Purpose. Continuity of care, equitable access, and quality and safety are major foci in health services management. The introduction of limited prescribing rights to pharmacists has the potential to reduce fragmentation within the health system, optimise medication management, improve continuity of patient care and improve patient access to medication. Results. Eight models for pharmacists' prescribing have been implemented internationally, varying in their dependency on protocols, formularies and collaboration with physicians. These have also been described using terms such as Supplementary Prescribing and Patient Group Directions. Conclusion. Issues relating to practical implementation of pharmacists' prescribing include negotiation of national health policy, pharmacists' training and accreditation, liability, reimbursement and documentation.

/pdf/pharmacists-and-prescribing-rights-review-of-international-3xd8mxhgxx.pdf

Pharmacists and prescribing rights: review of international developments.

Background Supplementary prescribing (SP) is a drug therapy management model implemented in the United Kingdom since 2003. It is a voluntary partnership between an independent prescriber; a supplementary prescriber, for example, nurse or pharmacist; and the patient, to implement an agreed patient-specific clinical management plan (CMP). 

Objective

 To investigate pharmacist prescribers' views and experiences of the early stages of SP implementation. 

Methods

 A qualitative, longitudinal study design was used. A purposive, maximum variability sample of 16 pharmacist supplementary prescribers, trained in Southern England, participated. Eleven were hospital pharmacists, owing to the overrepresentation of hospital pharmacists in the first cohort. Two semistructured interviews were conducted with each participant, at 3 and 6 months after their registration as prescribers. The Framework approach was used for data collection, management, and analysis. 

Results

 Three typologies of pharmacists' experiences were identified: “a blind alley”, “a stepping stone” and “a good fit”. Despite some delays in its implementation, SP was seen as a step forward. Some participants also believed that it improved patient care and pharmacists' integration in the health care team and increased their job satisfaction. However, there was a concern that SP, as first implemented, was bureaucratic and limited pharmacists' freedom in their decision making. Hence, pharmacists were more supportive of the then imminent introduction of a pharmacist independent prescribing (IP) role. 
Conclusions

 Despite challenges, the SP role represented a step forward for pharmacists in the United Kingdom. It is possible that pharmacist SP can coexist with IP in the areas suitable for CMP use. Elsewhere, SP is likely to become more of a “stepping stone” to an IP role than the preferred model for pharmacist prescribing. Future research needs to objectively assess the outcomes of pharmacist SP, preferably in comparison with IP, to inform decision making among pharmacists regarding the adoption of such an innovative role.

Pharmacist supplementary prescribing: A step toward more independence?

Background: Supplementary prescribing (SP) is a drug therapy management model implemented in the United Kingdom since 2003. It is a voluntary partnership between an independent prescriber; a supplementary prescriber, for example, nurse or pharmacist; and the patient, to implement an agreed patient-specific clinical management plan (CMP). Objective: To investigate pharmacist prescribers’ views and experiences of the early stages of SP implementation. Methods: A qualitative, longitudinal study design was used. A purposive, maximum variability sample of 16 pharmacist supplementary prescribers, trained in Southern England, participated. Eleven were hospital pharmacists, owing to the overrepresentation of hospital pharmacists in the first cohort. Two semistructured interviews were conducted with each participant, at 3 and 6 months after their registration as prescribers. The Framework approach was used for data collection, management, and analysis. Results: Three typologies of pharmacists’ experiences were identified: ‘‘a blind alley’’, ‘‘a stepping stone’’ and ‘‘a good fit’’. Despite some delays in its implementation, SP was seen as a step forward. Some participants also believed that it improved patient care and pharmacists’ integration in the health care team and increased their job satisfaction. However, there was a concern that SP, as first implemented, was bureaucratic and limited pharmacists’ freedom in their decision making. Hence, pharmacists were more supportive of the then imminent introduction of a pharmacist independent prescribing (IP) role. Conclusions: Despite challenges, the SP role represented a step forward for pharmacists in the United Kingdom. It is possible that pharmacist SP can coexist with IP in the areas suitable for CMP use. Elsewhere, SP is likely to become more of a ‘‘stepping stone’’ to an IP role than the preferred model for pharmacist prescribing. Future research needs to objectively assess the outcomes of pharmacist SP,

Original Research Pharmacist supplementary prescribing: A step toward more independence?

Background A number of jurisdictions, both in Canada and internationally, have recently expanded pharmacists' scope of practice to allow prescriptive authority. Objective To ascertain the initial perceptions of the Ontario government and health professional stakeholder groups regarding the prospect of prescriptive authority for pharmacists. Methods Qualitative research methods were used; data sources were policy documents and semi-structured interviews with key informants from the Ontario government and pharmacy and medical professional organizations. Purposive and snowball sampling strategies were used to identify 17 key informants. Fifty-one relevant policy documents were retrieved through searches of organizational websites and interviewee suggestions. Interview transcripts and documents were content analyzed independently by 2 researchers; and once consensus was achieved on key themes, the primary investigator analyzed the remainder. Results Pharmacy organizations and Ontario government representatives both expressed support for pharmacist prescriptive authority, suggesting that it would enhance patient access to primary care. Medical organizations were opposed to this expanded pharmacist role, arguing that pharmacists' lack of training and experience in diagnosis and prescribing would endanger patient safety. Other concerns were fragmentation of care and pharmacists' lack of access to patient clinical information. Some government and pharmacy informants felt that pharmacist prescribing would decrease health system costs through substitution of cheaper health professionals for physicians, while others felt that costs would increase due to increased utilization of services. Medical organizations preferred delegated medical authority as the policy alternative to pharmacist prescribing. Conclusions Widely different views were expressed by the Ontario government and pharmacy organizations on the one hand and medical professional organizations on the other hand, regarding the potential impact of pharmacist prescribing on patient safety and access to primary care. This is likely due, at least in part, to the lack of evidence on the expected impact of this expanded pharmacist role. More research is needed to help inform discussions regarding this issue.

