nearly all participants were supportive of California's new law allowing pharmacist prescribing of contraception. Thematic analyses revealed that while participants were satisfied with traditional service providers and valued those relationships, they appreciated the benefit of increased access and convenience of going directly to a pharmacy. Participants expected increased access to contraception in pharmacies would lead to both personal and societal benefits. They expressed concerns regarding parental involvement, as well as confidentiality in the pharmacy environment and with insurance disclosures. CONCLUSION Older teens in California are very supportive of pharmacies and pharmacists as direct access points for contraception, but confidentiality concerns were noted. Policy makers and pharmacies can incorporate study findings when designing policies, services, and physical pharmacy spaces to better serve teens. Further research is warranted after pharmacies implement this new service to assess teen utilization and satisfaction as well as outcomes. IMPLICATION STATEMENT Several states recently passed legislation enabling pharmacists to prescribe contraception and other states are considering similar legislation. Older teens are interested in this additional method of contraceptive access and understanding their perspectives can help guide implementation by states and in individual pharmacies.
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Affiliation(s)
- Tracey A Wilkinson
- Indiana University School of Medicine, Department of Pediatrics, Indianapolis, IN
| | - Courtney Miller
- University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, CA
| | | | | | - Sally Rafie
- University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, CA; University of California San Diego Health, San Diego, CA.
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17
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Ung E, Czarniak P, Sunderland B, Parsons R, Hoti K. Assessing pharmacists' readiness to prescribe oral antibiotics for limited infections using a case-vignette technique. Int J Clin Pharm 2016; 39:61-69. [PMID: 27848173 DOI: 10.1007/s11096-016-0396-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/31/2016] [Indexed: 11/28/2022]
Abstract
Background Pharmacist's skills are underutilized whilst they are directly involved with antibiotic supply to the community. Addressing this issue could lead to better use of antibiotics and hence decreased resistance. Objective Explore how pharmacists can prescribe oral antibiotics to treat a limited range of infections whilst focusing on their confidence and appropriateness of prescribing. Setting Community pharmacies, Western Australia. Method Data were collected using a self-administered questionnaire also containing case vignettes. These were distributed to a random sample of metropolitan and rural community pharmacies in Western Australia. A Generalised Estimating Equation was used to compare respondents' level of confidence in treating various infections and to assess appropriateness of prescribing. Main outcome measure Appropriateness and confidence of antibiotic prescribing. Results A response rate of 34.2% (i.e. 425 responses to case vignettes) was achieved from 240 pharmacies. There were high levels of confidence to treat simple infections such as uncomplicated UTIs (n = 73; 89.0%), impetigo (n = 65; 79.3%), mild bacterial skin infections (n = 62; 75.6%) and moderate acne (n = 61; 72.4%). Over 80% of respondents were confident to prescribe amoxicillin (n = 73; 89%), trimethoprim (n = 72; 87.8%), amoxicillin and clavulanic acid (n = 70; 85.4%), flucloxacillin (n = 70; 85.4%) and cephalexin (n = 68; 82.9%). High levels of appropriate antibiotic prescribing were shown for uncomplicated UTI (97.2%), cellulitis (98.2%) and adolescent acne (100.0%). Conclusion This study identified key limited infections and antibiotics for which pharmacists were supportive and confident to prescribe. This role could lead to better use of antibiotics in the community and minimisation of resistance.
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Affiliation(s)
- Elizabeth Ung
- Curtin Health and Innovation Research Institute, School of Pharmacy, Curtin University, Perth, WA, Australia
| | - Petra Czarniak
- Curtin Health and Innovation Research Institute, School of Pharmacy, Curtin University, Perth, WA, Australia
| | - Bruce Sunderland
- Curtin Health and Innovation Research Institute, School of Pharmacy, Curtin University, Perth, WA, Australia
| | - Richard Parsons
- Curtin Health and Innovation Research Institute, School of Pharmacy, Curtin University, Perth, WA, Australia
| | - Kreshnik Hoti
- Curtin Health and Innovation Research Institute, School of Pharmacy, Curtin University, Perth, WA, Australia. .,Pharmacy Department, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo.
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Auta A, Strickland-Hodge B, Maz J. Stakeholders' views on granting prescribing authority to pharmacists in Nigeria: a qualitative study. Int J Clin Pharm 2016; 38:960-7. [PMID: 27194098 DOI: 10.1007/s11096-016-0321-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
Abstract
Background In Nigeria, only medical doctors, dentists and some nurses in primary care facilities have the legal right to prescribe medicines to patients. Patients' access to prescription medicines can be seriously affected by the shortage of prescribers leading to longer waiting times in hospitals. Objective This research was carried out to investigate stakeholders' views on granting prescribing authority to pharmacists in Nigeria. Setting The study was conducted in Nigeria. Methods Qualitative, semi-structured interviews were conducted with 43 Nigerian stakeholders including policymakers, pharmacists, doctors and patient group representatives. Transcribed interviews were entered into the QSR NVivo 10 software and analysed using a thematic approach. Main outcome measure Stakeholders' perception on the granting of prescribing authority to pharmacists in Nigeria. Results Three major themes emerged from the interviews: (1) prescribing as a logical role for pharmacists, (2) pharmacist prescribing- an opportunity or a threat and (3) the potential barriers to pharmacist prescribing. Many non-medical stakeholders including pharmacists and patient group representatives supported an extended role for pharmacists in prescribing while the majority of medical doctors including those in policy making were reluctant to do so. Generally, all stakeholders perceived that pharmacist prescribing represents an opportunity to increase patients' access to medicines, reduce doctors' workload and promote the utilisation of pharmacists' skills. However, many stakeholders including pharmacists and doctors commonly identified pharmacists' inadequate skills in diagnosis, medical resistance and shortage of pharmacists as potential barriers to the introduction of pharmacist prescribing in Nigeria. Conclusion The present study showed a split of opinion between participants who were medical doctors and those who were non-doctors in their support for pharmacist prescribing. However, all stakeholders acknowledged the potential of pharmacist prescribing to increase patients' access to medicines in Nigeria.
