Future perspectives on nonmedical prescribing

Abstract

Many countries have implemented nonmedical prescribing (NMP) and many others are scoping prescribing practices with a view to developing NMP. This paper provides a future perspective on NMP in light of findings of an umbrella review of aspects of NMP. This is followed by coverage of the Scottish Government strategy of pharmacist prescribing and finally, consideration of two key challenges. The review identified seven systematic reviews of influences on prescribing decision-making, processes of prescribing, and barriers and facilitators to implementation. Decision making was reported as complex with many, and often conflicting, influences. Facilitators of NMP included perceived improved patient care and professional autonomy, while barriers included lack of defined roles and resource pressures. Three systematic reviews explored patient outcomes that were noted to be equivalent or better to physician prescribing. In particular, a Cochrane review of 46 studies of clinical, patientreported, and resource-use outcomes of NMP compared with medical prescribing showed positive intervention-group effects. Despite positive findings, authors highlighted high bias, poor definition and description of 'prescribing' and the 'prescribing process' and difficulty in separating NMP effects from the contributions of other healthcare team members. While evidence of benefit and safety is essential to inform practice, for NMP to be implemented and sustained on a large scale, there needs to be clear commitment at the highest level. The approach being taken by the Scottish Government to pharmacist prescribing implementation may inform developments in other professions and countries. The vision is that by 2023, all pharmacists providing pharmaceutical care will be pharmacist-independent prescribers. There are, however, challenges to implementing NMP into working practice; two key challenges are the need for sustainable models of care and evaluation research. These challenges could be met by considering the theoretical basis for implementation, and robust and rigorous evaluation.

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

“…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.…”

“…The severity of the workforce deficit makes changes, such as the increased level of clinical autonomy, associated with independent prescribing an attractive option to commissioners who seek to address gaps in service delivery. As the world leader in extending prescribing rights to nurses, pharmacists and allied health professions the findings are of significant importance to international policy makers who seek to learn from the pioneering advancement of prescribing rights in UK (31,34) to inform their own approach to addressing the workforce deficit.…”

“…Although several other countries, including Australia, Ireland, and Netherlands, have seen similar developments in non-medical prescribing, approaches to training, accreditation and models of prescribing practice are varied (31)(32)(33)(34). Physiotherapists have for example, authorisation to provide advice about and/or to administer or supply medicines in some states in Australia, New Zealand and Canada, but only those in the US military can prescribe (35,36).…”

“…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.…”

A Comparative Case Study of Prescribing and Non-Prescribing Physiotherapists and Podiatrists

“…Although several other countries, including Australia, Ireland, and Netherlands, have seen similar developments in non-medical prescribing, approaches to training, accreditation and models of prescribing practice are varied (31)(32)(33)(34). Physiotherapists have for example, authorisation to provide advice about and/or to administer or supply medicines in some states in Australia, New Zealand and Canada, but only those in the US military can prescribe (35,36).…”