Initial perceptions of key stakeholders in Ontario regarding independent prescriptive authority for pharmacists.

Aim: To evaluate the literature describing pharmacist prescribing activities and identify areas in need of further research.

Method: Relevant literature was identified by searching Medline (1974 to February 2004), Embase (1980 to February 2004) and Pharmline (1980 to February 2004). Relevant studies were selected based on titles and abstracts.

Results: 18 studies (17 USA, 1 UK) measured outcomes of drug therapy management by a dependent pharmacist prescriber compared to standard care. 19 studies described pharmacist interventions or recommendations on drug therapy that could be implemented with the approval of an independent prescriber. 52 papers described pharmacist-prescribing activities in practice but lacked an experimental design. Prescribing protocols used were presented in 14 papers. Evidence from these studies supports the role of dependent prescribing pharmacists through positive patient outcomes.

Conclusion: Few studies employed adequate research designs to control threats to internal and external validity. Additional research is needed to assess clinical, humanistic and economic outcomes to establish the viability of pharmacist prescribers.

J Pharm Pract Res 2004; 34: 300–4.

Pharmacist Prescribing: Review of the Literature

INTRODUCTION In the traditional model of health care, physicians have the authority to prescribe medications, order laboratory tests, and conduct or supervise procedures consistent with a patient’s diagnosis. More recently, prescribing privileges have been extended to other health care professionals, such as nurse practitioners (NP), expanded role nurses (ERN), clinical nurse specialists (CNS), registered midwives, and optometrists. While the roles of some of these health care professionals have evolved to fill gaps in the health care system where physicians are unavailable, most work within a hospital or specialized clinic affiliated with a health care facility. There is a continuing attempt in Canadian health care to contain or reduce costs by reducing patient length of stay in hospital and eliminating inefficiencies and duplication of effort. Pharmacists are increasingly aware that the current process of delivering health care to patients frequently results in drug therapy outcomes that are not as effective, appropriate, safe, or economical as possible and desirable.1-3 They have a responsibility to work toward establishing a better system that could improve the outcomes and cost-effectiveness of drug therapy. It has been postulated that by granting prescribing authority to pharmacists the fragmented and disjointed process of health care delivery could be improved. Improved medication management and continuity of care may be achieved by decreasing the number of steps a patient must take to obtain the optimal medication regimen for their condition.4 It has been argued that if pharmacists truly intend to practise and implement pharmaceutical care, then every pharmacist should be able to maximally utilize their extensive pharmaceutical knowledge by prescribing drugs.5 Having the authority to prescribe medications would facilitate the delivery of more effective pharmaceutical care by some pharmacists. Yet, given the present practice of most pharmacists, it has also been suggested that those with delegated prescribing authority have little advantage over those without it in the overall delivery of pharmaceutical care to patients.6 Currently, many pharmacists in organized health care settings in Canada have some form of authority and responsibility for prescribing. It is important to note that in a survey of Canadian institutions, the Canadian Society of Hospital Pharmacists Task Force on Pharmacist Prescribing found a significant amount of pharmacist prescribing occurring with limited control or regulation7 (see below). This paper is not intended to examine the current state of provincial legislation regarding prescribing authority in Canada. Various degrees of prescribing authority for pharmacists are currently being examined and implemented in a number of provinces (e.g., specially instructed and certified pharmacists prescribing post-coital contraception).

/pdf/an-information-paper-on-pharmacist-prescribing-within-a-4td8xtt6do.pdf

An Information Paper on Pharmacist Prescribing Within a Health Care Facility

The provision of health care to Canadians in institutions and organized health care settings involves the collaborative efforts of physicians, pharmacists, nurses, and other health care professionals. The focus of the pharmacist’s efforts in this interdisciplinary approach to patient care is to ensure the responsible provision of drug therapy for the purpose of achieving definite outcomes (pharmaceutical care). Ultimately, pharmacists share in the responsibility for patient outcomes from drug therapy. Pharmacists do not just provide basic dispensing functions and drug information services, but they also solve patientand medication-related problems and make decisions regarding drug prescribing, drug monitoring, and drug regimen adjustments. Consequently, CSHP advocates the role of pharmacists as capable prescribers and supports the pharmacist’s role in a collaborative prescribing model to improve patient health outcomes and increase the successful and efficient delivery of pharmaceutical care. A collaborative prescribing model requires that a cooperative practice relationship exist between a pharmacist and a physician or other health care professional with the legal authority to prescribe medications. Recognition of physician expertise in disease diagnosis and pharmacist expertise in pharmacotherapy and disease management, as the foundation for the establishment of a collaborative practice, optimizes the training and expertise of both of these health care professionals in the provision of patient care. In an ideal collaborative practice, the physician will diagnose and make initial treatment decisions for the patient and then the pharmacist will select, initiate, monitor, modify, continue, and discontinue pharmacotherapy as appropriate in order to achieve the desired patient outcomes. In this collaborative practice model, both the physician and the pharmacist share in the risk and responsibility for the patient outcomes achieved.

Statement on Pharmacist Prescribing

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An Information Paper on Pharmacist Prescribing Within a Health Care Facility

Statement on Pharmacist Prescribing