Risk of pharmacist prescribing with statins

Abstract

Pharmacist prescribing has been shown to have positive clinical outcomes and is cost effective. When used for primary prevention of atherosclerotic cardiovascular disease in patients with hypercholesterolaemia and/or diabetes mellitus type 2, statins reduce morbidity and mortality. Assessment of risks and benefits maximises effectiveness of statin treatment and enhances the advantages of pharmacist prescribing. The aim of this study was to determine the risks related to prescribing low- and moderate- intensity statins to patients aged 40-75 years with hypercholesterolaemia and/or diabetes mellitus type 2, both by medical practitioners and pharmacists. Two self-administered questionnaires, one for medical practitioners and one for pharmacists, were developed, content-validated using modified Delphi method and reliability tested. After ethics approval, questionnaires were distributed by principal investigator, both in person and online to pharmacists and general practitioners. Data was analysed using SPSS. A regression model I was developed to determine the statistical difference, if any, of risks associated with prescribing of statins by medical practitioners and by pharmacists. In regression model II, the relationship between different predictors and total risk associated with prescribing of statins was analysed. Two protocols were put forward to be followed by pharmacists while potentially prescribing statins to patients with diabetes mellitus type 2 and hypercholesterolaemia. The questionnaires were completed by 62 medical practitioners and 148 pharmacists. Pharmacists were supportive (83.1%) towards giving statin prescribing rights to pharmacists while medical practitioners opposed this scenario (67.7%). Factors that could ease the implementation of pharmacist prescribing in Malta, as perceived by both healthcare professionals, were patient privacy in a community pharmacy setting (73.8%) and good inter-professional collaboration (72.8%). Comparison of the responses showed that both healthcare professionals were perceiving risks associated with prescribing of statins similarly, without any statistically significant differences. Medical practitioners were more familiar with guideline recommendations regarding statin prescribing when compared to pharmacists (p<0.001-0.033). Regression model I showed no statistically significant difference (p=0.139) in risks associated with prescribing of statins by medical practitioners and by pharmacists, while regression model II showed that healthcare professionals who were against giving statin prescribing rights to pharmacists rated the total risk of prescribing statins higher (p=0.030). Pharmacists were in favour of expanding their scope of practice to prescribing of statins and results showed there are no increased risks associated with this activity, when compared to prescribing of statins by medical practitioners. Medical practitionerpharmacist collaboration should be strengthened. Training courses aimed towards pharmacist prescribing should be organised in both undergraduate and postgraduate levels. Pharmacists should adopt a systematic approach to risk management in the eventuality of prescribing so risks associated with this activity can be reduced and patient outcomes optimised. The suggested protocols may reduce the risks associated with pharmacist prescribing and may standardise patient care. Risk reduction may increase support towards pharmacist prescribing. With identified factors and suggested protocols, this research can help policymakers in the smooth implementation of pharmacist prescribing of statins in Malta.