Stakeholders’ views and experiences on pharmacist prescribing

Medicines illustration

Pharmacist prescribing is becoming increasingly important and prevalent, plus it’s going to play a major role in the future shape of the healthcare industry. Its significance is why we decided to make it the focus of our latest Verve Journal Club meeting.

This blog details our collective views after debating and sharing our opinions on a systematic review to explore the findings and experiences from stakeholders on pharmacist prescribing.

PAPER REVIEWED: 

‘Stakeholders’ views and experiences of pharmacist prescribing: a systematic review’

View the full paper here

This paper explores the views from a wide range of stakeholders, and countries, on pharmacist prescribing. These included the general public, patients, nurses, doctors, policyholders and pharmacists themselves.  

The review was divided into two key sections, with stakeholder views taken both pre- and post-implementation of pharmacist prescribing.

Introduction — Effectiveness and safety of pharmacist prescribing

There is increasing evidence of the effectiveness and safety of pharmacist prescribing. A Cochrane review of 46 studies, which included over 30,000 participants, concluded that non-medical prescribers – such as pharmacists and nurses – practising with varying, but high levels of prescribing, were as effective and as safe as traditional medical prescribers. 

JOURNAL CLUB DISCUSSION POINT:

Most people are resistant to the suggestion of change and even more if they don’t feel, or don’t understand, that change is necessary and beneficial. The procedure of a consultation with their GP or specialist leading to being prescribed their medication has been the way for many years. Getting used to the idea of a pharmacist prescribing may take some time and effort from different HCPs.

However, having pharmacists achieve the required additional qualifications and training in key defined therapy areas – and if this is well communicated to the general public – we believe patients will adapt to this new approach, especially if they can see a direct personal benefit. 

We discussed the fact that GPs will need to take a pivotal role in promoting this initiative and explaining to patients why and how pharmacists are also able to prescribe and the positive effect this gives to them. We all agreed that wider communications will be required to heighten public awareness and understanding.

Section 1 — General public

Pre-implementation of pharmacist prescribing – the study showed that the general public were supportive of a pharmacist prescribing.

Post-implementation of pharmacist prescribing – there were some concerns over pharmacists’ training in diagnosis and lack of access to patients’ medical records. This is a common theme seen in all stakeholder studies.

FROM THE JOURNAL CLUB DISCUSSIONS:

The general consensus was that if a pharmacist prescribed medicines for a condition previously diagnosed by a doctor or specialist, (supplementary prescribing), then pharmacist prescribing is more likely to be readily accepted. 

Pharmacists have extensive knowledge on the pharmacology of each drug and its MOA, so they can confidently prescribe a medication best suited for the condition and needs of an individual patient. 

The challenge ahead is for pharmacists to also be seen as effective and skilled diagnosticians. 

Within the UK, prescribing pharmacists will have access to summary care records which overcomes one of the above key concerns. 

Section 2 — Patients

Pre-implementation of pharmacist prescribing – Studies of patients and patient groups were generally supportive for pharmacist prescribing. This was seen as likely to improve access to healthcare and making better use of pharmacists’ skills. 

Post-implementation of pharmacist prescribing – The majority of patients who had consulted with a pharmacist prescriber were highly satisfied with their consultation and considered the prescribing by pharmacists as effective and safe as their doctors. 

They also gave positive feedback relating to the pharmacist’s personality, knowledge and communication skills as well as the consistency, accessibility, length and outcome of the care received.

JOURNAL CLUB DISCUSSION POINT:

The paper shows that the pharmacist’s experience in therapy areas is important, and personality, knowledge and communication skills are just as important. Additional training could facilitate pharmacists to establish even better relationships with patients and, hopefully speed up ‘acceptance’ of pharmacist prescribing. 

Patient materials in HCP environments may also play a confidence and awareness role here. ‘Go and speak to your pharmacist’ may be the message needed to drive pharmacy as the first port of call. As an added benefit, pharmacist prescribing will also ease time pressures on GPs – an important reason for pharmacist prescribing.

Training would also need to have a strong focus on diagnosis, red flag reporting and performing effective consultations. Identifying the most suitable/beneficial therapy areas is going to be a key success driver.

Within individual key therapy areas, direct engagement with pharma manufacturers concerning training and awareness we believe will  also play a significant role. 

Section 3 — Pharmacists 

Pre-implementation of pharmacist prescribing -– Pharmacists themselves were generally supportive of the prescribing role, it was seen as the next step given their expertise in medicine and the role they have in the community.

Post-implementation of pharmacist prescribing – It was still positive, but there were still some concerns over training and diagnoses. 

