Pharmacist Prescribing: Let's Have the Debate

Aim: To explore Australian general practitioners' views on extending prescribing rights to pharmacists, the appropriateness of pharmacist prescribing models, and the influence of general practitioners' characteristics on their preference for a particular pharmacist prescribing model. Method: The study consisted of two parts. Part A was a scenario-based questionnaire using Likert-scale responses and Part B was a semi-structured interview. General practitioners were randomly recruited from two Sydney divisions of general practice. Data were analysed using descriptive statistics and qualitative responses were thematically analysed. Results: Completed questionnaires were received from 22/ 150 general practitioners (response rate 15%), with 10 general practitioners providing additional comments. 10/12 (83%) general practitioners participated in the interviews. Repeat prescribing and prescribing by referral were the most favoured models; 53% of general practitioners rated them as appropriate or somewhat appropriate models of pharmacist prescribing. 6 major themes emerged: focus on safety issues, lack of awareness of pharmacist training and capabilities, division of professional/clinical responsibility, conflict in definition of prescribing versus treating, interference with the general practitioner-patient relationship and remuneration.

Section: Interference With the Focus On Safety Issues Conflicts In Dementioning

confidence: 99%

Australian General Practitioners' Views on Pharmacist Prescribing

Vracar¹,

Bajorek

2008

“…Supplementary prescribing has been defined as 'a voluntary prescribing partnership between an independent prescriber and a supplementary prescriber, to implement an agreed patient-specific clinical management plan with the patient's agreement' <www.dh.gov.uk>. 7 Thus at MPH the situation whereby analgesic requirements were selected by the pharmacist prior to discharge might be formalised in the context of a supplementary prescribing arrangement, whereby the prescriber carries out the initial assessment of the patient and subsequently, the pharmacist is able to write a prescription chargeable to the hospital or patient. This may also increase the proportion of prescriptions obtained for items listed on the PBS.…”

Section: Discussionmentioning

confidence: 99%

“…This topic is debated by Weeks who reported that pharmacist prescribing benefits patient outcomes and saves money. 7 Jones and Graham reported that pharmacists benefit from supplementary prescribing because it brings them clearer lines of responsibility and accountability and that organisations benefit from the better use of skills. 8 APAC principle 7 describes 'supply of medicines information to consumers'.…”

Section: Discussionmentioning

confidence: 99%

Optimising the Medication Management Continuum in a Private Hospital

Leach

2004

Aim: To audit the discharge process in a private hospital setting with a focus on clarity of discharge instructions. Method: A form was developed to collect data relating to the discharge process. The pharmacists for the neurology, surgical and cardiology wards at The Melbourne Private Hospital collected data over a 2-week period during December 2003. Results: Data relating to 270 patients discharged were collected. These data showed that discharge instructions were indicated on the drug chart in 52 (19%) cases. Discharge instructions were documented in the patient's case notes in 14 (5%) cases. Discharge prescriptions were written for submission to the Health Insurance Commission (as applicable), in 108 (40%) cases. Prescribers were contacted to clarify discharge instructions in 32 (12%) discharge episodes. Discharge medication requirements were established in consultation with the patient in 59 (22%) discharge episodes. Conclusion: The private hospital setting provides a number of challenges in obtaining complete and accurate information on discharge medication requirements. The pharmacist plays an important role in identifying the patient's discharge medication requirements and optimising the utilisation of the Pharmaceutical Benefits Scheme.

“…The extension of the pharmacist's role to that of a prescriber has been raised previously. [1][2][3] However, pharmacist prescribing projects in Australia will remain limited in scope until enabling legislation is passed and credentialing authorities established-along the lines of those in the UK for supplementary prescribing pharmacists. The opportunity to pursue a prescribing direction for hospital pharmacy practice arises from the significant challenge facing acute care hospitals to improve patient flow and decrease waiting times.…”

Section: Introductionmentioning

confidence: 99%

Pharmacist‐Initiated Electronic Discharge Prescribing for Cardiology Patients

Birdsey

Weeks

Bortoletto

et al. 2005

Self Cite

Aim To determine whether pharmacist‐initiated electronic discharge prescribing would decrease discharge times for selected cardiology patients and improve the accuracy of prescribing by limiting deviations from the intended therapeutic plan. Method A cardiology project team identified system issues impeding patient flow through the ward, including the discharge medication pathway. The stages of the medication pathway were mapped before and after the intervention of pharmacist‐initiated electronic discharge prescribing. The accuracy of prescribing in both phases of the study was measured against evidence‐based standards agreed by the cardiology unit. Results 39 patients were recruited in phase 1 (usual practice) and 35 patients in phase 2 (pharmacist‐initiated discharge prescriptions). The time from a decision to discharge a patient to the completed prescription reaching the patient was significantly reduced from a median of 190 minutes to 50 minutes in the intervention arm (p < 0.0001). However, this result did not translate into patients leaving the hospital earlier. In phase 1, 26% of prescriptions (n = 39) contained at least one error, including 19 clinically significant omissions. In phase 2, no omissions were made but the signing doctor made two changes to the pharmacist‐initiated prescriptions that were unrelated to the evidence‐based standards. Conclusion This pilot study has shown that an experienced pharmacy specialist using an electronic discharge prescribing system can significantly reduce the time elements of the discharge medication pathway. In addition, errors of omission that deviate from evidence‐based practice are reduced. This practice model can be extended to other specialist areas.