Table 3.
Characteristics and key findings of included quantitative studies (n = 41)
| Author (Year of publication) | Aim(s)/objective(s) | Definition and model of PP discussed | Country of focus | Stakeholder population studied (sample size) | Study design and methods | Key findings |
|---|---|---|---|---|---|---|
| Preimplementation of pharmacist prescribing | ||||||
| Pennock et al. (1988) 38 | Explore to what extent will pharmacist prescribing be accepted by consumers | No standardized definition provided | USA | Consumers (n = 400, RR 53%) | Questionnaire | Consumers' relationships with pharmacists is important in determining acceptance of prescribing role. |
| Segal and Grines (1988) 39 | Identify attitudes of organized pharmacy, organized medicine and pharmaceutical industry about prescribing authority for pharmacists | Models of PP in each US state presented | USA | Different pharmacy and medical associations and boards, PMA, manufacturers and non‐PMA‐member generic manufacturers (n = 307, RR 63%) | Questionnaire | Hospital pharmacy associations/boards to a lesser extent in support; non‐PMA‐member generic manufacturers/US state pharmacy associations relatively neutral. Medical associations/PMA‐member companies in opposition. |
| Spencer and Edwards (1992) 40 | Ascertain GPs' attitudes to an extended role for community pharmacists | No standardized definition provided | UK | Doctors (n = 1087, RR 68.4%) | Questionnaire | Pharmacists are too influenced by commercial pressures, should stick to dispensing and not supervise repeat prescriptions. However, GPs supported pharmacists prescribing nicotine chewing gum. |
| Child et al. (1998) 41 | Identify the attitudes of hospital‐based healthcare professionals involved in drug therapy towards prescription writing and initiation of drug treatment (prescribing) by the pharmacist, explore the perceived barriers to PP, and to examine the potential future role of the pharmacist in drug therapy management | No standardized definition provided | UK | Doctors (n = 195, RR 48.7%), nurses (n = 200, RR 57.5%), pharmacists (n = 87, 77%) | Questionnaire | Postgraduate education/training and attachment to clinical area are important requirements for PP. Barriers are pharmacists' willingness to accept this role, education/training and accountability. |
| Child and Cantrill (1999) 42 | Examine the reasons behind hospital doctors' perceived barriers to PP in the UK | No standardized definition provided | UK | Hospital doctors (n = 193, RR 49%) | Questionnaire | Awareness of clinical and patient details, communication, doctor writing initial prescription, clinical responsibility and review of treatment were reported. |
| Child (2001) 43 | Examine hospital nurses' perceptions of PP in the UK | No standardized definition provided | UK | Nurses at five NHS teaching hospitals (n = 200, RR 57.5%) | Questionnaire | Pharmacists' knowledge, review of treatment, pharmacists' workload, communication and accountability issues were discussed. |
| George et al. (2006) 44 | Investigate community pharmacists' awareness, views and attitudes relating to IP by community pharmacists and their perceptions of competence and training needs for the management of some common conditions | Provided definition of UK models | UK | Community pharmacists (n = 500, RR 43.4%) | Questionnaire | Confidence in abilities to IP, training, consultation skills and communication were highlighted. Facilitators include practising more hours/week as a pharmacist, training, and involvement in Scottish Executive pharmaceutical care model schemes. |
| Kay et al. (2006) 45 | Identify Australian pharmacists' awareness of their international colleagues' prescribing practices and explore their views about the feasibility and utility of PP privileges within the scope of their current practice | Provided definition of dependent prescribing | Australia | Pharmacists (n = 4158, RR 6.4%) | Questionnaire | 74% and 52% supported dependent and independent prescribing respectively. 86% believed they could justify their prescribing while 73% believed they would benefit from prescribing authority. |
| Nguyen and Bajorek (2008) 46 | Explore the clinical utility and capacity of pharmacists to undertake prescribing functions in anticoagulation management in the hospital setting (pilot study) | No standardized definition provided | Australia | Pharmacists (n = 16), graduates (n = 2) and final year pharmacy students (n = 6) | Questionnaire | Inpatient PP can be useful but outpatient and dependent models were more appropriate. 58% of prescribing was clinically inappropriate. Barriers include training, experience and doctors' opposition. |
| Weeks and Marriott (2008) 47 | Explore the views of Society of Hospital Pharmacy Australia pharmacist members on collaborative prescribing and the extent of de facto prescribing at their institution | Provided definition for collaborative and de facto prescribing | Australia | Pharmacists (n = 1367, RR 40%) | Questionnaire | 95% thought collaborative prescribing could circumvent hospital delays with timely service delivery. If a framework existed, 75% would consider PP. |
