Pharmacist Prescribing In Community Pharmacy Practice

• By: BUTTIGIEG, Anthony (University of Malta)
• Co-author(s): Ms Abigail Buttigieg (Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta)
  Prof. Lillian M. Azzopardi (Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta)
  Prof. Anthony Serracino-Inglott (Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta)
  
• Abstract:

  Pharmacist Prescribing in Community Pharmacy Practice
  Ms. Abigail Buttigieg, Prof. Lilian M. Azzopardi, Prof. Anthony Serracino-Inglott
  Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta
  Background
  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 individual 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.
  Purpose
  To investigate concerns and benefits of pharmacist prescribing by analysing different pharmacist interventions within the community and identifying scenarios in which pharmacist prescribing should occur.
  Method
  Patients were recruited within a community pharmacy and divided into two groups based on the presenting complaint. Group A patients were given a pharmacist intervention and/or a pharmacist recommended non-prescription medication. Group B patients were referred to a general practitioner (GP) and the resulting intervention was compared to clinical decision and hypothetical pharmacist recommended medication if the pharmacist could have prescribing rights. All patients were followed up after at least a week through a telephone interview where the therapeutic outcome was determined.
  Results
  One hundred patients (49F; 51M) with an age range between 25 to 34 years 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 following the doctor’s recommendation, 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 29 cases out of the 44 Group B patients, the pharmacist would have prescribed the same medication as that actually prescribed by the GP. The 15 cases, where prescribing differences between GP and pharmacist occurred, consisted of 10 cases where minor ailments were treated with a broad-spectrum antibiotic by the medical prescriber which was not recommended as first-line treatment, 2 cases of contraindications specifically in patients with cardiovascular diseases and 3 cases where a topical glucocorticoid was recommended but had no clinical indication.
  Conclusion
  The outcome of this study indicates concordance in clinical decision making and pharmacotherapy recommendation for prescription medication for 66% of the cases between the medical prescriber and the community pharmacist. Signals where pharmacist prescribing frameworks should consider additional patient safeguards include co-morbidities and risks of medications being recommended.
  Topic: Pharmacy Practice Research