Pharmacist prescribing in community pharmacy practice

Abstract

Within a community pharmacy setting, pharmacists are key players within the healthcare ecosystem to ensure equitable access to appropriate, quality and safe use of medications that are specifically meeting the patient’s needs. Pharmacist prescribing, within a collaborative practice context, is a means of facilitating timely patient access to healthcare services whilst ensuring safe and rational use of medicines. The aim of this study was to investigate concerns and benefits of pharmacist prescribing by analysing different pharmacist interventions and identifying scenarios in which pharmacist prescribing should occur. Patients were recruited within a community pharmacy and divided into two groups based on the presenting complaint. Group A patients were given a pharmacist recommended non-prescription medication. Group B patients were referred to a general practitioner (GP) and the resulting intervention was compared to a hypothetical pharmacist recommended medication if the pharmacist could have prescribing rights. All patients were followed up, where the therapeutic outcome was determined. One hundred patients were included in the study: 56 patients (Group A) accepted a pharmacist recommended medication and 44 patients (Group B) were referred to a GP. From the Group A patients, 46 patients reported symptomatic relief within the week. From the 10 patients without symptomatic relief, 7 requested a doctor’s appointment while 3 opted not to follow up. Twenty-seven patients from Group B, reported symptomatic relief. From the 17 patients with unresolved presenting symptoms: 12 patients opted for a specialist consultation, 3 were admitted to hospital and 2 opted not to follow-up. In 22 cases out of the 44 Group B patients, the pharmacist would have prescribed the same medication as that actually prescribed by the GP. The 22 cases, where prescribing differences between GP and pharmacist occurred, included 4 cases where minor ailments were treated with a broad-spectrum antibiotic by the medical prescriber which was not recommended as first-line treatment, 4 cases of contraindications and 3 cases where medications had no clinical indication. The outcome of this study indicates concordance in clinical decision making and pharmacotherapy recommendation for prescription medication for 50% of the cases between the medical prescriber and the community pharmacist.