| Hoti et al. (2010) 48 | Evaluate the views of Australian pharmacists on expanded PP roles and identify important drivers and barriers to its implementation | Current practice of Australian pharmacists presented | Australia | Pharmacists (n = 2592, RR 40.4%) | Questionnaire | 83.9% supported PP and 97.1% needed training. Inadequate training in patient assessment, diagnosis and monitoring were barriers to PP. |
| Hoti, Hughes and Sunderland (2011) 18 | Examine the views of regular pharmacy clients on PP and employ agency theory in considering the relationship between the stakeholders involved | Current practice of Australian pharmacists presented | Australia | Patients (n = 1153, RR 34.7%) | Interview (quantitative approach) | 71% trusted PP, while 66% supported doctor diagnosing first. Pharmacist diagnosing and prescribing was limited to pain management and antibiotics. 64% highlighted improved access to prescription medicines with PP. |
| Perepelkin (2011) 49 | Better understand public perceptions of pharmacists, and the acceptance of possible expanded roles for pharmacists, including prescribing authority | No standardized definition provided | Canada | General public (n = 1283, RR 31.4%) | Questionnaire | Emergency situations, renewal of long‐term medications and changing medications' frequency or strength were the most accepted scenarios for PP. |
| Erhun, Osigbesan and Awogbemi (2013) 50 | Determine the views of pharmacists and physicians on PP, appropriateness and the possible contribution to the healthcare system if pharmacists prescribe | No standardized definition provided | Nigeria | Pharmacists (n = 300, RR 61%) and physicians (n = 400, RR 40%) | Questionnaire | 77.5% of pharmacists supported while 74.4% of physicians opposed PP. However, if there was no doctor, some physicians supported PP. Reasons for opposition were legal provision and professional incompetence. |
| Hoti, Hughes and Sunderland (2013) 51 | Compare the attitudes of hospital and community pharmacists regarding an expanded prescribing role | An overview of international models presented | Australia | Pharmacists (n = 2592, RR 40.4%) | Questionnaire | Community pharmacists supported IP and emergency prescribing. Hospital pharmacists supported SP for heart failure and anticoagulant therapies; and IP for anticoagulant therapies. |
| Auta et al. (2014) 52 | Explore the views of patients of community pharmacists on their consultation experiences, and the possible extension of prescribing rights to pharmacists in Nigeria | No standardized definition provided | Nigeria | Patients (n = 432, RR 86.6%) | Questionnaire | 92.5% supported PP. 79.7% favoured restricted formulary prescribing, and 71.9% prefer to see a doctor if their conditions get worse. |
| Moore, Kennedy and McCarthy (2014) 53 | Explore GP–pharmacist relationship, gain insight into communication between the professions and evaluate opinion on extension of the role of the community pharmacist | No standardized definition provided | Ireland | Doctors (n = 500, RR 52%) and community pharmacists (n = 335, RR 62%) | Questionnaire | Compared to doctors, pharmacists were more supportive of PP. 82% of GPs and 96% of pharmacists favoured pharmacists dealing with minor ailments. |
| Hale et al. (2016) 54 | 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 PP | No standardized definition provided | Australia | Patients in preadmission (n = 200, RR 91%) and sexual health (n = 17, RR 85%) clinics | Questionnaire | Almost all patients (98% in preadmission and 97% in sexual health clinic) were satisfied with the consultation. |
| Ung et al. (2016) 55 | Explore how pharmacists can prescribe oral antibiotics to treat a limited range of infections whilst focusing on their confidence and appropriateness of prescribing | Current practice of Australian pharmacists presented | Australia | Pharmacists (n = 240, RR 34.2%) | Questionnaire | High levels of appropriate antibiotic prescribing were shown for uncomplicated urinary tract infections (97.2%), cellulitis (98.2%) and adolescent acne (100%). |
| Auta et al. (2017) 56 | Explore the views of pharmacists in Nigeria on the extension of prescribing authority to them, determine their willingness to be prescribers and identify the potential facilitators and barriers to introducing PP in Nigeria | Provided definition of UK models | Nigeria | Pharmacists (n = 775, RR 40.6%) | Questionnaire | 97.1% supported PP. Facilitators for PP were increasing patients' access to care and better utilization of pharmacists' skills. Barriers were medical resistance and pharmacists' inadequate diagnosis skills. |
| Khan et al. (2017) 57 | Assess the attitudes of rural population towards PP and their interest in using expanded PP services | No standardized definition provided | India | General public (n = 480, RR 85.4%) | Questionnaire | 81.5% supported PP. Participants with low income and tertiary education showed more interest towards PP (P < 0.05). |
