Stakeholders’ views on granting prescribing authority to pharmacists in Nigeria: a qualitative study

Background: In Nigeria, only medical doctors, dentists and some nurses in primary care facilities have the legal right to prescribe medicines to patients. Patients’ access to prescription medicines can be seriously affected by the shortage of prescribers leading to longer waiting times in hospitals. Objective: This research was carried out to investigate stakeholders’ views on granting prescribing authority to pharmacists in Nigeria. Setting: The study was conducted in Nigeria Methods: Qualitative, semi-structured interviews were conducted with 43 Nigerian stakeholders including policymakers, pharmacists, doctors and patient group representatives. Transcribed interviews were entered into the QSR NVivo 10 software and analysed using a thematic approach. Main outcome measure: Stakeholders’ perception on the granting of prescribing authority to pharmacists in Nigeria. Results: Three major themes emerged from the interviews: 1) prescribing as a logical role for pharmacists, 2) pharmacist prescribing- an opportunity or a threat and 3) the potential barriers to pharmacist prescribing. Many non-medical stakeholders including pharmacists and patient group representatives supported an extended role for pharmacists in prescribing while the majority of medical doctors including those in policy making were reluctant to do so. Generally, all stakeholders perceived that pharmacist prescribing represents an opportunity to increase patients’ access to medicines, reduce doctors’ workload and promote the utilisation of pharmacists’ skills. However, many stakeholders including pharmacists and doctors commonly identified pharmacists’ inadequate skills in diagnosis, medical resistance and shortage of pharmacists as potential barriers to the introduction of pharmacist prescribing in Nigeria. Conclusion: The present study showed a split of opinion between participants who were medical doctors and those who were non-doctors in their support for pharmacist prescribing. However, all stakeholders acknowledged the potential of pharmacist prescribing to increase patients’ access to medicines in Nigeria

Perceived facilitators to change in hospital pharmacy practice in England

Background Traditionally, hospital pharmacists’ roles have been associated with dispensing medications prescribed by doctors and offering advice about medicines to patients and other healthcare professionals. In England, significant changes in the structure of hospital pharmacy practice began in the 1970s and currently hospital pharmacists are undertaking a number of advanced roles including prescribing. Objective This study investigated the facilitators to change in hospital pharmacy practice in England in order to identify lessons that might assist in the potential changes needed in other countries for extended clinical roles. Setting The study was conducted in England. Methods A qualitative study using semi-structured interviews was conducted with 28 participants, comprising 22 pharmacists and 6 pharmacy technicians from England. They were recruited through a snowball sampling technique. Transcribed interviews were entered into the QSR NVivo 10 software for data management and analysed thematically. Main outcome measure Pharmacists and pharmacy technicians’ perception of the facilitators to hospital pharmacy practice change in England. Result Three major themes emerged from this study: drivers for change, strategies for change and efficiency. Many of the drivers identified were linked to changes in the structure of hospital pharmacy including education and training; specialisation in practice and career structure. Strategies employed to achieve practice change included broadening the role of pharmacy technicians in order to free-up pharmacists’ time; seizing opportunities for extended roles; developing a relationship with the medical profession and professional leadership influence. Participants perceived that the development of pharmacists’ clinical roles have resulted in a more efficient healthcare provision where patients were offered seamless services. Conclusion Changes in the professional structure of pharmacy including education and training, specialisation, career structure and the roles of pharmacy technicians could benefit the development of pharmacists’ clinical roles in other countries

Challenges to clinical pharmacy practice in Nigerian hospitals: a qualitative exploration of stakeholders' views

Rationale, aims and objectives In Nigeria, a shift from the traditional pharmacists' role of dispensing and compounding of medications began in the 1980s with the introduction of drug information services and unit dose-dispensing systems in some hospitals. More than three decades after this, clinical pharmacy practice is still underdeveloped. This study was conducted to explore stakeholders' views on the barriers to the development of clinical pharmacy practice in Nigerian hospitals. Methods Qualitative, semi-structured interviews were conducted with 44 purposefully sampled Nigerian stakeholders including pharmacists, pharmacy technicians, doctors, policymakers and patient group representatives. Transcribed interviews were entered into the QSR (Burlington, MA, USA) NVivo 10 software and analysed thematically. Results Three major themes emerged from the study: pharmacists' professional identity, the structure of pharmacy practice and external barriers. The results revealed an ongoing struggle by Nigerian hospital pharmacists to establish their clinical identities as many non-pharmacy stakeholders viewed pharmacists' roles to be mainly supply based. Barriers to the development of clinical pharmacy practice identified included pharmacists' lack of confidence, shortage of pharmacy staff, underutilisation of pharmacy technicians, lack of specialisation and clinical career structure, medical dominance and opposition and lack of policies that support clinical pharmacy practice. Conclusion Several years after its introduction, clinical pharmacy practice is yet to be fully developed in Nigerian hospitals. The barriers identified in this study need to be addressed in order for clinical pharmacy practice to flourish

