An investigation of the structures and processes of pharmacist prescribing in Great Britain: a mixed methods approach.

Dapar, Maxwell Patrick

Abstract

The aim of this research was to investigate the structures and processes of pharmacist prescribing in Great Britain, focusing on primary care settings. A sequential, mixed-methods approach was employed in the conduct of the research. The first phase in January 2009 was a cross-sectional postal questionnaire of all pharmacist prescribers (n= 1,654). The questionnaire aimed to quantify the extent and nature of prescribing, and key factors associated with prescribing practice. The response rate was 42.3% (n=695). The pharmacy practice setting was significantly associated with prescribing, with those in hospital or general medical practice being more likely to have prescribed (p < 0.05) than respondents in community practice. Factor analysis of attitudinal statements on prescribing implementation revealed factors, grouped as: administrative structures and processes, perceptions of pharmacists' prescribing role and facilities for prescribing. Scores for "facilities for prescribing" varied depending on practice setting; respondents in community practice recorded lower median scores compared with those in general medical practices, but there were no statistically significant differences in median scores between respondents based in general medical practices and hospital settings. In-depth qualitative work was undertaken in the second phase, which further explored facilitators of and challenges to prescribing practice identified in phase one, such as the lack of defined prescribing roles. Semi-structured interviews were conducted with a sample of 34 prescribers, selected from diverse settings including secondary care from England and Scotland. The interviews aimed to highlight key factors contributing to prescribing success, which could potentially inform extrapolations of successful practice from one setting to another. The framework approach to qualitative data analysis was rigorously applied, revealing that issues around access to clinical data and administrative support in the community setting, and also the issue of professional isolation may have negatively impacted on prescribing implementation. Notably, a perceived lack of clarity and definition of the pharmacist prescribing role was a key theme in hindering prescribing practice of pharmacists, irrespective of setting. Participants described ideal roles, which they perceived as potentially providing clarity, definition and direction in order to facilitate implementation. The original data generated through this research highlights that prescribing implementation is less than desired, especially in community pharmacies. Pharmacist prescribing appears to have progressed little since supplementary prescribing developments in 2004, even with the much-heralded arrival of independent prescribing in 2006. Interestingly, phase 2 participants suggested that a hybrid supplementary/independent prescribing model would be more likely to succeed. In this model, pharmacist prescribers favour a cooperative practice arrangement, in which doctors diagnose and pharmacists prescribe.

Citation

DAPAR, M.P. 2012. An investigation of the structures and processes of pharmacist prescribing in Great Britain: a mixed methods approach. Robert Gordon University, PhD thesis.

• Thesis Type: Thesis
• Deposit Date: Mar 22, 2012
• Publicly Available Date: Mar 22, 2012
• Keywords: Prescribing; Pharmacist; Supplementary; Independent; Nonmedical; Primary care; Structures; Processes; Great Britain
• Public URL: http://hdl.handle.net/10059/714
• Contract Date: Mar 22, 2012
• Award Date: Jan 31, 2012