Abstract
Background
Pharmacist prescribing has been introduced in several countries and is a possible future role for pharmacy in Australia.
Objective
To assess whether patient satisfaction with the pharmacist as a prescriber, and patient experiences in two settings of collaborative doctor‐pharmacist prescribing may be barriers to implementation of pharmacist prescribing.
Design
Surveys containing closed questions, and Likert scale responses, were completed in both settings to investigate patient satisfaction after each consultation. A further survey investigating attitudes towards pharmacist prescribing, after multiple consultations, was completed in the sexual health clinic.
Setting and Participants
A surgical pre‐admission clinic (PAC) in a tertiary hospital and an outpatient sexual health clinic at a university hospital. Two hundred patients scheduled for elective surgery, and 17 patients diagnosed with HIV infection, respectively, recruited to the pharmacist prescribing arm of two collaborative doctor‐pharmacist prescribing studies.
Results
Consultation satisfaction response rates in PAC and the sexual health clinic were 182/200 (91%) and 29/34 (85%), respectively. In the sexual health clinic, the attitudes towards pharmacist prescribing survey response rate were 14/17 (82%). Consultation satisfaction was high in both studies, most patients (98% and 97%, respectively) agreed they were satisfied with the consultation. In the sexual health clinic, all patients (14/14) agreed that they trusted the pharmacist's ability to prescribe, care was as good as usual care, and they would recommend seeing a pharmacist prescriber to friends.
Discussion and Conclusion
Most of the patients had a high satisfaction with pharmacist prescriber consultations, and a positive outlook on the collaborative model of care in the sexual health clinic.
Keywords: new models of health care, non‐medical prescribing, patient satisfaction, pharmacist prescribing, pharmacy
Introduction
Non‐medical prescribing is one proposed strategy to assist in meeting growing demand in Australia for health care and improving access to medicines. The Health Workforce Australia (HWA) Health Professionals Prescribing Pathway (HPPP) Project is developing a national pathway to prescribing by health professionals other than doctors.1 The first stage is complete, with the recommendations for implementation approved at a national policy level in November 2013. Key issues such as regulatory practice, education, training and accreditation requirements will now be addressed with key stakeholders. There is little evidence in Australia of patient perspectives and opinions on non‐medical prescribing, which will also be important to inform the implementation of this new model of health care.
Previous exploration of Australian patient views about pharmacist prescribing were based on surveys about a hypothetical role, utilising a theoretical framework to examine opinions on the expanded role, and any factors that contributed positively to their perception of trust in pharmacists.2 Hoti et al. showed that most clients indicated trust in pharmacists assuming an extended role, where doctors made the primary diagnosis and the recommendation was made that any introduction be made in a way that facilitates the already established relationships between doctors and patients. Before now, no study in Australia has examined patient perspectives after experiencing the pharmacist prescribing model of care.
The National Health Performance Framework (NHPF) provided indicators: effectiveness, safety, responsiveness, continuity of care, accessibility and efficiency, and sustainability, that were used as a guide for evaluation of the two studies of collaborative doctor‐pharmacist prescribing discussed in this paper.3 The part of the study in pre‐admission clinic (PAC) discussed in this paper is nested within a larger study, which has shown benefits across the NHPF indicators of safety, effectiveness and accessibility.4 Both studies examined patient satisfaction with the experience as a measure of responsiveness. The need to involve patients in decision making, especially in prescribing, has also become an integral part of health care.
Non‐medical prescribing has been introduced in a number of countries and evidence so far suggests acceptability to patients is high.5 In Australia, a focus has been placed recently on non‐medical prescribers within the health‐care system, and in the light of some resistance, it is important to have evidence that this potential new model of care satisfies any concerns.6, 7, 8, 9, 10
Data discussed in this paper describe what elements of pharmacist behaviour during a consultation lead to patient satisfaction with the pharmacist in the two models of care. Attitudes towards pharmacist prescribing are investigated, to assess whether this may be a barrier to expansion of the pharmacist role in Australia, and implementation of collaborative doctor‐pharmacist prescribing.
Method
Pharmacist training
The pharmacists in both studies attended a prescribing course, accredited by the General Pharmaceutical Council, UK as an Independent Pharmacist Prescribing Course.11
Pre‐admission clinic
Two hundred patients were seen by a nurse, prescribing pharmacist, resident medical officer (RMO) and anaesthetist. The pharmacist was responsible for taking a medication history, plus the prescribing of the inpatient medication chart. This was to ensure continuation of the patient's regular medications on admission, and that the medication chart reflected the plan for medication perioperatively, including initiation of venous thromboembolism (VTE) prophylaxis. Patients were asked to complete a satisfaction questionnaire after their appointment with the prescribing pharmacist, in order to be able to assess the prescribing pharmacist's consultation behaviours, and how these impacted on patient satisfaction and views of pharmacist prescribing.
