Table 3.
Characteristics of included studies (n=23) and key barriers and facilitators
| Author(s), year | Country, setting | Study focus, participants | Barriers | Facilitators | QATSDD score |
| Afseth and Paterson (2017)127 | Scotland. HEI. | Views on prescribing training. 6 NIP trainees, 6 DMPs. |
1, 2, 3 | 4, 5, 6, 7, 8 | 67% |
| Boreham et al (2013)128 | Scotland. | Views on prescribing training. 87 NIP trainees, 10 HEI leads. |
1, 2, 3, 8, 9 | 4, 5, 9, 10, 11 | 67% |
| Bowskill et al (2014)129 | England. HEI. | Views on prescribing training 6 IP trainees, 3 IPs (unspecified professions). |
1, 3, 9 | 12 | 60% |
| Brodie et al (2014)130 | Scotland. Gen-P, Comm. | Views on prescribing role. 4 NIPs, 4 PIPs. |
8, 13, 14, 15, 16, 17, 18, 19 | 9, 10, 20, 21, 22, 23, 24 | 38% |
| Carter et al (2021)131 | England, Scotland, Wales. Gen-P, Comm pharmacy. | Factors influencing prescribing and role of practice pharmacists on evidence based prescribing. 6 GPs, 6 NIPs, 6 PIPs, 12 key informants. |
25, 26, 27 | 9, 11, 24, 28, 29, 30, 31, 32, 61 | 78% |
| Cole and Gillett (2015)132 | England. Comm pall care. | Prescribing practices. 6 NIPs. |
2, 3, 15, 26, 27, 33, 34, 35, 36, 37, 38 | 21, 28, 30, 37, 61 | 29% |
| Courtenay et al (2010)133 | England. Gen-P, Comm clinics. | Patient experiences/views of nurse prescribing. 41 patients. |
10, 11, 22, 39 | 50% | |
| Courtenay et al (2017)134 | England, Scotland, Wales. Gen-P, Comm clinics. | Patient experiences/views of nurse and pharmacist antibiotic prescribing for respiratory tract infection. 16 NIPs, 1 PIP, 22 patients. |
27 | 22, 23, 39, 40, 41 | 67% |
| Courtenay et al (2019)135 | UK (unspecified countries). Gene-P, OOH, IC. | Factors influencing antibiotic prescribing for respiratory tract infection. 17 NIPs, 4 PIPs. |
18, 27, 38, 42, 43 | 6, 10, 11, 22, 23, 24, 28, 29, 32, 39, 40, 41, 44, 57 | 78% |
| Cousins and Donnell (2012)136 | England. Gen-P. | Views on prescribing role. 6 NIPs. |
3, 16, 18, 27, 34, 35, 37, 42, 45 | 6, 9, 10, 20, 24, 28, 61 | 59% |
| Daughtry and Hayter (2010)137 | England. Gen-P. | Experiences of prescribing role. 8 practice NIPs. |
3, 6, 18, 27, 29, 35, 62 | 5, 8, 9, 10, 11, 24, 28, 29, 30, 44, 46, 47, 57, 61 | 36% |
| Dhalivaal et al (2011)138 | England. Gen-P. | Patient views on nurse prescribing. 15 patients. |
22, 39 | 43% | |
| Downer and Shepherd (2010)139 | Scotland. Comm. | Views on prescribing role. 8 district NIPs. |
3, 15, 17, 18, 35, 37, 38, 45, 48, 49, 62 | 3, 9, 10, 30, 44, 57, 61 | 48% |
| Herklots et al (2015)140 | England. Comm. | Experiences of prescribing. 7 community matron IPs. |
3, 15, 16, 18, 35, 38, 48, 49, 62 | 6, 7, 10, 11, 12, 22, 29, 47, 57, 61 | 43% |
| Holden et al (2019)141 | England. | Medicines optimisation practices. 20 physio non-IPs, 1 physio-IP. |
3, 13, 36, 42, 45, 50, 51 | 10, 21 | 75% |
| Inch et al (2019)142 | England, Scotland, Northern Ireland. Elderly residential care. |
Feasibility of implementation. 2 P non-IPs, 4 PIPs, 6 GPs, 16 care home staff, 2 patients, 3 relatives, 1 dietician non-IP. |
3, 49 | 10, 21, 22, 23, 52 | 54% |
| Kelly et al (2010)143 | England. Gen-P. | Barriers to adoption of IP. 31 practice NIPs, 120 N non-IPs. |
1, 2, 3, 9, 13, 35, 36, 42, 45, 50, 51, 53, 54, 55 | 33% | |
| Lane et al (2020)144 | England, Scotland, Northern Ireland. Elderly residential care |
Barriers and facilitators to prescribing. 27 P non-IPs, 29 GPs, 12 care home staff, 7 patients, 7 relatives. |
3, 35, 43, 48, 49 | 6, 7, 8, 10, 11, 21, 22, 39, 46, 52, 56 | 78% |
| Latham and Nyatanga (2018a, b)145 146 | England. Comm pall care. | Views on prescribing role. 6 NIPs. |
3, 15, 18, 27, 35, 36, 38, 49, 50, 60 | 7, 8, 10, 11, 12, 20, 21, 22, 30, 44, 52, 57, 61 | 71% |
