Barriers to pharmacist prescribing: a scoping review comparing the UK, New Zealand, Canadian and Australian experiences

Abstract

Objectives Non‐medical prescribers, including pharmacists, have been found to achieve comparable clinical outcomes with doctors for certain health conditions. Legislation supporting pharmacist prescribing (PP) has been implemented in the United Kingdom (UK), Canada and New Zealand (NZ); however, to date, Australian pharmacists have not been extended prescribing rights. The purpose of this review was to describe the barriers to PP found in the literature from the UK, Canada, NZ and Australia, and examine the implications of these for the development of PP in Australia. Methods We conducted a scoping review, which included peer‐reviewed and grey literature, and consultation with stakeholders. Sources – Scopus, PubMed and CINAHL; Google Scholar, OpenGrey and organisational websites from January 2003 to March 2018 in the UK, Canada, NZ and Australia. Inclusion criteria – articles published in English, related to implementation of PP and articulated barriers to PP. Key findings Of 863 unique records, 120 were reviewed and 64 articles were eligible for inclusion. Three key themes emerged: (1) Socio‐political context, (2) Resourcing issues and (3) Prescriber competence. The most common barriers were inadequate training regarding diagnostic knowledge and skills, inadequate support from authorities and stakeholders, and insufficient funding/reimbursement. Conclusions If implementation of PP is to occur, attention needs to be focused on addressing identified barriers to PP implementation, including fostering a favourable socio‐political context and prescriber competence. As such, a concerted effort is required to develop clear policy pathways, including targeted training courses, raising stakeholder recognition of PP and identifying specific funding, infrastructure and resourcing needs to ensure the smooth integration of pharmacist prescribers within interprofessional clinical teams.

Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals

“…Many barriers to pharmacist prescribing exist. A scoping review of these barriers by Zhou et al [55] revealed three key themes that should be factored in to the current debate: (1) the socio-political context; (2) resourcing issues; and (3) prescriber competence. We advocate for the ongoing exploration of the expansion of the peri-operative pharmacists and nurses’ role in prescribing and collaborative partnered charting models.…”

Community pharmacists’ evolving role in Canadian primary health care: a vision of harmonization in a patchwork system

“…Research has captured Canadian pharmacists’ apprehension about their expanding role related to uncertainty around remuneration, perceived physician skepticism about pharmacists’ skills, and pharmacists’ access to comprehensive patient health records. 35 , 77 , 78 Pharmacists have expressed a need for continuing professional development and education delivered in innovative models that are tailored to the site of practice and learners’ unique needs. 79 Conversely, factors that may make pharmacists feel more comfortable and confident assuming new roles and responsibilities in the primary health care system, consequently facilitating practice change, are summarized by Gregory et al with the “9 Ps of practice change” mnemonic: permission, process pointers, practice/rehearsal, positive reinforcement, personalized attention, peer referencing, physician acceptance, patients’ expectations, professional identity, and payment.…”

Deprescribing needs to be considered in the pharmacists’ prescribing role

“…4,5 The pharmacists' expanded deprescribing role can be achievable with a teambased approach in which there is a clear delineation of roles and responsibilities, separating the prescribing from the dispensing pharmacist, as in New Zealand. 5,6 In Australia, many health practitioners can prescribe medications. For example, nurse practitioners can initiate and deprescribe within the boundaries of legislation and scope; that is, limited by the scope of practice, requirements from the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, and by relevant hospital formulary or prescribing arrangements.…”

“…The pharmacists’ expanded deprescribing role can be achievable with a team‐based approach in which there is a clear delineation of roles and responsibilities, separating the prescribing from the dispensing pharmacist, as in New Zealand . In Australia, many health practitioners can prescribe medications.…”