Barriers to and facilitators of endorsement for scheduled medicines in podiatry: a qualitative descriptive study

Abstract

Background Australian podiatrists and podiatric surgeons who have successfully completed the requirements for endorsement for scheduled medicines, as directed by the Podiatry Board of Australia, are eligible to prescribe a limited amount of schedule 2, 3, 4 or 8 medications. Registration to become endorsed for scheduled medicines has been available to podiatrists for over 10 years, yet the uptake of training has remained low (approximately 2% of registered podiatrists/podiatry surgeons). This study aimed to explore barriers to and facilitators of engagement with endorsement for scheduled medicines by podiatrists. Methods Qualitative descriptive methodology informed this research. A purposive maximum variation sampling strategy was used to recruit 13 registered podiatrists and a podiatric surgeon who were either endorsed for scheduled medicines, in training or not endorsed. Semi-structured interviews were employed to collate the data which were analysed using thematic analysis. Results Three overarching super-ordinate themes were identified which encompassed both barriers and facilitators: (1) competence and autonomy, (2) social and workplace influences, and (3) extrinsic motivators. Within these, several prominent sub-themes emerged of importance to the participants including workplace and social networks role in modelling behaviours, identifying mentors, and access to supervised training opportunities. Stage of life and career often influenced engagement. Additionally, a lack of financial incentive, cost and time involved in training, and lack of knowledge of training requirements were influential barriers. Rural podiatrists encountered a considerable number of barriers in most of the identified areas. Conclusion A multitude of barriers and facilitators exist for podiatrists as part of the endorsement for scheduled medicines. The findings suggest that a lack of engagement with endorsement for scheduled medicines training may be assisted by a more structured training process and increasing the number of podiatrists who are endorsed to increase the numbers of role models, mentors, and supervision opportunities. Recommendations are provided for approaches as means of achieving, and sustaining, these outcomes.

Australian podiatrists scheduled medicine prescribing practices and barriers and facilitators to endorsement: a cross‐sectional survey

“…DFU is another area of podiatric practice where health system efficiencies and Identifying factors that motivate podiatrists to become endorsed is an important step in developing strategies to increase engagement and participation. The findings of this survey build on the qualitative interviews by Graham et al [17] confirming that the self-determination theory (SDT) [26,27] can provide insights into the drivers of motivation. This universal motivational and personality framework is commonly applied in education and health settings and is based on the concept that people naturally develop through acquiring knowledge, skill, and habits they observe that support their basic psychological needs of autonomy, competence, and relatedness [28].…”

“…Questions concerning barriers and facilitators to endorsement were developed based on the previous qualitative study conducted by Graham and colleagues [ 17 ]. Specifically, endorsed and in-training participants were asked to identify which facilitators, from a given list, most contributed to their decision to undertake endorsement.…”

“…Little is known about why the uptake for endorsement for scheduled medicines remains low among Australian podiatrists. Graham and colleagues [ 17 ], in a qualitative thematic analysis of 13 podiatrists with and without endorsement, identified competence and autonomy (i.e. need/desire to broaden current scope of practice); social and workplace influences (i.e.…”

Continuing professional development opportunities for Australian endorsed for scheduled medicines podiatrists—What’s out there and is it accessible, relevant, and meaningful? A cross-sectional survey

“…For example, the isolated rural podiatrist may struggle to access adequate opportunities while those practicing in large multidisciplinary environments, surrounded by multiple prescribing practitioners may be at an advantage. It is well documented that rural health professionals experience barriers to engaging in professional development, including lengthy travel times to engage in events, a scarcity of backfill staffing to allow clinicians to attend events, and poor internet connections [63][64][65]. To ensure equity of access, CPD developers need to consider delivery modalities and the learning conditions of all potential participants regardless of their location.…”

“I know what I'm supposed to do, but I don't do it”: patient‐perceived risk factors that lead to their lower extremity amputations

“…This study applied a qualitative descriptive (QD) research design to explore patient perceptions of factors that lead to their LEA [17]. QD methodology has previously been used in other qualitative research to gain perspectives of population groups about cultural and clinical factors [18][19][20][21].…”