Development of consensus guidance to facilitate service redesign around pharmacist prescribing in UK hospital practice.

Background The last decade has seen a drive towards non-medical prescribing in the United Kingdom (UK). However, there is a dearth of any published literature on applying the principles of service redesign to support pharmacist prescribing in any sphere of practice. Objective To develop consensus guidance to facilitate service redesign around pharmacist prescribing. Setting UK hospital practice. Methods The Delphi technique was used to measure consensus of a panel of expert opinion holders in Scotland. Individuals with key strategic and operational roles in implementing initiatives of pharmacy practice and medicines management were recruited as experts. An electronic questionnaire consisting of 30 statements related to pharmacist prescribing service redesign was developed. These were presented as five-point Likert scales with illustrative quotes. Main outcome measures Consensus, defined as 70 % of panel members agreeing (ranked strongly agree/agree) with each statement. Results Responses were obtained from 35/40 (87.5 %) experts in round one and 29 (72.5 %) in round two. Consensus in round one was achieved for 27/30 of statements relating to aspects of generic service development (e.g. succession planning, multidisciplinary working, quality evaluation, practice development and outcome measures) and pharmacist prescribing role development (e.g. education and future orientation of service). Issues of disagreement were around targeting of pharmacist prescribing to clinical specialities and financial remuneration for prescribing in the hospital setting. Conclusion Consensus guidance has been developed to facilitate service redesign around hospital pharmacist prescribing

Influences on prescribing decision-making among non-medical prescribers in the United Kingdom: systematic review.

Background - Suitably qualified non-medical healthcare professionals may now prescribe medicines. Prescribing decision-making can be complex and challenging; a number of influences have been identified among medical prescribers but little appears to be known about influences among non-medical prescribers (NMPs). Objective - To critically appraise, synthesize and present evidence on the influences on prescribing decision-making among supplementary and independent NMPs in the UK. Methods - The systematic review included all studies between 2003 and June 2013. Included studies researched the prescribing decision-making of supplementary and independent NMPs practising in the UK; all primary and secondary study designs were considered. Studies were assessed for quality and data extracted independently by two researchers, and findings synthesized using a narrative approach. Results - Following duplicates exclusion, 886 titles, 349 abstracts and 40 full studies were screened. Thirty-seven were excluded leaving three for quality assessment and data extraction. While all studies reported aspects of prescribing decision-making, this was not the primary research aim for any. Studies were carried out in primary care almost exclusively among nurse prescribers (n = 67). Complex influences were evident such as experience in the role, the use of evidence-based guidelines and peer support and encouragement from doctors; these helped participants to feel more knowledgeable and confident about their prescribing decisions. Opposing influences included prioritization of experience and concern about complications over evidence base, and peer conflict. Conclusion - While there is a limited evidence base on NMPs' prescribing decision-making, it appears that this is complex with NMPs influenced by many and often opposing factors

Exploring and evaluating pharmacist prescribing.

This report describes in detail the research conducted by the 'Prescribing Research Group', supported by NES funding. Members of the group are listed on the front cover. Since inception date, this group has been highly active in the field of pharmacy prescribing research with: - 11 papers in peer-reviewed pharmacy and non-pharmacy journals - Over 20 research abstracts presented at national and international research conferences - Members invited to give key note presentations relating to pharmacist prescribing at leading conferences - Influence of findings on undergraduate and postgraduate pharmacy education and training at RGU and wider afield - Attraction of research monies to further explore areas of pharmacist prescribing

Provision of advice on alcohol use in community pharmacy: A cross-sectional survey of pharmacists' practice, knowledge, views and confidence

Objective: Community pharmacists are well placed to provide advice to clients on public health issues such as alcohol use. The aim of the study was to characterise community pharmacists' current level of activity and views on providing such advice in Scotland. Method: A postal questionnaire survey, covering provision of advice, knowledge and views on alcohol issues, was sent to all community pharmacies in Scotland (n = 1098). Key findings: The response rate was 45% (497/1098). Knowledge of recommended alcohol-intake limits was high (79 and 84% correct for male and female limits, respectively), but few respondents (5%) currently advised clients on alcohol consumption once a week or more and 29% had never done so. Around a quarter were confident in explaining alcohol limits, binge drinking and confidentiality issues, but about 40% lacked confidence in screening and providing a brief intervention on alcohol. Respondents expressed mixed views on the appropriateness of pharmacist involvement in discussing alcohol use with clients. Attitudes to harmful or hazardous drinkers varied: some 20% of respondents felt uncomfortable with this group, whereas another 20% felt they could work with this group as well as with any other. Conclusion: Community pharmacists in Scotland provide little advice on alcohol use, have a reasonable knowledge of recommended limits but lack the knowledge and confidence to provide a brief intervention. Implementation of a brief alcohol intervention in community pharmacy, therefore, would need to be underpinned by an appropriate training programme. Such a programme needs to provide factual knowledge but must also address pharmacists' attitudes to clients and promote confidence in service delivery

School-based drug education in northeast Scotland : policy, planning and practice

