A clinical expert panel of doctors in a small Australian study has found accredited pharmacist prescribers may help to optimise management of hypertension
In a survey of 30 accredited pharmacists (medicines review) within the Sydney metropolitan area, participants were asked to complete a scenario-based survey that asked them to demonstrate a simulated prescribing function.
The survey was run by Associate Professor Beata Bajorek, a registered clinical pharmacist from the University of Technology’s Graduate School of Health and pharmacy researcher Professor Ines Krass from the University of Sydney.
Management of six scenarios was assessed from the pharmacists’ perspective (i.e. usefulness, confidence in prescribing) and by an expert clinical panel (i.e. clinical appropriateness).
The clinical expert panel, comprising GPs, general medicine doctors and doctors specialising in hypertension management, rated the vast majority of pharmacotherapy recommendations by pharmacists to be “appropriate”.
For example, for five out of the total six scenarios, more than three-quarters of recommendations were rated appropriate.
In the sixth scenario – a clinically complex scenario – 57% of all recommendations were rated as appropriate.
“The prescribing interventions described by these pharmacists were assessed as being largely clinically appropriate by doctors themselves, in line with findings from other studies exploring the appropriateness and/or uptake of pharmacists’ recommendations in other contexts,” say A/Prof Bajorek and Prof Krass.
“Overall, the study findings indicate that pharmacists, who are accredited to conduct medication reviews, would find a prescribing function useful within their current scope of practice and would be confident in executing this.”
The researchers point out that the level of agreement between members of the expert panel varied across the scenarios: for example, there was a high level of agreement for the selection of drug in the first two scenarios, but slightly less (albeit still fairly in agreement) for the selection of dose in the same scenarios.
There was a lower level of agreement among panel members for the clinically complex sixth scenario.
“There has been much concern from medical practitioners about the appropriateness of pharmacist prescribing within the community setting,” A/Prof Bajorek and Prof Krass point out.
“Indeed pharmacists themselves have indicated that prescribing needs to occur within an appropriate context and a defined scope of practice… with the necessary experience and training to support this.
“This present study identifies the potential for pharmacist prescribing to optimise blood pressure control and provide seamless care, particularly around continuation of maintenance therapy or therapeutic adjustment (e.g. adjustment of doses).
“With an ageing population and under-resourced health system (GP shortages), the absence of a prescribing function is a contributor to poor patient management and specifically poor medication adherence,” they argue.
“Internationally, and within Australia in the local hospital system, the prescription of medicines by suitably qualified pharmacists has demonstrated positive clinical, humanistic and economic outcomes, and has been well-accepted by patients, doctors and allied health practitioners alike.”
A/Prof Bajorek and Prof Krass conclude that given the limited sample size and a selected panel of expert clinicians, a more in-depth qualitative evaluation should be undertaken in the future; however, they say the current study provides “important insights” into the potential for pharmacist prescribing in this context.
The study was published in the Journal of Pharmacy Practice and Research (online 10 May). See the full study here