Identifying enablers and barriers to individually tailored prescribing: a survey of healthcare professionals in the UK

Abstract

BackgroundMany people now take multiple medications on a long-term basis to manage health conditions. Optimising the benefit of such polypharmacy requires tailoring of medicines use to the needs and circumstances of individuals. However, professionals report barriers to achieving this in practice. In this study, we examined health professionals’ perceptions of enablers and barriers to delivering individually tailored prescribing.MethodsNormalisation Process Theory (NPT) informed an on-line survey of health professionals’ views of enablers and barriers to implementation of Individually Tailored Prescribing (ITP) of medicines. Links to the survey were sent out through known professional networks using a convenience/snowball sampling approach. Survey questions sought to identify perceptions of supports/barriers for ITP within the four domains of work described by NPT: sense making, engagement, action and monitoring. Analysis followed the framework approach developed in our previous work.ResultsFour hundred and nineteen responses were included in the final analysis (67.3% female, 32.7% male; 52.7% nurse prescribers, 19.8% pharmacists and 21.8% GPs). Almost half (44.9%) were experienced practitioners (16+ years in practice); around one third reported already routinely offering ITP to their patients. GPs were the group least likely to recognise this as consistent usual practice. Findings revealed general support for the principles of ITP but significant variation and inconsistency in understanding and implementation in practice. Our findings reveal four key implications for practice: the need to raise understanding of ITP as a legitimate part of professional practice; to prioritise the work of ITP within the range of individual professional activity; to improve the consistency of training and support for interpretive practice; and to review the impact of formal and informal monitoring processes on practice.ConclusionThe findings will inform the ongoing development of our new complex intervention (PRIME Prescribing) to support the individual tailoring of medicines needed to address problematic polypharmacy.Electronic supplementary materialThe online version of this article (10.1186/s12875-017-0705-2) contains supplementary material, which is available to authorized users.

Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: a systematic review

“…The mixedmethods studies used varying combinations of semistructured interviews, focus groups, survey data, patient data, and narrative and systematic reviews of the literature [31,40,42,43]. The document analysis article adopted a mapping approach and the quantitative paper utilised a cross-sectional survey [54,59].…”

“…The majority (n = 23) of studies reported using NPT in the pilot evaluation of interventions only [32, 36-41, 43-53, 55-58, 61], while five chose NPT as a framework for developing interventions [31,36,54,59,60], and three used the theory in RCTs [33,37,42].…”

“…The remaining eight studies used NPT prospectively, to inform the design of data collection tools and procedures [36,37,40,[48][49][50][51]54]. Among these, NPT was utilised in the design of interview guides (n = 6) [36,37,40,[49][50][51],…”

Revitalizing Generalist Practice: The Montreal Statement

“…5 Whole-person individually tailored clinical decision making is the expertise of the medical generalist. 6 Medical generalism is a distinct form of clinical practice that is complementary to, but different from, specialist practice.…”

Deprescribing: tackling increasing polypharmacy

“…Providing individually tailored care to patients with polypharmacy was the subject of a recent survey led by Dr Reeve. 24 A total of 444 health professionals responded, with nurses making up the majority of respondents (53%); 22% of respondents were GPs and 20% pharmacists. One-third of the respondents claimed to be providing individualised prescribing, with GPs being least likely to be doing so.…”