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Influences on prescribing decision-making among non-medical prescribers in the United Kingdom: systematic review.

McIntosh, Trudi; Stewart, Derek; Forbes-McKay, Katrina; McCaig, Dorothy; Cunningham, Scott


Trudi McIntosh

Derek Stewart

Dorothy McCaig


Suitably qualified non-medical healthcare professionals may now prescribe medicines. Prescribing decision-making can be complex and challenging; a number of influences have been identified among medical prescribers but little appears to be known about influences among non-medical prescribers (NMPs). The objective of this study was to critically appraise, synthesize and present evidence on the influences on prescribing decision-making among supplementary and independent NMPs in the UK. The systematic review included all studies between 2003 and June 2013. Included studies researched the prescribing decision-making of supplementary and independent NMPs practising in the UK; all primary and secondary study designs were considered. Studies were assessed for quality and data extracted independently by two researchers, and findings synthesized using a narrative approach. Following duplicates exclusion, 886 titles, 349 abstracts and 40 full studies were screened. Thirty-seven were excluded leaving three for quality assessment and data extraction. While all studies reported aspects of prescribing decision-making, this was not the primary research aim for any. Studies were carried out in primary care almost exclusively among nurse prescribers (n = 67). Complex influences were evident such as experience in the role, the use of evidence-based guidelines and peer support and encouragement from doctors; these helped participants to feel more knowledgeable and confident about their prescribing decisions. Opposing influences included prioritization of experience and concern about complications over evidence base, and peer conflict. While there is a limited evidence base on NMPs' prescribing decision-making, it appears that this is complex with NMPs influenced by many and often opposing factors.


MCINTOSH, T., STEWART, D., FORBES-MCKAY, K., MCCAIG, D. and CUNNINGHAM, S. 2016. Influences on prescribing decision-making among non-medical prescribers in the United Kingdom: systematic review. Family practice [online], 33(6), pages 572-579. Available from:

Journal Article Type Review
Acceptance Date Aug 1, 2016
Online Publication Date Aug 20, 2016
Publication Date Dec 31, 2016
Deposit Date Sep 7, 2016
Publicly Available Date Aug 21, 2017
Journal Family practice
Print ISSN 0263-2136
Electronic ISSN 1460-2229
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 33
Issue 6
Pages 572-579
Keywords Consultation; Doctor patient relationship; Family health; Multidisciplinary care; Nurse practitioners; Pharmacology/drug reactions
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