Supplementary pharmacist prescribing and point-of-care testing in community Pharmacy

Abstract

Non-medical prescribing refers to the provision of prescribing rights to healthcare professionals other than physicians. This practice has been successfully implemented to various degrees in countries beyond Malta. From an earlier study supplementary prescribing (SP) was identified to be the most appropriate model for the local scenario. The aim of this study was to provide an efficient pharmacist SP model for conditions that may be identified and managed through point-of-care tests (POCT), such as diabetes mellitus and hypertension in adults. Three treatment frameworks for these common chronic conditions were developed based on the recommendations of the National Institute for Health and Care Excellence, UK. These are to be used by the pharmacist in order to decide upon optimal patient treatment following diagnosis by a physician. A questionnaire was developed in order to identify the local pharmacist and physician opinions on the implementation of pharmacist prescribing, POCT commonly available and their perceived reliability for use within such a practice model. Participant suggestions were considered and the treatment frameworks updated accordingly, following which they were re-validated by means of a focus group. A response rate of 22.8 % (57) physicians and 65.14 % (142) pharmacies was obtained, yielding 205 pharmacist responses. The majority of participants gave answers in the affirmative when asked about the competency of pharmacists to prescribe with their current level of knowledge and training; where 51 %, 74 % and 67 % of physicians, community and locum pharmacists respectively strongly agreeing or agreeing. Pharmacists (81 %) showed a great willingness to partake in a conversion course in order to obtain prescribing rights, but commented that this would depend on various logistical factors. Modification of the frameworks included colour coding of decision trees, addition of page numbers and provision of generic examples for each drug class. In conclusion, this project puts forward a feasible framework that could be implemented in community pharmacies for POCT-led pharmacist prescribing in hypertension and diabetes mellitus. The perception of local pharmacists and physicians is in support of pharmacist SP for these conditions.