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

Carey, Nicola; Edwards, J. G.; Otter, Simon; Gage, Heather; Williams, Peter; Courtenay, Molly; Moore, Ann; Stenner, Karen

doi:10.1101/2020.01.09.900043

Cited by 7 publications

(12 citation statements)

References 41 publications

(54 reference statements)

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“…Improvements in the efficiency of healthcare delivery, access to medicines and reductions in costs across the health economy were suggested as potential benefits. These findings concur with those reported by student physiotherapists in Australia as detailed in a related article,16 as well as reflecting an evaluation of physiotherapist and podiatrist independent prescribers in the UK,27 strengthening the external validity and transferability of the results. Concerns regarding clinical safety and management of clinical risk were clearly identified throughout the quantitative and qualitative sections of the survey, supporting the results of an international multiprofession mixed-methods systematic review investigating the barriers and facilitators of the implementation and utilisation of NMP 5.…”

Section: Discussionsupporting

confidence: 90%

Perceptions about the implementation of physiotherapist prescribing in Australia: a national survey of Australian physiotherapists

et al. 2019

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ObjectivesTo explore: (1) the views of Australian physiotherapists regarding potential implementation of non-medical prescribing in Australia, (2) how the geographical location and health sector in which a clinician works may influence their perceptions and (3) the perceptions of Australian physiotherapists about how physiotherapist prescribing might impact the care that the profession can provide.DesignA cross-sectional descriptive survey using open and closed questions.SettingParticipants completed an online questionnaire.Participants883 Australian Health Professionals Registration Authority (AHPRA)-registered physiotherapists, working across all states and territories.Outcome measuresAn online questionnaire was developed by a panel of subject experts and pretested (n=10) for internal consistency. A hyperlink to the questionnaire was emailed to all members of the Australian Physiotherapy Association. A reminder email was sent 4 weeks later. Quantitative data were analysed descriptively, with use of absolute risk reductions (ARRs) and 95% CIs to determine the likelihood that health sector or geographical location were associated with specific views. Thematic analysis enabled synthesis of the qualitative data.Results79.0% participants felt that physiotherapist prescribing should be introduced in Australia, with 71.2% wanting to train as prescribers. Clinical governance, risk management, regulation of clinicians and the development of an education framework were identified as priorities for implementation. Participants working in the private sector were significantly more likely to train as prescribers than those in the public sector (ARR 9.9%; 95% CI 3.5 to 16.4) or educational/research institutions (ARR 23.3%; 95% CI 12.8 to 33.8), with city dwellers significantly more likely to train compared with physiotherapists in remote regions (ARR 19.8%; 95% CI 0.8 to 39.2). Physiotherapist prescribing was predicted to improve efficiency of healthcare delivery, access to medicines and reductions in healthcare costs.ConclusionsAHPRA-registered physiotherapists perceive that the introduction of autonomous physiotherapist prescribing would be beneficial for the Australian population and should be introduced. Decision makers should consider the results of this survey in conjunction with cost–benefit and risk analysis when planning the introduction of physiotherapist prescribing.

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Section: Discussionsupporting

confidence: 90%

Perceptions about the implementation of physiotherapist prescribing in Australia: a national survey of Australian physiotherapists

et al. 2019

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“… 61–64 Difficulties with implementation are frequently cited. 43 46 59 65–67 Several UK 68 69 and international systematic 54 70–72 and literature reviews, 73 74 have focused on implementation barriers and/or facilitators. However, these have been profession-specific, 54 70–72 74 have included international models with varying legislative/jurisdictional levels of prescribing autonomy 54 70–72 and/or have addressed prescribing in heterogenous care settings.…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review

2022

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ObjectivesTo support workforce deficits and rising demand for medicines, independent prescribing (IP) by nurses, pharmacists and allied health professionals is a key component of workforce transformation in UK healthcare. This systematic review of qualitative research studies used a thematic synthesis approach to explore stakeholders’ views on IP in primary care and identify barriers and facilitators influencing implementation.SettingUK primary/community care.ParticipantsInclusion criteria were UK qualitative studies of any design, published in the English language. Six electronic databases were searched between January 2010 and September 2021, supplemented by reference list searching. Papers were screened, selected and quality-appraised using the Quality Assessment Tool for Studies with Diverse Designs. Study data were extracted to a bespoke table and two reviewers used NVivo software to code study findings. An inductive thematic synthesis was undertaken to identify descriptive themes and interpret these into higher order analytical themes. The Diffusion of Innovations and Consolidated Framework for Implementation Research were guiding theoretical anchors.Primary and secondary outcome measuresN/A.ResultsTwenty-three articles addressing nurse, pharmacist and physiotherapist IP were included. Synthesis identified barriers and facilitators in four key stages of implementation: (1) ‘Preparation’, (2) ‘Training’, (3) ‘Transition’ and 4) ‘Sustainment’. Enhancement, substitution and role-specific implementation models reflected three main ways that the IP role was used in primary care.ConclusionsIn order to address global deficits, there is increasing need to optimise use of IP capability. Although the number of independent prescribers continues to grow, numerous barriers to implementation persist. A more coordinated and targeted approach is key to overcoming barriers identified in the four stages of implementation and would help ensure that IP is recognised as an effective approach to help alleviate workforce shortfalls in the UK, and around the world.PROSPERO registration numberCRD42019124400.

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“…Paramedic skills and experience can benefit multidisciplinary team working, and improve efficiency, capacity and quality of care. Independent prescribing facilitated the expansion of new and innovative roles for paramedics, as reported by other professions ( Carey et al, 2017 ; Hindi et al, 2019 ), and was considered an essential component for many advanced roles. Furthermore, it facilitated parity of access to ACP roles and this was a strong motivator to undertake the prescribing qualification.…”

Section: Discussionmentioning

confidence: 96%

Paramedic independent prescribing: a qualitative study of early adopters in the UK

Stenner

Even²,

Collen

2021

British Paramedic Journal

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Background: Paramedics working in advanced practice roles in the UK can now train to prescribe medicine. This is anticipated to benefit patient access to medicines and quality of care where there is a national shortage of doctors, particularly in primary care.Aim: To explore the experience of paramedics who are early adopters of independent prescribing in a range of healthcare settings in the UK.Design and setting: A qualitative study involving interviews between May and August 2019, with paramedics in the UK who had completed a prescribing programme.Methods: Individual interviews with a purposive sample of paramedics recruited via social media and regional paramedic networks. Interviews covered experiences, benefits and challenges of the prescribing role. A framework analysis approach was used to identify key themes.Results: Participants were 18 advanced paramedics working in primary care, emergency departments, urgent care centres and rapid response units. All participants reported being adequately prepared to prescribe. Key benefits of prescribing included improving service capacity, efficiency and safety, and facilitating advanced clinical roles. Challenges included technological problems, inability to prescribe controlled drugs and managing expectations about the prescribing role. Concerns were raised about support and role expectations, particularly in general practice.Conclusion: Paramedic prescribing is most successful in settings with a high volume of same-day presentations and urgent and emergency care. It facilitated advanced roles within multidisciplinary teams. Concerns indicate that greater consideration for support infrastructure and workforce planning is required within primary care to ensure paramedics meet the entry criteria for a prescribing role.

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

Cited by 7 publications

References 41 publications

Perceptions about the implementation of physiotherapist prescribing in Australia: a national survey of Australian physiotherapists

Perceptions about the implementation of physiotherapist prescribing in Australia: a national survey of Australian physiotherapists

Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review

Paramedic independent prescribing: a qualitative study of early adopters in the UK

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