Developing a framework for pharmacist prescribing : a risk-based approach

Abstract

Nonmedical prescribing provides improved patient access to healthcare. Risk assessment is essential before implementing a pharmacist prescribing model to identify weaknesses that may impact the success of the scheme. The aims of this study were to assess consumers’ perception of the risks of pharmacists prescribing, and to develop prescribing frameworks. A self-administered questionnaire was developed, in English and Maltese to assess risks, as perceived by the public, of pharmacists prescribing for selected medical conditions. The questionnaire was validated by one general practitioner, one linguist, two pharmacists and three laypersons, and a back-to-back translation was performed. Reliability testing, using the test-retest method, and a pilot study with 10 subjects were performed. The questionnaire was disseminated using convenience sampling via social media and in-person distribution. Two-hundred and five valid responses were collected. Eighty percent of respondents were female (n= 164), thirty-seven percent aged 18-30 years old (n= 75) and thirty-nine percent of respondents were educated to a post-graduate level (n=79). Respondents rated probability of side effects (On a scale of 1-5, where 1 indicates the lowest probability) occurring and the severity of consequences (On a scale of 1-5, where 1 indicates the least severe consequences). These scores were multiplied to calculate the Risk Priority Number (RPN) as perceived by consumers, of pharmacists prescribing for selected medical conditions. Thirty-six conditions were categorised as low risk (RPN= 1-5), twelve as medium risk (RPN= 6-15), and none as high risk, (RPN= 16- 25). Data was presented to an age- and gender- balanced focus group of four pharmacists and four general practitioners to select conditions for inclusion in pharmacist prescribing frameworks. The focus group identified twenty-one conditions for inclusion in a prescribing framework. The 5 conditions selected most frequently were chosen. These were urinary tract infections, conjunctivitis, mild acne, nicotine replacement therapy and muscle strains and sprains. Protocols were colour coded, including criteria ‘description of condition’, ‘features necessitating referral’, ‘non-pharmacological interventions’, 1st and 2nd line pharmacological interventions and ‘referral’. Validation was performed by the same focus group. By studying perceived risk of pharmacist prescribing, risk reduction strategies can be implemented to ensure acceptability of the model.