Sexual health clinic
Seventeen patients were seen by the prescribing pharmacist, as part of the study. The patient's first appointment was with both the staff specialist, and the prescribing pharmacist, for the development of an agreed care plan. Second and third appointments in the study were undertaken by the prescribing pharmacist alone. The pharmacist's scope of practice included on‐going management and prescribing of regular HIV medicines, with referral to the medical specialist still possible at the pharmacist's discretion, and in particular for anything outside of the care plan. Patients were asked to complete a consultation satisfaction questionnaire at the end of each appointment with the pharmacist, in order to assess consultation behaviours of the pharmacist, and how these impacted on patient satisfaction. At the end of their last appointment, patients were also asked to complete an attitudes towards pharmacist prescribing questionnaire, to assess their attitudes towards the new collaborative pharmacist prescribing model of care they had experienced during the study.
Questionnaire development
Patient satisfaction is an important outcome of care, and satisfied patients are more likely to co‐operate with treatment.12 For this reason, patient satisfaction was evaluated as a consultation goal in both studies. Patient satisfaction questionnaires were developed for both pilots, with relevant statements chosen from a scale developed initially for general practitioners.13 Relevant statements on attitudes towards pharmacist prescribing were chosen from a scale developed previously in the UK.14
Statements were developed to assess important elements of the scope of practice of the pharmacists in both settings that would contribute towards consultation goals, for example an assessment of the explanation of the plan for the patient's medications before their operation in PAC.
Pre‐admission clinic services prepare patients for their admission for elective surgery, aiming to ensure patients are admitted in the best possible state of health. Questionnaires were designed to assess whether the pharmacist had assisted in the patient feeling ‘prepared for surgery’. One questionnaire was developed for the PAC trial which focused on the goals of satisfaction and preparedness, elicited from experiences related to the delivery of the consultation. There were 12 questions in total, with information collected on a 5 point Likert scale, from strongly agree to strongly disagree.
Consultation goals in the sexual health clinic were satisfaction, and the extent to which patients felt involved in decisions about their health care, as evidence suggests that a patient‐centred approach contributes to the goals of treatment for patients with chronic disease: to reduce hospital admissions and improve quality of life.15 Two questionnaires were developed for the sexual health clinic, one focusing on consultation satisfaction, quality and patient involvement in treatment as the goals of the consultation, and the other on attitudes towards the pharmacist prescriber model of care. There were 15 questions in the appointment questionnaire and 10 in the attitudes towards pharmacist prescribing questionnaire. Both questionnaires collected information on a 5 point Likert scale, from strongly agree to strongly disagree.
Ethics approval for the PAC and the sexual health questionnaires was sought from the Princess Alexandra Hospital and the Gold Coast Health Service District Human Research Ethics Committees, respectively. Changes were requested to the PAC questionnaires and for questions 2, 3, 4, 6 and 9 to be changed to make the questionnaire a mixture of positive and negative responses. For example, question 2 was changed from ‘The pharmacist listened to what I had to say’ to ‘The pharmacist did not listen to me’. No changes were requested to the sexual health clinic questionnaires.
Following ethics approval, all questionnaires were piloted on five non‐study patients in each clinic prior to the studies commencing, with respondents asked about ease of completion, understanding and length. On the basis of the pilot, no changes were made to any of the questionnaires.
Statistical analysis
For reporting purposes, the 5 point Likert scale in all questionnaires was collapsed into a 3 point scale; agree (strongly agree/agree), disagree (strongly disagree/disagree) and neutral. Cronbach's alpha coefficient was used to evaluate the internal consistency reliability for the different themes in surveys. For these calculations, the 5 point Likert scales were used.
The consultation behaviours associated with achievement of consultation goals in both settings were examined using the Spearman's rank correlation test.
Results
Pre‐admission clinic consultation satisfaction
The patient response rate was 91% (182/200). Respondents had a median age of 56 (range 18–86) and 60% were male. At the time of the PAC appointment, 83% (148/178) were taking regular medications.
Consultation goals – satisfaction and preparedness for surgery
Responses showed a very high level of satisfaction with the consultation, 98% of patients agreed that they were satisfied with the consultation provided by the pharmacist (Table 1). Importantly, 92% of patients agreed the information the pharmacist had given them helped prepare them for surgery.
Table 1.
