Medicines management activity with physiotherapy and podiatry: A systematic mixed studies review

Abstract

Objective: Making best use of existing skills to increase service capacity is a global challenge. The aim was to systematically review physiotherapy and podiatrist prescribing and medicines management activity, including evidence of impact on patient care, levels of knowledge and attitudes towards extended medicines role. Methods: A search of MEDLINE, CINAHL, and Cochrane databases, using terms to identify prescribing and medicines management across a range of roles, was conducted from January 1985 to May 2016 for physiotherapy, and January 1968 to May 2016 for podiatry. Hand searching of citations and databases from professional organisations was undertaken. Data were extracted and analysed descriptively, and quality appraised by 2 reviewers using the mixed methods appraisal tool. Results: 1316 papers were identified, and 21 included in the review. No studies were identified that reported prescribing and no studies specific to podiatry met the inclusion criteria. Physiotherapists were highly involved in administering medicines, providing medicines advice, and recommending new medicines. Patient satisfaction, cost and outcomes were equivalent when comparing physiotherapist-led injection therapy to traditional care. Pharmacology knowledge was variable and unmet training needs identified. Conclusion: Medicines management practices were identified in physiotherapy and positive outcomes of extended scope physiotherapy. There was a lack of evidence regarding podiatric practice. Review of educational preparation for medicines management is recommended along with evaluation of medicines management practice.

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

“…This is the only known national evaluation of PP-IP in the UK or the world, and the rst to adopt a comparative case study design to compare outcomes and costs for patients managed by PP-IPs and NP-PPs. Unlike nurses and pharmacists, where prescribing has been explored in some detail using selfreported outcomes (32,53,62), there is a dearth of equivalent information in the allied health professions, including either physiotherapy and/ or podiatry (35,41) and/ or studies adopting direct observation of outcomes (32). Our study demonstrates that care provided by PP-IPs is equivalent, in terms of quality of life and patient satisfaction, to care provided by NP-PPs with prescribing undertaken by doctors.…”

“…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). Podiatrists have similar authority in Australia and some European countries but are only entitled to prescribe in some Canadian states (35,37).…”

“…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). Podiatrists have similar authority in Australia and some European countries but are only entitled to prescribe in some Canadian states (35,37).…”

“…More recently a systematic review of non-doctor prescribing, also known as non-medical prescribing (NMP), reported that NMP has no adverse impact upon patient outcomes, patient satisfaction or resource utilisation (41). Reviews on the impact of extended physiotherapist roles reveal research hampered by small numbers of practitioners, role variation and poor role de nition (42,43), literature dominated by service descriptions and audit with positive reporting bias (35,42,43), and a lack of evidence regarding podiatric practice (35). Whilst PP-SP helps streamline service delivery (44,45), IP is expected to bring additional bene ts in line with nurse and pharmacist prescribing (46,47).…”

Limited pharmaceuticalisation: a qualitative case study of physiotherapist prescribing practices in an NHS Trust in England following the expansion of non‐medical prescribing in the UK

“…In this article, we seek to offer insights into the role of one of the allied health professions in expanding access to medicines, by reporting on a case of physiotherapists' prescribing practices in the English NHS. UK physiotherapists have been able to prescribe medicines since 2005, but relatively little is known about their prescribing practices or their influence on pharmaceuticalisation (Carey et al 2017, Stenner et al 2018.…”