Pharmacist prescribing: a cross-sectional survey of the views of pharmacists in Nigeria

Objectives: This study was carried out to: 1) explore the views of pharmacists in Nigeria on the extension of prescribing authority to them and determine their willingness to be prescribers 2) identify the potential facilitators and barriers to introducing pharmacist prescribing in Nigeria. Method: An online cross-sectional survey was conducted from August to October 2014 among 775 pharmacists recruited from the Facebook group of the Pharmaceutical Society of Nigeria using a simple random technique. The questionnaire used for the survey was developed based on the review of the literature and previous qualitative studies conducted in Nigeria. The instrument was evaluated for content validity by two external pharmacy practice researchers and the reliability of items assessed using internal consistency tests. Data obtained from the survey were entered into SPSS v.22 and descriptive statistics were generated. Relationships between variables were evaluated using the chi-square test and p < 0.05 was considered statistically significant. Key findings: The response rate was 40.6% (315/775). Three hundred and six (97.1%) respondents agreed that pharmacists should be given prescribing authority. Of these 306, 295 (96.4%) were willing to be prescribers and just over half of them (148/295; 50.2%) would prefer to prescribe in collaboration with medical doctors. Of those willing to be prescribers, 285 (96.6%) reported that they would need additional training. The most perceived areas of training needed were in the principles of differential diagnosis (81.4%), pathophysiology of diseases (74.0%) and interpretation of laboratory results (68.1%). Respondents identified increasing patients’ access to care (308/315; 97.8%) and better utilisation of pharmacists’ skills (307/315; 97.5%) as the most likely facilitators to pharmacist prescribing in Nigeria. On the other hand, resistance from the medical doctors (299/315; 94.9%) and pharmacists’ inadequate skills in diagnosis (255/315; 81.0%) were perceived as the most likely barriers. Conclusion: Pharmacist prescribing represents an opportunity to promote patients’ access to care and the utilisation of pharmacists’ skills in Nigeria. The majority of pharmacists showed a positive attitude towards pharmacist prescribing and were willing to be prescribers. The findings of this study could potentially contribute to future medicine prescribing policy and pharmacy practice in Nigeria

Pharmacist prescribing in the United Kingdom and the implication for the Nigerian context

Background: Non-medical professionals including pharmacists have been granted the right to prescribe medicines in the United Kingdom. In Nigeria, only medical doctors, dentists and some nurses in primary care facilities have the legal right to prescribe medicines and patients' access to prescriptions can be seriously affected by a shortageof prescribers and long waiting times in hospitals. Objective: This article presents a review of pharmacist prescribing in the UK including its model, impact, facilitators and barriers and discusses the implications for the Nigerian context. Methods: A literature search was conducted in Medline, Embase, International Pharmaceutical Abstracts and Cumulative Index to Nursing and Allied Health Literature databases for studies investigating pharmacist prescribing in the UK between 1990 and August 2013. Results: The review identified that legislative change in the UK has enabled pharmacists to prescribe first as supplementary prescribers then as independent prescribers. This policy change was driven by the desire to increase patients' access to medicines and promote the utilisation of the skills of non-medical professionals while maintaining patient safety. Although more robust research evidence is needed to demonstrate the effectiveness of pharmacist prescribing, available evidence shows that it has had an impact on patient access to medicines. Conclusion: Pharmacist prescribing has the potential to promote access to prescription medicines, free doctors' time to enable them deal with complex cases and promote efficient use of pharmacists' clinical skills in Nigeria as it does in the UK. Factors which can promote the extension of prescribing rights to pharmacists in Nigeria include the current level of pharmacists' training and the clinical roles of pharmacists in some tertiary hospitals

Prevalence and factors associated with the use of antibiotics in non-bloody diarrhoea in children under 5 years of age in sub-Saharan Africa

