Using scenarios to test the appropriateness of pharmacist prescribing in asthma management
Methods: Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers.
Results: In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios.
Conclusion: Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way.
2. Armour CL, LeMay K, Saini B, Reddel H, Bosnic-Anticevich S, Smith L, Burton D, Song Y, Alles M, Stewart K, Emmerton L, Krass I. Using the community pharmacy to identify patients at risk of poor asthma control and factors which contribute to this poor control. J Asthma. 2011;48(9):914-922. doi: 10.3109/02770903.2011.615431
3. Marks G, Abramson M, Jenkins C, Kenny P, Mellis C, Ruffin R, Stosic R, Toelle B, Wilson D, Xuan W. Asthma management and outcomes in Australia: a nation-wide telephone interview survey. Respirology. 2007;12(2):212-219.
4. Kenny P, Hall J, King M, Lancsar E. Sources of variation in the costs of health care for asthma patients in Australia. J Health Serv Res Policy. 2009;14(3):133-140. doi: 10.1258/jhsrp.2008.008078
5. Matheson M, Wicking J, Raven J, Woods R, Thien F, Abramson M, Walters E. Asthma management: how effective is it in the community? Intern Med J. 2002;32(9-10):451-456.
6. Burton C, Proudfoot J, Ramsay E, Holton C, Bubner T, Harris M, Beilby J. Management of asthma in Australian general practice: care is still not in line with clinical practice guidelines. Prim Care Respir J. 2009;18(2):100-105. doi: 10.3132/pcrj.2008.00059
7. Armour C, Bosnic-Anticevich S, Brillant M, Burton D, Emmerton L, Krass I, Saini B, Smith L, Stewart K. Pharmacy Asthma Care Program (PACP) improves outcomes for patients in the community. Thorax. 2007;62(6):496-502.
8. Gordois A, Armour C, Bosnic-Anticevich S, Brillant M, Burton D, Emmerton L, Krass I, Saini B, Smith L. Cost effectiveness of a pharmacy asthma care program in Australia. Dis Manag Health Outcomes. 2007;15(6):387-396.
9. Armour C, Reddel H, LeMay K, Saini B, Bosnic-Anticevich S, Song Y, Alles M, Burton D, Emmerton L, Stewart K, Krass I. Feasibility and effectiveness of an evidence-based asthma service in Australian community pharmacies: a pragmatic cluster randomised trial. J Asthma. 2013;50(3):302-309. doi: 10.3109/02770903.2012.754463
10. Tonna A, Stewart D, West B. Pharmacist prescribing in the UK - a literature review of current practice and research. J Clin Pharm Ther. 2007;32(6):545-556.
11. Dijana V, Bajorek B. Australian General Practitioners' views on pharmacist prescribing. J Pharm Pract Res. 2008;38(2):96-102.
12. Bhanbhro S, Drennan VM, Grant R, Harris R. Assessing the contribution of prescribing in primary care by nurses and professionals allied to medicine: a systematic review of the literature. BMC Health Serv Res. 2011;11:330. doi: 10.1186/1472-6963-11-330
13. Yuksel N, Eberhart G, Bungard TJ. Prescribing by pharmacists in Alberta. Am J Health Syst Pharm. 2008;65(22):2126-2132. doi: 10.2146/ajhp080247
14. Latter S, Blenkinsopp A. Non-medical prescribing: current and future contributions of pharmacists and nurses. Int J Pharm Pract. 2011;19(6):381-382. doi: 10.1111/j.2042-7174.2011.00183.x
15. Hoti K, Hughes J, Sunderland B. An expanded prescribing role for pharmacists – an Australian perspective. Australas Med J. 2011;4(4):236-242. doi: 10.4066/AMJ.2011.694
16. Health Workforce Australia. Health Professionals Prescribing Pathway project. Available from: https://www.hwa.gov.au/work-programs/workforce-innovation-and-reform/health-professionals-prescribing-pathway-project (Accessed 11/11/2013).
17. NPS: Better choices, Better health. Competencies required to prescribe medicines: putting quality use of medicines into practice. Sydney: National Prescribing Service Limited, 2012.
18. Kay O, Brien J. Pharmacist prescribing: review of the literature. J Pharm Pract Res. 2004;34(4):300-304.
19. Hanes C, Bajorek B. Pharmacist prescribing: is Australia behind the times? Aust J Pharm. 2004;85(1014):680-1.
20. Hanes C, Bajorek B. Pharmacist prescribing: views of Australian hospital pharmacists. J Pharm Pract Res. 2005;35(3):178-180.
21. Kay OC, Bajorek B, Brien JE. Pharmacist prescribing activities – an electronic survey on the opinions of Australian pharmacists. J Pharm Pract Res. 2006;36(3):199-203.
22. Hoti K, Sunderland B, Hughes J, Parsons R. An evaluation of Australian pharmacist’s attitudes on expanding their prescibing role. Pharm World Sci. 2010;32(5):610-621. doi: 10.1007/s11096-010-9400-2
23. Vracar D, Bajorek B. Australian general practitioners’ views on pharmacist prescribing. J Pharm Pract Res. 2008;38(2):96-102.