This research utilised qualitative methods to gain a deeper insight into the policy, planning and practice of school-based drug education than had previously been achieved in Scotland. Semi-structured interviews were carried out with staff in nine Grampian secondary schools together with a case study of one school. The case study involved direct lesson observations as well as in-depth interviews and feedback sessions with stakeholders in drug education including staff and 48 pupils. In both parts of the study schools were selected by theoretical sampling, each interview was transcribed in full and all data were annotated and analysed with the aid of specialist computer software. Validity and reliability were enhanced by constant vigilance in data analysis and by various procedures including reactivity analysis, peer examination,triangulation and consideration of any potential bias on the part of the researcher. The highest standards of ethics were applied throughout the study. Whereas previous studies have revealed the lack of impact of drug education on drugtaking behaviour in young people, this research is unique in attempting to explain this lack of impact. The research findings revealed that teaching and learning processes in drug education were below best practice as defined by the relevant research literature and national guidelines. Four key underlying issues were identified: (1) A lack of clarity and understanding about the goals of drug education;( 2) A lack of time and support for researching, planning and reviewing drug education; (3) A low priority assigned to Personal and Social Education (PSE) in general; (4) A failure to recognise drug education as a broad and complex subject requiring considerable expertise to teach. Fundamental changes to how drug education is approached both locally and nationally would be required to resolve these issues in full. Ihe nature of these changes is discussed in detail in the thesis.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Developing and evaluating training for community pharmacists to deliver interventions on alcohol issues

Objective: To evaluate community pharmacists' readiness to provide brief interventions on alcohol and to use study findings to develop training to enable them to screen for hazardous or harmful drinking and intervene appropriately. Setting: Community pharmacies in Scotland. Method: Eight community pharmacies in Greater Glasgow, Scotland were purposively selected on the basis of pharmacy (independent, multiple), population deprivation index, location (rural, urban, suburban), and local level of hospital admissions for alcohol misuse. Baseline pharmacist telephone interviews covered: current practice; attitudes towards a proactive role; and perceived training needs. A two-day course was designed focusing on: consequences of problem alcohol use; attitudes; sensible drinking; familiarity with client screening using the Fast Alcohol Screening Tool; brief interventions and motivational interviewing. Main Outcome Measures: Knowledge of problem alcohol use and brief interventions; attitudes; competence. Results: Participants felt it was feasible for trained pharmacists to provide brief interventions. Core training needs centred on communication and alcohol related knowledge. The training course was positively evaluated and led to increases in knowledge, attitudinal scores and self related competence. Conclusion: A training programme for pharmacists to deliver brief interventions to problem drinkers was successfully delivered resulting in enhanced knowledge, attitudinal scores and self related competence

Exploring pharmacist prescribing in hospitals in Scotland, with a focus on antimicrobials

This aim of the research was to explore pharmacist prescribing (PP) with a focus on antimicrobials, in hospitals in Scotland. A mixed-methods approach was used to collect, generate and synthesise data. A systematic review of peer-reviewed published literature on evidence-based roles for the pharmacist as part of an antimicrobial multidisciplinary team, identified roles for pharmacists within the teams but limited evidence relating to outcomes associated with these roles. Six qualitative focus groups, with 37 hospital pharmacists in 5 Scottish Health Boards, contextualised perceptions of barriers to, and facilitators of, implementation of PP in hospitals. Key themes were: perceived lack of pharmacy management support to take on a prescribing role and little strategic attention paid to PP implementation and sustainability. These issues were discussed in relation to PP in general and not only for antimicrobials. Participants perceived successful implementation of PP to be associated with factors including ward type and patient’s clinical condition. None of the pharmacists were prescribing antimicrobials and consequently further studies focused on PP in general. A scoping exercise, utilising various sources of information, reinforced findings from Phase 1; it highlighted the absence of any national or Health Board frameworks to support implementation of PP in secondary care in Scotland. Consensus-based research was undertaken, therefore, to provide guidance to facilitate service redesign involving PP in secondary care in Scotland. A Delphi approach undertaken with 40 experts, mainly in strategic posts, resulted in a high level of agreement in areas relating to succession planning, rather than role development; more variability was obtained in areas relating to future orientation of service, competencies required by prescribers and potential development of non-medical prescribing teams. The guidance was developed into a self-assessment toolkit providing an analytical strategy for implementation and role development of PP in secondary care. While the results and conclusions generated through this research need to be interpreted with caution, the data generated is an original contribution to the evidence base relating to PP.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

General practitioners' views and experiences of over-the-counter simvastatin in Scotland

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Statins are widely used for the primary and secondary prevention of coronary events in high risk populations. • In 2004 simvastatin was reclassified in the UK from prescription only to being available over-the-counter (OTC). WHAT THIS STUDY ADDS • The majority of GPs do not support the supply of OTC simvastatin by the community pharmacist. • GPs were particularly concerned by the lack of cholesterol and blood pressure data in the CHD risk assessment prior to sale. AIMS The aims of this study were to determine the views and experiences of Scottish GPs towards CVD risk assessment by community pharmacists and the supply and sale of simvastatin. METHODS A cross sectional postal questionnaire survey of all primary care general practices in Scotland was carried out. The main outcome measure was GPs' awareness of and opinions regarding OTC simvastatin use, experience of OTC simvastatin and opinions regarding community pharmacist involvement in CHD risk assessment. RESULTS A response rate of 45.7% was obtained. The majority (92.6%, 428) were aware that community pharmacists could sell simvastatin to reduce the risk of a first coronary event in individuals at moderate risk of CHD. However, over half (55.6%, 257) believed that the OTC sale of simvastatin was inappropriate. Just over half were unaware that the pharmacist's CHD risk assessment for the sale of simvastatin did not include lipid (54.8%, n= 253) or blood pressure measurement (53.7%, n= 248) and 56.7% (262) and 57.8% (267) of respondents, respectively, thought these omissions inappropriate. Almost half of the respondents (48.1%, 222) supported community pharmacists supplying simvastatin as supplementary prescribers while fewer (26.6%, 132) were in favour of supply via an independent prescribing arrangement. CONCLUSION This study confirms that the majority of GPs do not support the supply of OTC simvastatin by the community pharmacist, being particularly concerned by the lack of cholesterol and blood pressure data in the CHD risk assessment prior to sale. Other methods of pharmacy based simvastatin supply including supplementary prescribing merit further evaluation