Assessing the contribution of prescribing in primary care by nurses and professionals allied to medicine: a systematic review of literature

Abstract

BackgroundSafe and timely access to effective and appropriate medication through primary care settings is a major concern for all countries addressing both acute and chronic disease burdens. Legislation for nurses and other professionals allied to medicine to prescribe exists in a minority of countries, with more considering introducing legislation. Although there is variation in the range of medicines permitted to be prescribed, questions remain as to the contribution prescribing by nurses and professionals allied to medicine makes to the care of patients in primary care and what is the evidence on which clinicians, commissioners of services and policy makers can consider this innovation.MethodsA integrative review of literature on non-medical prescribing in primary care was undertaken guided by dimensions of health care quality: effectiveness, acceptability, efficiency and access.Results19 papers of 17 empirical studies were identified which provided evidence of patient outcome of non medical prescribing in primary care settings. The majority were undertaken in the UK with only one each from the USA, Canada, Botswana and Zimbabwe. Only two studies investigated clinical outcomes of non-medical prescribing. Seven papers reported on qualitative designs and four of these had fewer than ten participants. Most studies reported that non medical prescribing was widely accepted and viewed positively by patients and professionals.ConclusionsPrimary health care is the setting where timely access to safe and appropriate medicines is most critical for the well-being of any population. The gradual growth over time of legislative authority and in the numbers of non-medical prescribers, particularly nurses, in some countries suggests that the acceptability of non-medical prescribing is based on the perceived value to the health care system as a whole. Our review suggests that there are substantial gaps in the knowledge base to help evidence based policy making in this arena. We suggest that future studies of non-medical prescribing in primary care focus on the broad range of patient and health service outcomes and include economic dimensions.

Stakeholders’ views on granting prescribing authority to pharmacists in Nigeria: a qualitative study

“…Prescribing to patients was the exclusive role of doctors and dentists, until the introduction of non-medical prescribing (NMP) in some countries which allowed non-medical professionals including nurses and pharmacists to prescribe medicines [2,3]. A number of countries have legislated for NMP including the United States of America (USA), United Kingdom (UK), Australia, New Zealand, Canada, Sweden, Republic of Ireland, South Africa, Botswana, Kenya and Uganda [4]. Nurse prescribing is the most popular form of NMP.…”

Medication prescription by nurses and the case of the Brazil: What can we learn from international research?

“…At the same time, national studies of supplementary prescribing (Bissell et al, 2008) mental health nurse prescribing (Norman et al, 2010) and independent prescribing in Ireland (Naughton et al, 2013) all showed largely positive findings, and so helped build support and confidence for nurse prescribing in the UK. Studies demonstrate that the prescription of medication by nurses is safe and competent, has led to better access and quality of care for patients, improvements in the abilities and experience of nurses, increased professional recognition, the legitimation of responsible autonomous practice and enabled better team working between the various healthcare professionals (Latter et al, 2012;Kroezen et al, 2011;Bhanbhro et al, 2011). Kroezen et al (2011) state that patient support and grassroots legislative constituency are crucial in battles over prescribing rights and these UK national studies all consistently reported patient support for nurse prescribing.…”

Non-medical prescribing in New Zealand: an overview of prescribing rights, service delivery models and training

“…72 There has also been research into NMP in Australia, Canada, and the USA. 62,73,74 There is a considerable lack of research on NMP in NZ compared with other countries. 72 The establishment of a collaborative research network in NZ could address this issue.…”