Patient satisfaction pre‐admission clinic
| Strongly agree 5 | Agree 4 | Uncertain 3 | Disagree 2 | Strongly disagree 1 | Median score (range) | |
|---|---|---|---|---|---|---|
| Consultation experience | ||||||
| The pharmacist explained to me clearly what his/her role was in Pre‐Admission Clinic | 98 (54%) | 80 (44) | 3 (1) | 1 (1) | 0 | 5 (2–5) |
| The pharmacist did not listen to me | 5 (3%) | 5 (3) | 5 (3) | 47 (27) | 115 (65) | 1 (1–5) |
| The pharmacist did not explain clearly what to do with my medications before my operation | 10 (6%) | 15 (8) | 1 (1) | 40 (23) | 110 (62) | 1 (1–5) |
| The pharmacist did not explain clearly what to do with my medications after my operation | 7 (4%) | 16 (9) | 11 (6) | 44 (25) | 101 (56) | 1 (1–5) |
| The pharmacist checked that I understood what to do with my medications | 99 (55%) | 78 (43) | 1 (1) | 2 (1) | 1 (1) | 5 (1–5) |
| Any information the pharmacist gave me was irrelevant and difficult to understand | 5 (3%) | 7 (4) | 3 (2) | 54 (30) | 109 (61) | 1 (1–5) |
| The pharmacist answered any questions I asked in a way I easily understood | 95 (53%) | 80 (44) | 3 (2) | 1 (1) | 1 (1) | 5 (1–5) |
| I felt the pharmacist understood any concerns I had about my medications | 81 (45%) | 91 (51) | 4 (2) | 2 (1) | 1 (1) | 4 (1–5) |
| I did not trust the pharmacist's ability to provide me with a plan for the management of my medication | 6 (3%) | 11 (6) | 5 (3) | 49 (28) | 106 (60) | 1 (1–5) |
| To make sure the pharmacist is giving me the right plan I would like it to be checked by a doctor in the clinic | 22 (12%) | 44 (25) | 24 (14) | 48 (27) | 39 (22) | 3 (1–5) |
| Cronbach's alpha: | 0.612 | |||||
| Consultation goals | ||||||
| I am satisfied by the consultation provided by the pharmacist | 104 (57%) | 74 (41) | 4 (2) | 0 | 0 | 5 (3–5) |
| The information the pharmacist gave me has helped me prepare for my surgery | 72 (40%) | 95 (52) | 13 (7) | 2 (1) | 0 | 2 (2–5) |
Consultation experience
High percentages of patients agreed that the pharmacist explained their role in clinic (98%), that the pharmacist listened to them (92%), that they had a plan for medications, both before and after their operation, clearly explained to them (85% and 81%, respectively).
With regard to responsiveness to patients, high percentages agreed that the pharmacist checked their understanding of the plan for medication (98%) and that the pharmacist answered questions in a way that was easily understood (97%) and understood their concerns about medications (96%).
High percentages of patients agreed that any information they were given was easy to understand, and 88% of patient agreed they trusted the pharmacist's ability to provide them with a plan.
Spearman's correlation results highlighted elements of the consultation which are most strongly associated with feelings of patient satisfaction and preparedness for surgery. Both goals shared the highest ranked elements, namely the pharmacist explaining their role clearly, checking the patient understanding, understanding patient concerns and answering any questions the patient had effectively. This would suggest effective listening and communication, information provision and empathy are all important in ensuring patient satisfaction and preparedness (Table 2).
Table 2.
Spearman's rank correlation with consultation goals‐pre‐admission clinic
| I am satisfied by the consultation provided by the pharmacist | The information the pharmacist gave me has helped me prepare for my surgery | |
|---|---|---|
| The pharmacist explained to me clearly what his/her role was in Pre‐Admission Clinic | 0.712a | 0.574a |
| The pharmacist did not listen to me | −0.381a | −0.277a |
| The pharmacist did not explain clearly what to do with my medications before my operation | −0.334a | −0.213a |
| The pharmacist did not explain clearly what to do with my medications after my operation | −0.400a | −0.284a |
| The pharmacist checked that I understood what to do with my medications | 0.632a | 0.583a |
| Any information the pharmacist gave me was irrelevant and difficult to understand | −0.360a | −0.314a |
| The pharmacist answered any questions I asked in a way I easily understood | 0.637a | 0.554a |
| I felt the pharmacist understood any concerns I had about my medications | 0.615a | 0.618a |
| I did not trust the pharmacist's ability to provide me with a plan for the management of my medication | −0.428a | −0.319a |
| To make sure the pharmacist is giving me the right plan I would like it to be checked by a doctor in the clinic | −0.185b | −0.085 |
| The information the pharmacist gave me has helped me prepare for my surgery | 0.581a | – |
Correlation is significant at the 0.01 level (two‐tailed).
