Service user perceptions of nurse and pharmacist prescribing
Asystematic review published in 2018 synthesised evidence from 42 papers and highlighted the facilitators and barriers to nurse and pharmacist independent prescribing (Graham-Clarke et al, 2018). An emergent theme from this review was the impact of prescribing on colleagues, managers and patients, or human-factors. The review highlighted the positive effect supportive managers and medical staff had on implementation, particularly in the context of team working. The impact that independent prescribing had on service users was less evident. This month's research round up will review some of the latest peer-reviewed evidence exploring service users' perceptions of prescribing by nurses, midwives, pharmacists and Allied Health Professionals. Following a search of the literature, four articles were selected for round up (Gerard et al, 2015; Hale et al, 2016; Hand Née Davies, 2019; Hindi et al, 2019).
Patients' valuation of the prescribing nurse in primary care: a discrete choice experiment
This UK paper applied a novel, yet increasingly more common, methodology, discrete choice experiment (DCE), to explore which profession a patient preferred to be reviewed by, and factors influencing choice, when presenting with a minor illness (n=451). This methodology presented participants with three hypothetical vignettes that contained study contained three variables viewed as influencing choice. These variables were selected from the literature and expert opinion. They were: access, length of attention, and type of help provided. The participant was invited to select their preferred choice from: review by a nurse prescriber, own doctor, or doing nothing. Results revealed that service users preferred a consultation with their own doctor, but accessibility and quality of the patient-professional relationship was most important. This suggests that a high-quality consultation regardless of profession is paramount. Interestingly, participants with experience of a nurse or pharmacist prescriber were likely to prefer these practioners, suggesting that an effective consultation with a nurse or pharmacist was preferred to no consultation at all. This suggests that the reputation of nurse and allied health professional prescribers is growing and the quality of the consultation, rather that the profession leading it, is most important.
Patient satisfaction from two studies of collaborative doctor-pharmacist prescribing in Australia
The second article investigated the service users' views of pharmacist prescribing in two outpatient settings; a pre-assessment clinic for elective surgery (n=200) and a sexual health clinic in Australia (n=17). Service users were surveyed using an adapted satisfaction scale, initially used for general practitioners, focusing on consultation satisfaction, quality and patient involvement in shared decision-making. Participants were asked to rate their perceptions of each of these aspects using a Likert scale ranging from strongly agree to strongly disagree. Results suggested that the majority of respondents were satisfied with the consultation in both the pre-assessment (98%) and sexual health clinic (97%), and, similarly to previous research, are as satisfied with a pharmacist prescriber as with any other prescribing professional. This is further evidenced by respondents in this study being willing to receive ongoing support and review from a pharmacist prescriber. This suggests that service users are becoming increasingly confident in the support provided to them by pharmacist prescribers and that an interprofessional model of prescribing practice is growing in acceptability.
Non-medical prescribing of systemic anticancer therapy in a multidisciplinary team oncology clinic
The third article in this month's round up explored the service users' and consultant colleagues' experiences of nurse prescribers working in a neuroendocrine clinic in the UK. Consultant colleagues (n=5) reviewed 38 prescriptions written for 19 patients, and researchers obtained views from 14 services users from the clinic. Consultant feedback revealed overall satisfaction with the nurse prescriber. With regards to the service user experience, all were satisfied with the consultation and the level of involvement they had in the consultation. Similarly to the previous article, patients assigned more emphasis to the quality of the consultation than the professional carrying it out. Of particular importance in this speciality was the level of psychological support that patients reported when they were reviewed by a nurse prescriber. This suggests that previously reported positive effects of independent prescribing on patient satisfaction are continuing and extending to more specialist and complex areas of practice (Duarte et al, 2017).
Independent prescribing in primary care: A survey of patients', prescribers' and colleagues' perceptions and experiences.
The final article used a mixed methods approach to obtain service users' (n=24), independent prescribers' (n=20) and peers' (n=26) views of independent prescribers in a health board in the northwest of England. The findings suggested that the majority of respondents were satisfied with the service they provided. Service users trusted the judgment of prescribers, and viewed it as easier to get an appointment with them. All quantitative results were corroborated by qualitative responses, suggesting patients found care provided to them convenient, professional and of high quality. Yet some respondents were still unaware of the range of medicines nurse and Allied Health Professionals could prescribe. Independent and medical prescribers viewed that the role was a more efficient use of their time and there was a perception amongst some of the independent prescribers that there was greater respect for their role and professional status on qualifying.
Conclusion
It appears that the most recent evidence obtaining service users views of independent prescribing is consistent with previous systematic reviews, which have reported a high level of satisfaction and parity in the quality of the prescribing consultation (Duarte et al, 2016). This could be further improved by informing service users of the scope and range of independent prescribing; a limitation highlighted by the majority of the articles presented in this round up. The application of DCE to explore preferences was novel and may have merit in being replicated in a large multi-centre study that includes patients presenting to secondary, as well as primary care. Future studies of this type should also include Health and Care Professions Council registrants with legislative authority to prescribe. A study of this type would provide further insight into the acceptability and quality of prescribing consultations provided to service users accessing a wide range of clinical services.
‘accessibility and quality of the patientprofessional relationship was most important’