JOURNAL CLUB DISCUSSION POINT:

The benefits of becoming an effective independent prescriber is highly dependent on the type of pharmacists. Community pharmacists may encounter different challenges and see different types of patients compared to hospital and practice-based pharmacists. 

Hospital and practice-based pharmacists may also benefit from having easy access to other HCPs/medics for a second opinion if needed. 

A good relationship between pharmacists and GP is of key importance. Potentially, if a pharmacist has a strong relationship with their local GPs and is an active part of their primary care network (PCN) community, they may have easier access to a patient’s history and be able to help with ongoing patient assessments. 

Pharmacists with this enhanced status can be a crucial additional support to patients, as they are providing a consultation which is more than just about medications. 

The additional time and resource needed to gain the supplementary prescribing qualification would be the greatest challenge with the benefits being seen in the long term. 

With the goal of all newly qualified pharmacists having independent prescriber status from 2024, the current set of practicing pharmacists will need to add this extra skill set to keep pace with the industry

It also provides a significant and unique advantage in the services that can be provided versus digital purchasing of OTC products. But we didn’t explore this much more as it is a journal club discussion all on its own!

Section 4 — GP 

Pre-implementation of pharmacist prescribing – A range of different views were reported. In one study, the majority were supportive, provided that additional, accredited training was completed. 

In other studies, doctors were more cautious in their support, but acknowledged that a model of pharmacist prescribing for limited conditions, such as minor ailments, was a logical development.

Post-implementation of pharmacist prescribing – The majority supported pharmacist prescribing across the studies with many understanding the benefits. 

FROM THE JOURNAL CLUB DISCUSSIONS:

Some caution around pharmacists taking the lead in diagnosis, not their traditional role, is understandable. This may be strongly influenced by their personal relationship with, and regard for, the pharmacists within their local network rather than thinking of them as a whole.

The therapy area is also likely to be a strong determining factor on their views. The increasing role of pharmacists as prescribers and how this change is communicated with all doctors needs careful consideration and implementation. 

Prescribing pharmacists can offer a noticeable benefit and opportunity for GPs to focus their efforts on more complex conditions. Strong partnerships across PCNs will also be of paramount importance. 

Section 5 — Nurses 

Pre-implementation of pharmacist prescribing – Nurses considered pharmacist  prescribing for existing or new therapy areas as useful due to their knowledge in pharmacology and training in patient care.

FROM THE JOURNAL CLUB DISCUSSIONS:

This could be very dependent on the type of nurse and their role. For example; care home or hospital nurses may find prescribing pharmacists lead to increased efficiency and speed of access to everyday medicines.

Section 6 — Policyholders

Pre-implementation of pharmacist prescribing – Results were not from the UK, but were derived from USA, Canada, and Nigeria. The overall anticipated benefit from pharmacist prescribing, from the policyholder’s viewpoint, were in terms of improved continuity of care, better patient outcomes, reduced prescribing costs, and reduced physician workload.  

Post-implementation of pharmacist prescribing – The main findings were that these decision-makers responded positively to pharmacist prescribing due to pharmacists’ knowledge around the drugs and their mechanisms of action.

JOURNAL CLUB DISCUSSION POINT:

Who do you think are the key stakeholders/policymakers in the UK if pharmacist prescribing is going to be driven forward?

Public support from GPs and the NHS would not only create better understanding of the benefits of pharmacist prescribing but also increase the speed of acceptance. Government bodies also need to take a lead in terms of how pharmacist prescribing is best communicated to the public. 

All relevant parties within PCNs and CCGs will have key roles to play if we are to maximise the effective implementation and benefit from pharmacist prescribing. 

JOURNAL CLUB OVERALL VIEW:

The systematic review provided a good insight on the views from different stakeholders on pharmacist prescribing. 

Views from all stakeholders, including doctors and patients, is largely very positive on the assumption that the additional qualifications and training are effective in enhancing the additional skills required.

There are still some organisational and communication challenges to be overcome in order to drive implementation and heighten the opportunities for pharmacist prescribing, but this can offer some significant benefits to the industry.

WHAT IS THE VERVE JOURNAL CLUB?

Our monthly journal club is a great opportunity for us to keep up with the latest research in different therapy areas. It allows us to combine our HCP work with our passion for advances and knowledge in healthcare. The club is a chance for the team to come together to evaluate and discuss articles within pharmaceutical literature within a social environment.

ABOUT THE AUTHOR:

AMI DESAI

Ami Desai Headshot
Ami spent six years at Barts Cancer Institute, specialising in peptide-targeting research and has been published in a number of peer-reviewed journals. That and her MSc in Molecular Pathology and Genomics means she can be trusted with the recipe for Verve.

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