Correlation is significant at the 0.05 level (two‐tailed).
The independence of the pharmacist caused most ambivalence, and uncertainty (14%), amongst respondents, as indicated by responses to the question whether patients would like the plan given to them by the pharmacist to be checked by the doctor?
Sexual health clinic
Consultation satisfaction
The patient response for appointment feedback was 85%, with one patient only completing one questionnaire after the first pharmacist appointment, and two patients not completing either. Median age was 49 (range 33–65), and 87% were male.
Consultation goals – consultation satisfaction, quality and patient empowerment
There was high satisfaction with the consultation; patients agreed they were satisfied for 97% of appointments, and only after 3% of consultations did they agree that some things could have been better (Table 3). All of the patients agreed the pharmacist allowed them the opportunity to be involved in decisions about their care.
Table 3.
Consultation satisfaction sexual health clinic (n = 29 consultations)
| Strongly agree 5 | Agree 4 | Uncertain 3 | Disagree 2 | Strongly disagree 1 | Median score (range) | |
|---|---|---|---|---|---|---|
| Professional care | ||||||
| The prescriber told me everything about my treatment | 27 (93%) | 2 (7) | 0 | 0 | 0 | 5 (4–5) |
| I understand my illness more after seeing the prescriber than I did beforehand | 9 (31%) | 12 (41) | 7 (24) | 1 (3) | () | 4 (2–5) |
| I understand my medications and how to take them more after seeing the prescriber than beforehand | 13 (45%) | 10 (34) | 5 (17) | 0 | 1 (3) | 4 (1–5) |
| The prescriber checked that I understood my medications and that I would take them correctly | 25 (86%) | 4 (14) | 0 | 0 | 0 | 5 (4–5) |
| Any information the prescriber gave me was relevant and easy to understand | 23 (79%) | 6 (21) | 0 | 0 | 0 | 5 (4–5) |
| I will follow this prescriber's advice because I think he/she is absolutely right | 19 (66%) | 10 (34) | 0 | 0 | 0 | 5 (4–5) |
| The prescriber was interested in me as a person, not just my illness | 20 (69%) | 8 (28) | 1 (3) | 0 | 0 | 4 (3–5) |
| I felt the prescriber appeared to understand my concerns about medication | 18 (62%) | 9 (31) | 2 (7) | 0 | 0 | 5 (3–5) |
| Cronbach's alpha: | 0.70 | |||||
| Empathy | ||||||
| The prescriber understood my health problem | 26 (90%) | 3 (10) | 0 | 0 | 0 | 5 (4–5) |
| The prescriber listened to what I had to say | 25 (86%) | 4 (14) | 0 | 0 | 0 | 5 (4–5) |
| The prescriber took time to discuss any questions or worries I had | 22 (76%) | 7 (24) | 0 | 0 | 0 | 5 (4–5) |
| The prescriber appeared genuinely caring and concerned for my well‐being | 26 (90%) | 3 (10) | 0 | 0 | 0 | 5 (4–5) |
| Cronbach's alpha: | 0.85 | |||||
| Consultation goals | ||||||
| I am totally satisfied with my visit to the prescriber | 24 (83%) | 4 (14) | 1 (3) | 0 | 0 | 5 (3–5) |
| Some things about my consultation with the prescriber could have been better | 1 (3%) | 2 (7) | 2 (7) | 5 (17) | 19 (66) | 1 (1–5) |
| The prescriber allowed me an opportunity to be involved in making decisions about my care | 24 (83%) | 5 (17) | 0 | 0 | 0 | 5 (4–5) |
Professional care
All of the patients agreed that the prescriber told them everything about their treatment during the appointment, checked that they understood their medications, and how to take them, and that any information given to them by the pharmacist was relevant and easy to understand (Table 4). After their appointment, 72% of patients agreed that they understood their illness more, and 79% agreed that they understood their medications, and how to take them more. Overall, all of the patients agreed that they would follow the pharmacist's advice because he/she was absolutely right.
Table 4.