| Postimplementation of pharmacist prescribing | ||||||
| Eng et al. (1990) 19 | Examine the attitudes and self‐reported prescribing activities of a sample of Florida pharmacists interviewed 6 months and 12 months after enactment of the Florida Pharmacist Self‐Care Consultant Law | No standardized definition provided | USA | Pharmacists (prescribers and nonprescribers; n = 200, RR 97% for Phase 1; n = 131, RR 66% for Phase 2) | Interview (quantitative approach) | Prescribers perceive that the law positively affected their relationships with patients. Both prescribers and nonprescribers believed that the law has not affected their relationships with physicians. |
| White‐Means and Okunade (1992) 20 | Assess the current status of IP by Florida pharmacists two years after the law was enacted, examine correlates of the choice to prescribe, and discuss policy implications of the findings | Provided a description of the Self‐Care Consultant Law | USA | Pharmacists (prescribers and nonprescribers; n = 1800, RR 32.3%) | Questionnaire | Prescribers are more likely to perceive they have enough training to prescribe and to view their skills as comparable to those of physicians, but less likely to think a PharmD is needed. |
| Erwin et al. (1996) 21 | Explore GPs' views on various drugs being dispensed by community pharmacists without a prescription to determine whether these views have changed since 1990 | No standardized definition provided | UK | Doctors (not exposed to PP; n = 250, RR 69% for fundholding, n = 600, RR 57% for nonfundholding practices) | Questionnaire | GPs overall level of approval for PP had increased. GPs from fundholding practices agreed to a slightly wider range of drugs being made available over‐the‐counter than those from nonfundholding practices. |
| George et al. (2006a) 22 | Explore SP pharmacists' early experiences of prescribing and their perceptions of the prescribing course | Provided definition of UK models | Great Britain | SP pharmacist (n = 518, RR 82.2%) | Questionnaire | Better patient management and funding issues were the main benefit and barrier respectively. Predictors of SP included time since SP registration; confidence and practicing in a setting other than community pharmacy. |
| Hobson and Sewell (2006) 23 | Study the implementation of SP by pharmacists within primary care trusts (PCTs) and secondary care trusts (SCTs) in England | Provided definition of UK models | UK | Pharmacists (not exposed to PP; n = 143, RR 68% for SCT; n = 271, RR 68% for PCT) | Questionnaire | Additional training required around the clinical area of practice for SCT and the completion of continuing professional development for PCT respondents. |
| Hobson and Sewell (2006b) 24 | Provide data on the views of chief pharmacists and PCT pharmacists on the risks and concerns surrounding SP | An overview of global experiences presented | UK | Chief pharmacists and PCT pharmacists (not exposed to PP; n = 143, RR 68% for SCT; n = 271, RR 68% for PCT) | Questionnaire | There was a positive attitude about implementing SP, but concerns rose over training and professional competency/responsibility. |
| Smalley (2006) 25 | Evaluate patients' experience of our established pharmacist‐led SP hypertension clinic | No standardized definition provided | UK | Patients who experienced SP (n = 127, RR 87%) | Questionnaire | 91% continued to attend. 57% found the care they received was better than previous care. 86% understood their condition more, were more involved in decision‐making and could easily schedule appointment. |
| George et al. (2007) 26 | Investigate the challenges experienced by pharmacists in delivering SP services, explore their perceptions of benefits of SP and obtain feedback on both SP training and implementation | Provided definition of UK SP model | Great Britain | SP pharmacists (n = 488, RR 82.2%) | Questionnaire | Better patient management was the main benefit. Barriers include lack of organizational recognition of SP and funding. Greater emphasis on clinical skills development should be part of the SP course. |
| Stewart et al. (2008) 27 | Explore patients' perspectives and experiences of pharmacist SP in Scotland | Provided definition of UK SP model | UK | Patients who experienced SP (sample size not clear, RR 57.2%) | Questionnaire | 89.3% were satisfied with the consultation, 78.7% thought it was comprehensive and most would recommend PP to others. However, 65% would prefer to consult a doctor. |
| Stewart et al. (2009) 28 | Determine the awareness of, views on, and attitudes of members of the Scottish general public toward nonmedical prescribing, with an emphasis on PP | Provided definition of UK models | UK | General public (exposed and nonexposed to PP; n = 500, RR 37.1%) | Questionnaire | 56.6% were aware of nonmedical prescribing. More than half supported PP. Concerns rose about privacy despite acknowledging its enhanced convenience. |
