Pharmacist prescribing in community pharmacy practice

Abstract

Background: In a community pharmacy setting, pharmacists are key players in the healthcare ecosystem, ensuring equitable access to appropriate, quality, and safe medication use that specifically meets the individual patient's needs. Pharmacist prescribing, within a collaborative practice context, facilitates t imely patient access to healthcare services while ensuring the safe and rational use of medicines. Purpose: To investigate concerns and benefits of pharmacist prescribing by analysing different pharmacist interventions within the community and identifying scenarios in which pharmacist prescribing should occur. Method: Patients were recruited within a community pharmacy and divided into two groups based on the presenting complaint. Group A patients were given a pharmacist intervention and/or a pharmacist-recommended non-prescription medication. Group B patients were referred to a general practitioner (GP), and the resulting intervention was compared to clinical decision and hypothetical pharmacist-recommended medication if the pharmacist could have prescribing rights. All patients were followed up after at least a week through a telephone interview, where the therapeutic outcome was determined. Results: One hundred patients (49F; 51M) with an age range between 25 to 34 years were included in the study: 56 patients (Group A) accepted a pharmacist-recommended medication, and 44 patients (Group B) were referred to a GP. Of the Group A patients, 46 reported symptomatic relief within the week. Of the ten patients without symptomatic relief, 7 requested a doctor's appointment, while three opted not to follow up. Following the doctor's recommendation, twenty-seven patients from Group B reported symptomatic relief. Of the 17 patients with unresolved presenting symptoms, 12 patients opted for a specialist consultation, three were admitted to the hospital, and two opted not to follow up. In 29 cases out of the 44 Group B patients, the pharmacist would have prescribed the same medication as t hat prescribed by the GP. The 15 cases where prescribing differences between GP and pharmacist occurred consisted of 10 cases where minor ailments were treated with a broad spectrum antibiotic by the medical prescriber, which was not recommended as first-line treatment, 2 cases of contraindications specifically in patients with cardiovascular diseases and 3 cases where a topical glucocorticoid was recommended but had no clinical indication. Conclusion: The outcome of this study indicates concordance in clinical decision-making and pharmacotherapy recommendation for prescription medication in 66% of the cases between the medical prescriber and the community pharmacist. Signals, where pharmacist prescribing frameworks should consider additional patient safeguards, include co-morbidities and risks of medications being recommended