Clinical and cost-effectiveness of non-medical prescribing: a systematic review of randomised controlled trials

Noblet, Tim; Marriott, James; Graham-Clarke, Emma; Shirley, Debra; Rushton, A.

doi:10.1016/j.physio.2018.11.063

Cited by 5 publications

(9 citation statements)

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“…There is increasing emphasis on establishing systems, rather than single episodes of care, that dissolve traditional boundaries (96,97) to support the increasing number of people with long-term conditions. There is limited evidence available with which to compare our study findings (32,41,51,52,91). Despite positive findings that NMP is safe, and provides beneficial clinical outcomes (32,34,79), the impact on the health economy, as reported in two recent systematic reviews examining clinical and cost effectiveness, remains unclear (51,52,91).…”

Section: Discussionmentioning

confidence: 80%

“…There is limited evidence available with which to compare our study findings (32,41,51,52,91). Despite positive findings that NMP is safe, and provides beneficial clinical outcomes (32,34,79), the impact on the health economy, as reported in two recent systematic reviews examining clinical and cost effectiveness, remains unclear (51,52,91). The authors, as in this study, highlight the difficulty in separating NMP effects from the contributions of healthcare team members, and a lack of adequately powered randomised controlled trials examining NMP across clinical specialities, professions and settings (31,51).…”

Section: Discussionmentioning

confidence: 99%

“…Despite positive findings that NMP is safe, and provides beneficial clinical outcomes (32,34,79), the impact on the health economy, as reported in two recent systematic reviews examining clinical and cost effectiveness, remains unclear (51,52,91). The authors, as in this study, highlight the difficulty in separating NMP effects from the contributions of healthcare team members, and a lack of adequately powered randomised controlled trials examining NMP across clinical specialities, professions and settings (31,51). Given that extended prescribing rights to nurses, pharmacists and AHPs offers a sustainable approach to improving the global workforce deficit, there is an urgent need to establish economic benefits, or otherwise of non-medical prescribing to inform future international policy developments.…”

Section: Discussionmentioning

confidence: 99%

“…A different approach, involving highly targeted specific outcomes, and or longitudinal studies is therefore required. The development of a minimum data set of important outcome measures for NMP assessment would as Noblet et al suggests (51), be highly beneficial, and generate the required evidence to evaluate the overall benefit of NMP and inform future developments in the UK and around the world.…”

Section: Discussionmentioning

confidence: 99%

“…Whilst PP-SP helps streamline service delivery (44,45), IP is expected to bring additional benefits in line with nurse and pharmacist prescribing (46,47). Exploration of clinical and cost effectiveness in this area is however limited and has to date lead to inconclusive findings (48)(49)(50)(51)(52)(53). As most evidence relates to nurses and pharmacists, it is important to evaluate the impact of prescribing by allied health professionals (AHPs) in order to inform commissioning and implementation of NMP services where they are beneficial.…”

Section: Introductionmentioning

confidence: 99%

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Physiotherapist and Podiatrist Independent Prescribing in the United Kingdom: A quasi experimental study

Carey

Edwards

Otter

et al. 2020

Preprint

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BackgroundIncreasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists. Aim: to compare outcomes of Physiotherapist and Podiatrist Independent Prescriber (PP-IP) patients with those of Physiotherapist and Podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications.Design: a quasi-experimental, post-test control group design Methods: Using mixed methods outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015)(2016).Results: 489 patients were recruited: n=243 IP sites, and n=246 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p>0.05) and patient satisfaction (p≤0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than NP-PP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 minutes).

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Physiotherapist and Podiatrist Independent Prescribing in the United Kingdom: A quasi experimental study

Carey

Edwards

Otter

et al. 2020

Preprint

View full text Add to dashboard Cite

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A theoretically informed, mixed-methods study of pharmacists’ aspirations and readiness to implement pharmacist prescribing

et al. 2021

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Background Studies have highlighted advancing clinical pharmacy practice in Qatar. Objective To explore pharmacists’ aspirations and readiness to implement pharmacist prescribing. Setting Hamad Medical Corporation (HMC), the main provider of secondary and tertiary care. Method A sequential explanatory mixed-methods design. Questionnaire items were derived from the Consolidated Framework of Implementation Research (CFIR), in domains of: awareness/support; readiness; implementation; and facilitators and barriers. Following piloting, all pharmacists (n = 554) were invited to participate. Questionnaire data were analysed using descriptive and inferential statistics with principal component analysis of attitudinal items. Focus groups were recorded, transcribed and analysed using the Framework Approach. Main outcome measure Aspirations and readiness to implement pharmacist prescribing. Results The response rate was 62.8% (n = 348), with respondents highly supportive of implementation in Qatar (median 4, scale 0–5, extremely supportive). The majority (64.9%, n = 226) considered themselves ready, particularly those more senior (p < 0.05) and classifying themselves innovative (p < 0.01). Outpatient (72.9%, n = 221 agreeing) and inpatient (71.1%, n = 218 agreeing) HMC settings were those perceived as being most ready. PCA identified 2 components, with ‘personal attributes’ being more positive than ‘prescribing support’. Facilitators were access to records, organizational/management support and the practice environment, with physician resistance and scope of practice as barriers. Focus groups provided explanation, with themes in CFIR domains of innovation characteristics, characteristics of individuals and the inner setting. Conclusion HMC pharmacists largely aspire, and consider themselves ready, to be prescribers with inpatient and outpatient settings most ready. CFIR domains and constructs identified as facilitators and barriers should be focus for implementation.

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

Graham

Banwell

Causby

et al. 2021

Journal of Foot and Ankle Research

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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.

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Clinical and cost-effectiveness of non-medical prescribing: a systematic review of randomised controlled trials

Cited by 5 publications

References 0 publications

Physiotherapist and Podiatrist Independent Prescribing in the United Kingdom: A quasi experimental study

Physiotherapist and Podiatrist Independent Prescribing in the United Kingdom: A quasi experimental study

A theoretically informed, mixed-methods study of pharmacists’ aspirations and readiness to implement pharmacist prescribing

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

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