Spearman's rank correlation with consultation goals‐sexual health clinic
| I am totally satisfied with my visit to the prescriber | Some things about my consultation with the prescriber could have been better | The prescriber allowed me an opportunity to be involved in making decisions about my care | |
|---|---|---|---|
| I am totally satisfied with my visit to the prescriber | – | −0.639a | 0.764a |
| Some things about my consultation with the prescriber could have been better | – | – | −0.413b |
| The prescriber told me everything about my treatment. | 0.632a | −0.443b | 0.596a |
| I understand my illness more after seeing the prescriber than I did beforehand | −0.088 | 0.056 | 0.185 |
| I understand my medications and how to take them more after seeing the prescriber than beforehand | −0.078 | −0.067 | 0.158 |
| The prescriber checked that I understood my medications and that I would take them correctly | 0.583a | −0.474a | 0.612a |
| Any information the prescriber gave me was relevant and easy to understand | 0.674a | −0.614a | 0.668a |
| I will follow this prescriber's advice because I think he/she is absolutely right | 0.627a | −0.570a | 0.629a |
| The prescriber was interested in me as a person, not just my illness | 0.458b | −0.226 | 0.453b |
| I felt the prescriber appeared to understand my concerns about medication. | 0.343 | −0.487a | 0.338 |
| The prescriber understood my health problem | 0.474a | −0.481a | 0.444b |
| The prescriber listened to what I had to say | 0.883a | −0.523a | 0.876a |
| The prescriber took time to discuss any questions or worries I had | 0.601a | −0.388b | 0.596a |
| The prescriber appeared genuinely caring and concerned for my well‐being | 0.763a | −0.481a | 0.744a |
Correlation is significant at the 0.01 level (two‐tailed).
Correlation is significant at the 0.05 level (two‐tailed).
Empathy
All of the patients agreed the pharmacist understood their health problem, listened to them, took time to answer any questions and appeared genuinely caring and concerned for their well‐being.
In line with results from PAC, the Spearman's correlation showed that elements of the consultation behaviour that were most strongly associated with patient satisfaction were those concerning effective listening and answering of questions, information provision, and checking of patient understanding. The highest correlation with satisfaction was patients feeling they were involved in decisions concerning their treatment.
Attitudes towards pharmacist prescribing
The response rate for the attitudes towards pharmacist prescribing questionnaire was 82% (14/17) (Table 5). Respondents’ median age was 49 (range 33–65), and 87% were male
Table 5.
Patient responses relating to experience of pharmacist prescribing in the sexual health clinic (n = 14)
| Strongly agree 5 | Agree 4 | Uncertain 3 | Disagree 2 | Strongly disagree 1 | Median score (range) | |
|---|---|---|---|---|---|---|
| I trusted the pharmacist's ability to prescribe | 12 (86%) | 2 (14) | 0 | 0 | 0 | 5 (4–5) |
| I was satisfied by the consultation(s) provided by the pharmacist prescriber | 11 (79%) | 3 (21) | 0 | 0 | 0 | 5 (4–5) |
| I think the care provided by the prescribing pharmacist was as good as my usual care | 10 (71%) | 4 (29) | 0 | 0 | 0 | 5 (4–5) |
| I think the pharmacist prescriber improved the health care I received | 5 (36%) | 6 (43) | 3 (21) | 0 | 0 | 4 (3–5) |
| Changes to my treatment plan were explained to my satisfaction | 9 (64%) | 2 (14) | 3 (21) | 0 | 0 | 5 (3–5) |
| Changes to my medication were explained to my satisfaction | 8 (57%) | 2 (14) | 4 (29) | 0 | 0 | 5 (3–5) |
| I had enough time with the pharmacist prescriber for discussing medication related issues | 13 (93%) | 1 (7) | 0 | 0 | 0 | 5 (4–5) |
| I am more interested in the quality of care than the profession of the person who provides it | 8 (57%) | 1 (7) | 2 (14) | 0 | 3 (21) | 5 (1–5) |
| I would recommend seeing a pharmacist prescriber to other people | 11 (79%) | 3 (21) | 0 | 0 | 0 | 5 (4–5) |
| I would consider seeing a pharmacist prescriber for ongoing management, under an agreed care plan, of my condition and medication | 9 (64%) | 4 (29) | 1 (7) | 0 | 0 | 5 (3–5) |
The consultation
Consistent with the consultation satisfaction questionnaire, all of the patients were satisfied with the consultations provided by the pharmacist. All patients agreed that they had enough time to discuss medication‐related issues.
Provision of information and understanding of treatment plan
All patients who had changes to their treatment plan or medication agreed that changes had been explained to their satisfaction.
Trust in pharmacist
All of the patients trusted the pharmacist's ability to prescribe and thought that care provided was as good as usual care. This was all reflected in the overall willingness to engage with a pharmacist prescriber; 93% agreed they would consider seeing a pharmacist prescriber for on‐going management of their condition and medication, and all patients would recommend seeing a pharmacist prescriber to other people.
One question that caused most ambivalence amongst respondents was whether they were more interested in the quality of care than the profession of the person who provides it; 63% agreed, 21% disagreed and 14% were unsure.