Objectives To estimate the prevalence and determine the factors associated with the use of antibiotics in the management of non-bloody diarrhoea in children under 5 years of age in sub-Saharan Africa (SSA). Methods We conducted a meta-analysis of demographic and health survey data sets from 30 countries in SSA. Pooled prevalence estimates were calculated using random effects model. Χ2 tests were employed to determine the factors associated with the antibiotic use. Results The pooled prevalence of antibiotic use among cases of non-bloody diarrhoea in children under 5 years of age was 23.1% (95% CI 19.5 to 26.7). The use of antibiotics in children with non-bloody diarrhoea in SSA was associated with (p<0.05) the source of care, place of residence, wealth index, maternal education and breastfeeding status. Conclusion We found an unacceptably high use of antibiotics to treat episodes of non-bloody diarrhoea in children under the age of 5 in SSA

Examining the utility of the connect with pharmacy (CWP) intervention in reducing elderly readmission

YesConference abstract from the British Geriatrics Society Autumn Meeting, 14-16 Nov 2018, London, UK

There is still a case for a generic qualitative approach in some pharmacy practice research

Pharmacy practice researchers are increasingly employing qualitative research to understand complex social problems.1 This is as a result of the value of qualitative research in exploring people’s experience, behaviour and emotions, and in understanding a phenomenon from the participants’ perspectives. Qualitative research involves a wide range of philosophies and approaches and has been variously classified and described in the literature. However, our experience in one of our studies still makes a case for a generic approach in some pharmacy practice research. We therefore present a brief overview of the two qualitative approaches, phenomenology and grounded theory that we thought could be applicable to our research

Global access to antibiotics without prescription in community pharmacies: a systematic review and meta-analysis

Objective: To estimate the proportion of over-the-counter antibiotic requests or consultations that resulted in non-prescription supply of antibiotics in community pharmacies globally. Methods: We systematically searched EMBASE, Medline and CINAHL databases for studies published from January 2000 to September 2017 reporting the frequency of non-prescription sale and supply of antibiotics in community pharmacies across the world. Additional articles were identified by checking reference lists and a Google Scholar search. A random effects meta-analysis was conducted to calculate pooled estimates of non-prescription supply of antibiotics. Results: Of the 3302 articles identified, 38 studies from 24 countries met the inclusion criteria and were included in the review. All the included countries with the exception of one, classified antibiotics as prescription-only medicines. The overall pooled proportion of non-prescription supply of antibiotics was 62% (95% CI 53 – 72). The pooled proportion of non-prescription supply of antibiotics following a patient request was 78% (95% CI 59 - 97) and based on community pharmacy staff recommendation was 58% (95% CI 48 – 68). The regional supply of non-prescription antibiotics was highest in South America, 78% (95% CI 72 - 84). Antibiotics were commonly supplied without a prescription to patients with symptoms of urinary tract infections (68%, 95% CI 42 – 93) and upper respiratory tract infections (67%, 95% CI 55 - 79). Fluoroquinolones and Penicillins respectively were the most commonly supplied antibiotic classes for these indications. Conclusion: Antibiotics are frequently supplied without prescription in many countries. This overuse of antibiotics could facilitate the development and spread of antibiotic resistance

The intriguing HI gas in NGC 5253: an infall of a diffuse, low-metallicity HI cloud?

(Abridged) We present new, deep HI line and 20-cm radio continuum data of the very puzzling blue compact dwarf galaxy NGC 5253, obtained with the ATCA as part of the `Local Volume HI Survey' (LVHIS). Our low-resolution HI maps show the disturbed HI morphology that NGC 5253 possesses, including tails, plumes and detached HI clouds. The high-resolution map reveals an HI plume at the SE and an HI structure at the NW that surrounds an Ha shell. We confirm that the kinematics of the neutral gas are highly perturbed and do not follow a rotation pattern. We discuss the outflow and infall scenarios to explain such disturbed kinematics, analyze the environment in which it resides, and compare it properties with those observed in similar star-forming dwarf galaxies. The radio-continuum emission of NGC 5253 is resolved and associated with the intense star-forming region at the center of the galaxy. We complete the analysis using multiwavelength data extracted from the literature. We estimate the SFR using this multiwavelength approach. NGC 5253 does not satisfy the Schmidt-Kennicutt law of star-formation, has a very low HI mass-to-light ratio when comparing with its stellar mass, and seems to be slightly metal-deficient in comparison with starbursts of similar baryonic mass. Taking into account all available multiwavelength data, we conclude that NGC 5253 is probably experiencing the infall of a diffuse, low-metallicity HI cloud along the minor axis of the galaxy, which is comprising the ISM and triggering the powerful starburst. The tidally disturbed material observed at the east and north of the galaxy is a consequence of this interaction, which probably started more than 100 Myr ago. The origin of this HI cloud may be related with a strong interaction between NGC 5253 and the late-type spiral galaxy M 83 in the past.Comment: 19 pages, 12 figures, accepted for publication in MNRA