| McCann et al. (2011) 29 | Capture information on PP in Northern Ireland | Provided definition of UK models | UK | Pharmacists who were identified as qualified prescribers (n = 105, RR 76%) | Questionnaire | Benefits for patient care and pharmacist were reported. IP was viewed as the way forward, but concerns were raised about prescribing without a diagnosis or beyond the team setting. |
| McIntosh et al. (2011) 30 | Investigate newly registered pharmacists' awareness of PP and views on potential future roles as prescribers | No standardized definition provided | Great Britain | Newly registered pharmacists (not exposed to PP; n = 1658, RR 25.2%) | Questionnaire | 86.4% were interested in prescribing. Training is needed in clinical examination, patient monitoring and medico‐legal aspects of prescribing. 66.3% thought the current requirement for SP was appropriate. |
| Stewart et al. (2011) 31 | Evaluate the views of patients across primary care settings in Great Britain who had experienced PP | No standardized definition provided | Great Britain | Patients who experienced PP (n = 1622, RR 29.7%) | Questionnaire | The vast majority were satisfied with their consultation, believed their pharmacist prescribed as safely as their GP and considered them approachable and thorough. |
| Hutchison et al. (2012) 32 | Determine reasons for the slow adoption of prescribing authority by hospital pharmacists in the Canadian province of Alberta | An overview of PP in Canada presented | Canada | Pharmacists (not exposed to PP; n = 500, RR 62.8%) | Questionnaire | The value of PP motivates pharmacists to apply for PP. Barriers include the lengthy application process, increased liability and documentation requirements. |
| MacLure et al. (2013) 33 | Explore the views of the Scottish general public on nonmedical prescribing | Provided definition of UK models | UK | General community in Scotland (exposed and nonexposed to PP; n = 500, RR 37.1%) | Questionnaire | There was lack of awareness of NMP knowledge and training but support for a limited range of prescribing. Barriers included lack of access to medical records and issues with privacy and confidentiality. |
| Tinelli et al. (2013) 34 | Obtain feedback from primary care patients on the impact of prescribing by nurse independent prescribers and pharmacist independent prescribers on experiences of the consultation, the patient–professional relationship, access to medicines, quality of care, choice, knowledge, patient‐reported adherence and control of their condition | Provided definition of UK models | UK | Patients who experienced PP (n = 975, RR 30%) | Questionnaire | Satisfaction and confidence with pharmacist independent prescribers were high. When comparing nurse independent prescriber to doctor prescribing, most reported no difference in their experience of care. |
| Hill et al. (2014) 35 |
Not explicitly stated: Explore the acceptability of PP in addiction services in NHS Lanarkshire amongst the stakeholders and service users |
Provided definition of UK models | UK | Patients (n = 110, RR 78.2%), PP (n = 5, 100%), medical prescribers (n = 12, RR 50%) | Questionnaire | PP is seen as effective and preferred by patients. Although doctors have more reservations, the majority believed it was beneficial. All thought IP would be more beneficial. |
| Mansell et al. (2015) 36 | Determine whether patients prescribed treatment for minor ailments by a pharmacist symptomatically improve within a set time frame | No standardized definition provided | Canada | Patients who experienced PP (all population was included) | Questionnaire | Condition significantly/completely improved in 80.8% with only 4% experiencing bothersome side effects. Trust in pharmacists and convenience were the common reasons for choosing a pharmacist over a physician. |
| Bourne et al. (2016) 37 | Determine the current and proposed future IP practice of UK clinical pharmacists working in adult critical care | No standardized IP definition provided | UK | UK Clinical Pharmacy Association members (prescribers and nonprescribers; n = 404, RR 33%) | Questionnaire | Over a third were IP, and 70% intended to be prescribers within the next 3 years. Experience and working in a team facilitated IP. Pharmacists reported significant positives in patient care and job satisfaction. |
| Isenor et al. (2017) 58 | To identify the relationship between barriers and facilitators to pharmacist prescribing and self‐reported prescribing activity using the Theoretical Domains Framework version 2 | An overview of PP in Nova Scotia (Canada) presented | Canada | Pharmacists (prescribers and nonprescribers; n = 1100, RR 8%) | Questionnaire | The three domains most positively associated with prescribing were Knowledge (84%), Reinforcement (81%) and Intentions (78%). The largest effect on prescribing activity was the Skills domain. |
NMP: nonmedical prescribing; IP: independent prescribing; SP: supplementary prescribing; PP: pharmacist prescribing; RR, response rate; PMA, Pharmaceutical Manufacturers Association; GP, general practitioner