Pharmacist supplementary prescribing: A step toward more independence?

Dawoud, Dalia; Griffiths, Peter; Maben, Jill; Goodyer, Larry; Greene, Russell

doi:10.1016/j.sapharm.2010.05.002

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Volume 7, Issue 3 , Pages 246-256, September 2011

Pharmacist supplementary prescribing: A step toward more independence?

Dalia Dawoud, Ph.D.
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini, Cairo, P.O. Box 11562, Egypt
- Cicely Saunders Institute, King's College, London, Division of Cancer Studies, Denmark Hill, Bessemer Road, London SE5 9PJ, UK
- Corresponding author. Cicely Saunders Institute, King's College London, Division of Cancer Studies, Denmark Hill, Bessemer Road, London SE5 9PJ, UK. Tel.: +44 20 7848 5636; fax: +44 20 7848 5517.
Peter Griffiths, Ph.D.
- National Nursing Research Unit, King's College, London, Florence Nightingale School of Nursing and Midwifery, Waterloo Road, London, SE1 8WA, UK
Jill Maben, Ph.D.
- National Nursing Research Unit, King's College, London, Florence Nightingale School of Nursing and Midwifery, Waterloo Road, London, SE1 8WA, UK
Larry Goodyer, Ph.D.
- The Leicester School of Pharmacy, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
Russell Greene, Ph.D.
- Pharmacy Department, King's College, London, School of Biomedical and Health Sciences, Stamford Street, London, SE1 9NH, UK

published online 26 July 2010.

Abstract

Background

Supplementary prescribing (SP) is a drug therapy management model implemented in the United Kingdom since 2003. It is a voluntary partnership between an independent prescriber; a supplementary prescriber, for example, nurse or pharmacist; and the patient, to implement an agreed patient-specific clinical management plan (CMP).

Objective

To investigate pharmacist prescribers' views and experiences of the early stages of SP implementation.

Methods

A qualitative, longitudinal study design was used. A purposive, maximum variability sample of 16 pharmacist supplementary prescribers, trained in Southern England, participated. Eleven were hospital pharmacists, owing to the overrepresentation of hospital pharmacists in the first cohort. Two semistructured interviews were conducted with each participant, at 3 and 6 months after their registration as prescribers. The Framework approach was used for data collection, management, and analysis.

Results

Three typologies of pharmacists' experiences were identified: “a blind alley”, “a stepping stone” and “a good fit”. Despite some delays in its implementation, SP was seen as a step forward. Some participants also believed that it improved patient care and pharmacists' integration in the health care team and increased their job satisfaction. However, there was a concern that SP, as first implemented, was bureaucratic and limited pharmacists' freedom in their decision making. Hence, pharmacists were more supportive of the then imminent introduction of a pharmacist independent prescribing (IP) role.

Conclusions

Despite challenges, the SP role represented a step forward for pharmacists in the United Kingdom. It is possible that pharmacist SP can coexist with IP in the areas suitable for CMP use. Elsewhere, SP is likely to become more of a “stepping stone” to an IP role than the preferred model for pharmacist prescribing. Future research needs to objectively assess the outcomes of pharmacist SP, preferably in comparison with IP, to inform decision making among pharmacists regarding the adoption of such an innovative role.

Keywords: United Kingdom, Pharmacist, Supplementary prescribing, Drug therapy management, Qualitative, Framework analysis