End of consult goals were consistent with overall study satisfaction.
Discussion
In line with previous research on patient perspectives of non‐medical prescribing, patients in PAC and the sexual health clinic were highly satisfied with the pharmacist consultations, and patients in the sexual health clinic positive about their experiences in the model of care.5, 16, 17
A recent review suggested consultations with patients need to be treated as partnerships, and patients must be given the confidence, skills and knowledge to be partners.18 A questionnaire for assessing satisfaction with General Practitioner (GP) consults was developed in 1990, with the appreciation that patient satisfaction is an important outcome of care, and in the light of previous research which showed satisfied patients are more likely to co‐operate with treatment.12, 13 United Kingdom (UK) guidelines have since highlighted key consultation characteristics that support adherence to medication, including rapport, being given relevant information about medicines, being understood by the prescriber and being involved in decisions about their medicines, and a previous literature review reported that most of the studies reviewed demonstrated correlation between effective physician‐patient communication and improved patient health outcomes.19, 20 Giving patients the opportunity to feedback on the health care they receive is an important part of any health‐care programme and, if used effectively, can drive improvements in health‐care delivery.21, 22
The two models of care in our studies differ significantly, with PAC being an acute, single meeting between patient and prescriber, and the sexual health clinic being a chronic model of care, with repeat appointments. In both studies, the pharmacist was unknown to participants. Desired outcomes for the models of care are different, with the main goal in PAC ensuring the patient's medication is optimised prior to surgery, and that the patient understands and follows a clear plan for their medications perioperatively. Not following the plan for medications, especially with regard to anticoagulants, for example, increase the likelihood of surgery cancellation, and patient morbidity and mortality.23, 24 The positive responses in PAC with regard to the pharmacist explaining their role, listening, providing effective information, effectively answering any questions and understanding of concerns are suggestive of the pharmacist managing to build a good rapport within a relatively short space of time. Most patients agreed the pharmacist explained instructions clearly and also checked their level of understanding. From previous research, these are all key components in forming an effective partnership with a patient, and maximising the chance of co‐operation and adherence with treatment plans.12, 13, 18, 19
From the Spearman's correlation, it was also shown that these elements of the questionnaire were the most strongly correlated to both the overall feeling of consultation satisfaction and the feeling of being prepared for surgery.
In models of care such as the sexual health clinic, a patient‐centred approach, which empowers individuals to manage their health and health care, contributes to the goals of treatment: to reduce hospital admissions and improve quality of life for people with chronic disease.15
Patients in the sexual health clinic were highly satisfied with the pharmacist consultation, with the consistently high positive feedback across all questions again suggestive that an effective partnership was built between prescriber and patient. Patients felt like they were understood, given effective information and involved in treatment decisions, all key to patient empowerment and indicators for adherence and positive health outcomes.19, 20
There were some reservations in PAC with regard to the trust in the pharmacist to take on the extended role over the usual model of care, which again was in line with UK research in 2006 which explored patient perspectives, as part of a study of pharmacist prescribers in both primary and secondary care.17 The results showed positive consultation experiences and positive attitudes towards pharmacist prescribing. However, 65% of patients reported they would rather see a doctor. The question in PAC which divided opinion and had the highest percentage of ‘unsure’ respondents was whether the patients would like a doctor to double check the plan for medications. This would suggest that patients are not altogether comfortable to relinquish contact with a medical officer within clinic, when it comes to the medication‐related aspect of their appointment, which is also in line with the Australian survey of pharmacy clients' attitudes to pharmacist prescribing.2 The advantage of the collaborative prescribing model of care proposed within this study is that having to choose between health‐care professionals is not a requirement, and it facilitates the already established relations between doctors and patients by ensuring lines of referral between pharmacist and doctor are readily available.
A recent study from the UK ascertained views from patients on the impact of prescribing by nurse and pharmacist prescribers, including satisfaction with the consultation and the impact on choice, access, quality of care, knowledge, adherence and control of their condition.25 The results showed a high satisfaction with their last consultation, and a good relationship with, and high confidence in, their non‐medical prescriber. When comparing non‐medical prescribing and doctor prescribing, most patients reported no difference in their experience of care provided. The difference between the results in this study with regard to willingness to engage with non‐medical prescribers in previous UK studies may be explained by a maturation of attitudes within the general public, as non‐medical prescribing becomes an accepted model of care with time.