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Abstract
Pharmacy prescribing policy in Israel has been negotiated and changed in recent years in order to improve patient treatment and access to medicines, and reduce national health insurance costs by allowing pharmacists to prescribe medications. Various stakeholders and institutions were involved in the formulation process, affecting the process while representing different motives. The complexity of pharmacy prescribing policy formulation is universal - any policy project needs, for strategic and tactical reasons, to acquire an inventory of institutions involved, identify the key players and explore potential support or opposition among them. This article uses the field (theory) of new institutional economics to explain the process of pharmaceutical institutional change and identifies the stakeholders who are involved in the reform. In the framework of pharmaceutical policies, seven models of prescribing practices are outlined, and the Canadian and British prescribing models are presented. The paper then focuses on the Israeli case and the main issues that concern decision-makers in the Israeli health system, such as inequality in access to health services and the erosion of the notion of universal health services. These concerns and the involvement of different stakeholders, such as The Israeli Medical Association (IMA) and health funds, influenced and directed the final Pharmacist Prescribing Law. After several rejections and amendments the law was passed, enabling experienced pharmacists to prescribe only to patients with a previous prescription given by a physician in the hope it would improve services to patients and reduce physicians’ workloads. Here, the topic of the new prescribing policy is introduced, using tools from the new institutional school in political economy.
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Affiliation(s)
- Hila Yariv
- Poznań School of Economics, aleja Niepodległości 10, Poznań, Poland
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20
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Schindel TJ, Given LM. The pharmacist as prescriber: a discourse analysis of newspaper media in Canada. Res Social Adm Pharm 2012; 9:384-95. [PMID: 22835707 DOI: 10.1016/j.sapharm.2012.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 05/31/2012] [Accepted: 05/31/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Legislation to expand the scope of practice for pharmacists to include authority to independently prescribe medications in Alberta, Canada was announced in 2006 and enacted in April 2007. To date, very little research has explored public views of pharmacist prescribing. OBJECTIVE This study analyzes newspaper media coverage of pharmacist prescribing 1 year before and 2 years after prescribing was implemented. METHODS News items related to pharmacist prescribing were retrieved from 2 national, Canadian newspapers and 5 local newspapers in Alberta over a 3-year period after the announcement of pharmacist prescribing. A purposive sample of 66 texts including news items, editorials, and letters were retrieved electronically from 2 databases, Newscan and Canadian Newsstand. This study uses social positioning theory as a lens for analyzing the discourse of pharmacist prescribing. RESULTS The results demonstrate a binary positioning of the debate on pharmacist prescribing rights. Using social positioning theory as a lens for analysis, the results illustrate self- and other-positioning of pharmacists' expected roles as prescribers. Themes related to the discourse on pharmacist prescribing include qualifications, diagnosis, patient safety, physician support, and conflict of interest. Media representations of pharmacist prescribing point to polarized views that may serve to shape public, pharmacist, physician, and others' opinions of the issue. CONCLUSIONS Multiple and contradictory views of pharmacist prescribing coexist. Pharmacists and pharmacy organizations are challenged to bring clarity and consistency about pharmacist prescribing to better serve the public interest in understanding options for health care services.
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Affiliation(s)
- Theresa J Schindel
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, 3-171 Edmonton Clinic Health Academy, Edmonton, Alberta, Canada.
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Abstract
Expanded pharmacist prescribing is a new professional practice area for pharmacists. Currently, Australian pharmacists' prescribing role is limited to over-the-counter medications. This review aims to identify Australian studies involving the area of expanded pharmacist prescribing. Australian studies exploring the issues of pharmacist prescribing were identified and considered in the context of its implementation internationally. Australian studies have mainly focused on the attitudes of community and hospital pharmacists towards such an expansion. Studies evaluating the views of Australian consumers and pharmacy clients were also considered. The available Australian literature indicated support from pharmacists and pharmacy clients for an expanded pharmacist prescribing role, with preference for doctors retaining a primary role in diagnosis. Australian pharmacists and pharmacy client's views were also in agreement in terms of other key issues surrounding expanded pharmacist prescribing. These included the nature of an expanded prescribing model, the need for additional training for pharmacists and the potential for pharmacy clients gaining improved medication access, which could be achieved within an expanded role that pharmacists could provide. Current evidence from studies conducted in Australia provides valuable insight to relevant policymakers on the issue of pharmacist prescribing in order to move the agenda of pharmacist prescribing forwards.
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Affiliation(s)
- Kreshnik Hoti
- Curtin Health and Innovation Research Institute, School of Pharmacy, Curtin University, Perth, WA, Australia
| | - Jeffery Hughes
- Curtin Health and Innovation Research Institute, School of Pharmacy, Curtin University, Perth, WA, Australia
| | - Bruce Sunderland
- Curtin Health and Innovation Research Institute, School of Pharmacy, Curtin University, Perth, WA, Australia
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