| Maddox et al (2016)147 | England. Gen-P, Comm, Nursing homes, Comm pharmacy. | Barriers and facilitators to prescribing. 25 NIPs, 5 PIPs. |
3, 15, 16, 26, 27, 29, 35, 37, 42, 48, 62 | 6, 7, 10, 12, 24, 29, 30, 42, 47, 57, 61 | 71% |
| Stenner et al (2011)148 | England. Gen-P, Comm clinics. | Patient views on nurse prescribing. 41 patients. |
11, 22, 23, 29, 39 | 55% | |
| Weiss et al (2016)149 | England. Gen-P. | Views on prescribing role. 7 NIPs, 7 PIPs, 7 GPs. |
3, 6, 17, 25, 35, 45, 49, 51, 56, 58, 59, 63 | 3, 6, 8, 11, 12, 22, 24, 29, 39, 44, 46, 47, 63 | 52% |
| Williams et al (2018)150 | England. OOH/unscheduled care. |
Factors influencing nurse and GP antibiotic prescribing for respiratory tract infection. 15 NIPs, 15 GPs. |
15, 16, 18, 26, 27, 34, 49, 59 | 6, 12, 22, 23, 24, 28, 32, 41 | 76% |
Barriers: 1=Lack of backfill/protected/study time, 2=Lack of DMP role clarity/supervision/availability, 3=Lack of medical/managerial support/leadership, 14=Lack of national IP incentives/policy initiatives, 15=Lack of clinical record/IT access, 16=Lack of CPD/supervision, 17=IP role isolation, 18=Time/workload constraints, 19=Lack of IP strategy, 25=Lack of interprofessional collaboration/communication networks, 26=Unclear/absent clinical protocols/guidelines, 27=Inappropriate patient/team pressure for prescribing, 33=Lack of local policies for IP, 34=Lack of governance/accountability structures, 35=Lack of team understanding of IP, 36=Lack of clinical/service advantage of IP, 37=Lack of peer support/mentoring, 38=Lack of prescribing confidence/competence, 42=Fear of responsibility/accountability/error, 43=Lack of practitioner specialist skills, 45=Lack of professional/personal adoption incentive, 48=Poor/absent physician relationships, 49=Lack of IP role clarity, 50=Expedient medicines pathways, 51=Prescribing considered outside professional practice scope, 53=Lack of course information, 54=Inconsistent selection policies, 55=Lack of workforce planning, 58=Formulary restrictions, 59=Lack of service user acceptance, 60=Delayed registration post qualification, 62=Lack of medical supervision, 63=Employment model.
Facilitators: 4=DMP role clarity/good DMP supervision, 5=Interprofessional training model, 6=IP role clarity, 7=Established physician relationships, 8=Medical/managerial support/leadership, 9=Professional/personal adoption incentive, 10=Clinical/service advantage of IP, 11=Interprofessional collaboration/communication networks, 12=Peer support/mentoring, 13=Lack of course funding, 20=Prescribing integral to advanced practice, 21=Identified service pathways gaps, 22=Practitioner specialist skills, 23=Consultation time, 24=CPD/supervision, 28=Clinical/professional protocols/guidelines, 29=Prescribing confidence/competence, 30=Exposure to prescribing opportunity, 31=Adequate formulary, 32=National incentives/policy initiatives for prescribing, 39=Service user acceptance of IP, 40=Governance/accountability structures, 41=Audit/feedback on prescribing practice, 44=Good interprofessional relationships, 46=Stakeholder consultation, 47=Team understanding of IP, 52=Clinical record/IT access, 56=Employment model, 57=Medical supervision, 61=Delineated scope of prescribing competence.
Comm, community; CPD, continued professional development; DMPs, designated medical practitioners; Gen-P, general practice; GPs, general practitioners; HEI, higher educational institute; IC, integrated care; IP, independent prescribing; IT, information technology; NIP, nurse IP; N non-IPs, nurse non-IPs; OOH, out of hours; pall, palliative; physio-IP, physiotherapist IP; physio non-IPs, physiotherapist non-IP; PIPs, pharmacist IP; QATSDD, Quality Assessment Tool for Studies with Diverse Designs.