Consistent with other research, patients in the sexual health clinic were also highly satisfied with the concept of pharmacist prescribing, having experienced it over multiple appointments.16 The trust that patients had in the pharmacist's abilities to prescribe was high, patients were willing to engage with the pharmacist prescriber on an on‐going basis, and all patients thought that care was as good as usual care, with some believing the standard of care was better. Almost two thirds of patients were more interested in the quality of care provided, than the profession of the person who provided it. From the results, the authors would suggest an effective patient‐centred model of care was achieved, maximising the chances of positive health outcomes.15 The difference between the two models in terms of willingness to engage with a pharmacist over medical staff may well be a reflection of the chronic nature of the sexual health clinic model, in that the pharmacist was able to build a relationship with the patients through several appointments, when compared to the acute model of a single appointment in PAC. The collaborative model of care that seems so important to patients in the early stages of pharmacist prescribing implementation may have been more obvious to patients in the sexual health clinic than those in the PAC.2, 17.
The results from our studies are encouraging and show what pharmacist behaviours are associated with patients feeling satisfied with a consultation. The attitudes shown towards pharmacist prescribing bode well for any future introduction of the model of care into the Australian health‐care system and suggest initially that models of care which are more obviously collaborative would be most acceptable to patients.
Limitations include small numbers of patients in the sexual health clinic, with 14 respondents to the overall satisfaction questionnaire; however, the authors suggest the emphatic nature of the results overcome this. In PAC, it was difficult to ascertain views on the pharmacist prescribing model of care in the same way as in the sexual health clinic, due to the acute nature and also because, from the patient's perspective, the appointment differed in no way from usual care. Generalisability of the results from this study to pharmacist prescribing in general may be limited. This is partly due to the use of questionnaires containing normative questions, which tend to define how things should be according to the researchers. Questions of this nature may not always provide a totally unbiased picture of patient views.26
Recognising these limitations of the study is important; however, the trustworthiness of the findings is supported by the use of an evaluation framework which means evidence can be added to that from other studies, to strengthen the overall evidence base. The findings of our study are consistent with previous studies undertaken in Australia and UK.2, 17 There is also a strong consistency in the results between our two studies and strong internal consistency in the results of the sexual health clinic study. This study is also in keeping with findings from other studies where patient perceptions of service quality have a positive relationship with satisfaction and behavioural intent.27
In both models, there are consistent responses between ratings of satisfaction and behavioural intent, as shown by preparedness for surgery in PAC and recommending the pharmacist prescriber to others in the sexual health clinic.
Our studies trialled a single pharmacist prescriber in a designated scope of practice. Communication and consultation skills are a key component of the UK pharmacist prescribing course, as directed by the General Pharmaceutical Council guide on learning outcomes and indicative content.11 Prescribing competencies have recently been produced in Australia, to guide and direct learning outcomes for prescribers, and to be used in the development, or revision, of prescribing curricula.28 The results of our study show that effective listening and communication, empathy, effective information provision and empowerment of the patient in their treatment would seem to be the most important behaviours which are responsible for patient satisfaction, and the associated benefits. The challenge lies in ensuring training and education requirements for any future collaborative prescribing course are appropriate, and courses consistently and reliably produce competent and fit for purpose prescribers, who can replicate these results and outcomes on an on‐going basis.
Conclusion
Most patients were highly satisfied with the consultations with pharmacists in both studies, with positive attitudes on the model of care from patients in the sexual health clinic. The results suggest that patient satisfaction and willingness to engage will not be barriers to the implementation of collaborative doctor‐pharmacist prescribing models in Australia.
Conflict of interests
All authors declare no conflict of interests
Funding
No external sources of funding
References
- 1. Health Workforce Australia . Health Professionals Prescribing Pathway (HPPP) Project – Final Report. Adelaide: Health Workforce Australia, 2013. [Google Scholar]
- 2. Hoti K, Hughes J, Sunderland B. Pharmacy clients' attitudes to expanded pharmacist prescribing and the role of agency theory on involved stakeholders. International Journal of Pharmacy Practice, 2011; 19: 5–12. [DOI] [PubMed] [Google Scholar]
- 3. National Health Information Standards and Statistics Committee . The National Health Performance Framework, 2nd edn Canberra: National Health Information Standards and Statistics Committee, 2009. [Google Scholar]
- 4. Hale A, Coombes ID, Stokes J et al Perioperative medication management: expanding the role of the preadmission clinic pharmacist in a single centre, randomised controlled trial of collaborative prescribing. BMJ Open, 2013; 3: e003027. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Latter S, Blenkinshop A, Smith A et al Evaluation of Nurse and Pharmacist Independent Prescribing, Department of Health Policy Research Program Project 016 0108, Editor. University of Southampton, Keele University, 2010.
