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

doi:10.1093/fampra/cmw085

Cited by 30 publications

(25 citation statements)

References 37 publications

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“…Specific factors included low self‐confidence, perceptions of risk due to the error‐prone nature of prescribing, limited flexibility due to clinical management plan adherence, little contact with patients to gain a full clinical picture, little experience with prescribing, inadequate communication and involvement with stakeholders and inadequate communication skills . Decision‐making in PP is, by its nature, complex and affected by many factors, including self‐confidence, work experience, communication skills and interactions with other stakeholders …”

Section: Resultsmentioning

confidence: 99%

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

Zhou

Desborough

Parkinson

et al. 2019

International Journal of Pharmacy Practice

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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.

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Section: Resultsmentioning

confidence: 99%

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

Zhou

Desborough

Parkinson

et al. 2019

International Journal of Pharmacy Practice

View full text Add to dashboard Cite

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“…More recent studies have focused on educational interventions to contribute towards promoting clinical reasoning (Ark, Brooks, & Eva, 2007;Harris, Boyce, & Ajjawi, 2011;Radomski & Russell, 2010;Stieger, Praschinger, Kletter, & Kainberger, 2011). However, little research explores how non-medical prescribers clinically reason to arrive at a clinically appropriate decision (Mcintosh, Stewart, Forbes-Mckay, Mccaig, & Cunningham, 2016). A study investigating prescribing decisions of general practitioners and nurse prescribers when prescribing antibiotics for children found both used pattern recognition followed by deductive reasoning (Horwood, Cabral, Hay, & Ingram, 2016).…”

Section: Introductionmentioning

confidence: 99%

A qualitative study exploring how pharmacist and nurse independent prescribers make clinical decisions

Abuzour

Lewis

Tully

2017

Journal of Advanced Nursing

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“…A recent systematic review (McIntosh, Stewart, Forbes-McKay, McCaig, & Cunningham, 2016) examining factors that influence prescribing decisions of "non-medical" prescribers, such as nurse practitioners, included only 3 studies, all employing qualitative methods (Offredy, Kendall, & Gooman, 2008;Philp & Winfield, 2010;Rowbotham et al, 2012). Multiple factors, some found to be contradictory, were found to influence "non-medical" prescriber`s decisions.…”

Section: Factors That Influence Prescribingmentioning

confidence: 99%

“…Multiple factors, some found to be contradictory, were found to influence "non-medical" prescriber`s decisions. These factors included the following experience in the role (Philp & Winfield, 2010), use of evidence-based guidelines (Philp & Winfield, 2010;Rowbotham et al, 2012), peer support (Offredy et al, 2008), encouragement from doctors (Offredy et al, 2008) and clinical uncertainty (McIntosh et al, 2016). Two of the studies (Philp & Winfield, 2010;Rowbotham et al, 2012) included in the review focused specifically on antimicrobial prescribing, in these two studies, sometimes prescribers chose to ignore evidence-based guidelines and practice policy in response to uncertainty of clinical outcomes and the risk of potential complications.…”

Section: Factors That Influence Prescribingmentioning

confidence: 99%

A survey of nurse practitioner controlled drugs and substances prescribing in three Canadian provinces

O’Rourke

Kirk

Duff

et al. 2019

Journal of Clinical Nursing

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Aims and objectives In Canada, nurse practitioners (NP) were legally authorised to prescribe controlled drugs and substances (CDS) in 2012. The objective of this study was to understand current NP‐CDS prescribing in Alberta, Manitoba and Saskatchewan, Canada. This study is a component of a larger three‐phase survey of NP practice patterns in these same provinces. Background Nurse practitioners are nurses with a graduate degree who have the legal authority to perform expanded functions in health systems, including prescribing CDS. Given the novelty of CDS prescribing for NPs in Canada, little is known about this component of their role. Design A secondary analysis of survey data collected between March 2016 and May 2017 was used to examine NP‐CDS‐prescribing patterns and identify potential associated factors. Methods Nurse practitioners in Alberta, Manitoba and Saskatchewan were invited to complete a professional practice pattern survey. The survey was administered through a secure electronic data collection software application (redcap). In the practice pattern survey, 42 variables from 15 distinct conceptual questions were analysed in this study as potential predictors of NP‐CDS prescribing within a purposeful selection ordinal logistic regression model. This scientific submission has been assessed for accuracy and completeness using the Equator STROBE guideline criteria (see Appendix S1). Results/Findings Five variables were found to be associated with an increased odds of more frequent NP‐CDS prescribing in addition to three confounders/clinically relevant variables. Factors commonly associated with an increased frequency of NP‐CDS prescribing relate to location of practice, area of practice, previous nursing experience, team environments and common diagnoses. Conclusion Little is known about NP‐CDS prescribing. Understanding this important component of the NPs emerging legal scope of professional practice can contribute to the continued refinement of this role as well as support ongoing enquiry into the causes of, and potential interventions to prevent, the present opioid overdose deaths occurring while under an active prescription. Relevance to clinical practice Understanding factors that influence NP‐CDS prescribing has relevance to the current drug‐related prescription fatalities crisis in all countries.

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

Cited by 30 publications

References 37 publications

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

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

A qualitative study exploring how pharmacist and nurse independent prescribers make clinical decisions

A survey of nurse practitioner controlled drugs and substances prescribing in three Canadian provinces

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