24. Hoti K, Hughes J, Sunderland B. Identifying the perceived training needs for Australian pharmacist prescribers. Int J Pharm Pract. 2014;22(1):38-46. doi: 10.1111/ijpp.12014
25. Weeks GR, Marriott J, George J. Australian hospital pharmacists’ experiences of a UK non-medical prescribing course. J Pharm Pract Res. 2010;40(3):187-193.
26. Kamarudin G, Penm J, Chaar B, Moles R. Preparing hospital pharmacists to prescribe: Stakeholders’ views of postgraduate courses. Int J Pharm Pract. 2013;21(4):243-251. doi: 10.1111/ijpp.12000
27. Hale AR, Stowasser DA, Coombes ID, Stokes J, Nissen L. An evaluation framework for non-medical prescribing research. Aust Health Rev. 2012;36(2):224-228. doi: 10.1071/AH10986
28. Khoo A, Bajorek B. Extended roles for pharmacists in warfarin therapy: identifying opportunities for pharmacists prescribing. J Pharm Pract Res. 2006;36(3):190-193.
29. Marotti SB. Pharmacist prescribing in the pre-operative setting. J Pharm Pract Res. 2009;39(4):331.
30. Hale A, Coombes I, Stokes J, McDougall D, Whitfield K, Maycock E, Nissen L. Perioperative medication management: explading the role of the preadmission clinic pharmacist in a single centre, randomised controlled trial of collaborative prescribing. BMJ Open. 2013;3(7).pii:e003027. doi: 10.1136/bmjopen-2013-003027
31. Primary Health Care Reform in Australia: Report to Support Australia's First National Primary Health Care Strategy, Commonwealth of Australia, 2009; ISBN:1-74186-936-6.
32. Stewart D, MacLure K, Bond C, Cunningham S, Diack L, George J, McCaig D. Pharmacist prescribing in primary health care: the views of patients across Great Britain who had experienced the service. Int J Pharm Pract. 2011;19(5):328-332. doi: 10.1111/j.2042-7174.2011.00130.x
33. Nguyen N, Bajorek B. Pharmacist prescribing in warfarin therapy: exploring clinical utility in the hospital setting. J Pharm Pract Res. 2008;38(1):35-39.
34. Respiratory Expert Group. Therapeutic Guidelines: Respiratory. Version 4. Melbourne: Therapeutic Guidelines Limited; 2009.
35. Margolis K, Asche S, Bergdall A, Dehmer S, Groen S, Kadrmas H, Kerby T, Klotzle K, Maciosek M, Michels R, O'Connor P, Pritchard R, Sekenski J, Sperl-Hillen J, Trower N. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control. A cluster randomized clinical trial. JAMA. 2013;310(1):46-56. doi: 10.1001/jama.2013.6549
36. Reid F, Murray P, Storrie M. Implementation of a pharmacist-led clinic for hypertensive patients in primary care - a pilot study. Pharm World Sci. 2005;27(3):202-207.
37. Blenkisopp A, Tann J, Evans A, Grime J. Opportunity or threat? General practitioner perceptions of pharmacist prescribing. Int J Pharm Pract Res. 2008;16(1):29-34.
38. Cooper R, Bissell P, Ward P, Murphy E, Anderson C, Avery T, James V, Lymn J, Guillaume L, Hutchinson A, Ratcliffe J. Further challenges to medical dominance? The case of nurse and pharmacist supplementary prescribing. Health (London). 2012;16(2):115-133. doi: 10.1177/1363459310364159
39. Emmerton L, Marriott J, Bessell T, Nissen L, Dean L. Pharmacists and prescribing rights: review of international developments. J Pharm Pharm Sci. 2005;8(2):217-225.
40. Tann J, Blenkisopp A, Grime J, Evans A. The great boundary crossing: Perceptions on training pharmacists as supplementary prescribers in the UK. Health Educ J. 2010;69(2):183-191. doi: 10.1177/0017896910363300
41. Barber N. Extended prescribing rights - the UK experience. Australian Prescriber. 2009;32(5):118-119.
42. Bregnhoj L, Thirstrup S, Kristense M, Bjerrum L, Sonne J. Prevalence of inappropriate prescribing in primary care. Pharm World Sci. 2007;29(3):109-115.
43. Lucas A, Smeenk F, Smeele I, van Schayck C. Overtreatment with inhaled corticosteroids and diagnostic problems in primary care patients, an exploratory study. Fam Pract. 2008;25(2):86-91. doi: 10.1093/fampra/cmn006
44. Diette G, Patino C, Merriman B, Paulin L, Riekert K, Okelo S, Thompson K, Krishnan J, Quartey R, Perez-Williams D, Rand C. Patient factors that physicians use to assign asthma treatment. Arch Intern Med. 2007;167(13):1360-1366.
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