- 6. Van Der Weyden M. Doctor displacement: a political agenda or a health care imperative? Medical Journal of Australia, 2008; 189: 608–609. [DOI] [PubMed] [Google Scholar]
- 7. Australian Institute of Health and Welfare . Medical Labour Force 2005. Canberra: Australian Institute of Health and Welfare, Cat. no. HWL 41, Series number 40, 2008. [Google Scholar]
- 8. Health Workforce Australia . Health Workforce Australia Annual Report 2012‐2013. Adelaide: Health Workforce Australia, 2013. [Google Scholar]
- 9. National Health Workforce Taskforce . Health Workforce in Australia and Factors for Current Shortages. Brisbane: National Health Workforce Taskforce, 2009. [Google Scholar]
- 10. National Health Workforce Planning and Research Collaboration . Non‐Medical Prescribing. An Exploration of Likely Nature of, and Contingencies for, Developing a Nationally Consistent Approach to Prescribing by Non‐Medical Health Professionals. Brisbane: National Health Workforce Planning and Research Collaboration, 2010. [Google Scholar]
- 11. General Pharmaceutical Council . Pharmacist Independent Prescribing Programme‐Learning Outcomes and Indicative Content. London: General Pharmaceutical Council, 2010. [Google Scholar]
- 12. Kincey J, Bradshaw P, Ley P. Patients' satisfaction and reported acceptance of advice in general practice. Journal of the Royal College of General Practitioners, 1975; 25: 558–566. [PMC free article] [PubMed] [Google Scholar]
- 13. Baker R. Development of a questionnaire to assess patients' satisfaction with consultations in general practice. British Journal of General Practice, 1990; 40: 487–490. [PMC free article] [PubMed] [Google Scholar]
- 14. Stewart D et al, Evaluating supplementary prescribing by pharmacists in Scotland, Report submitted to NHS Education for Scotland, Editor. 2007.
- 15. Queenland Health . Queensland Strategy for Chronic Disease 2005‐2015. Brisbane: Springer, 2005. [Google Scholar]
- 16. Smalley L. Patient's experience of pharmacist‐led supplementary prescribing in primary care. Pharmaceutical Journal, 2006; 276: 567–569. [Google Scholar]
- 17. Steward D, George J, Bond C, Cunningham I, Diack H, McCaig D. Exploring patients' perspectives of pharmacist supplementary prescribing in Scotland. Pharmacy World & Science, 2008; 30: 892–897. [DOI] [PubMed] [Google Scholar]
- 18. Bond C, Blenkinsopp A, Raynor D. Prescribing and partnership with patients. British Journal of Clinical Pharmacology, 2012; 74: 581–588. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. National Institute for Clinical Excellence . Medicines Adherence: Involving Patients in Decisions about Prescribed Medicines and Supporting Adherence. London: National Institute for Clinical Excellence, 2009. [Google Scholar]
- 20. Stewart M. Effective physician‐patient communication and health outcomes: a review. Canadian Medical Association Journal, 1995; 152: 1423–1433. [PMC free article] [PubMed] [Google Scholar]
- 21. Wensing M, Elwyn G. Research on patients' views in the evaluation and improvement of quality of care. Quality and Safety in Health Care, 2002; 11: 153–157. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22. Draper M, Cohen P, Buchan H. Seeking consumer views: what use are results of hospital satisfaction surveys. International Journal for Quality in Health Care, 2001; 13: 463–468. [DOI] [PubMed] [Google Scholar]
- 23. Emanuel A, Mcpherseon R. The anaesthetic pre‐admission clinic is effective in minimising surgical cancellation rates. Anaesthesia and Intensive Care, 2013; 41: 90–94. [DOI] [PubMed] [Google Scholar]
- 24. De Boer M, Boeker EB, Kiewiet JJS et al Incidence and nature of adverse events in surgical patients. European Journal of Hospital Pharmacy, 2012; 19: 97–98. [Google Scholar]
- 25. Tinelli M, Blenkinsopp A, Latter S, Smith A,Chapman SR. Survey of patients' experiences and perceptions of care provided by nurse and pharmacist independent prescribers in primary care. Health Expectations, 2013. doi:10.1111/hex.12099. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26. Lincoln Y, Guba E. Naturalistic Enquiry. Newbury Park, CA: Sage, 1985. [Google Scholar]
- 27. Ramez W. Patients' perceptions of health care quality, satisfaction and behavioural intention: an empirical study in Bahrain. International Journal of Business and Social Science, 2012; 3: 131–141. [Google Scholar]
- 28. NPS . Better Choices, Better Health. Competencies Required to Prescribe Medicine: Putting Quality Use of Medicines into Practice. Sydney: N.P.S. Limited, Editor, 2012. [Google Scholar]