Barry Strickland-Hodge

Perceived facilitators to change in hospital pharmacy practice in England

Background Traditionally, hospital pharmacists’ roles have been associated with dispensing medications prescribed by doctors and offering advice about medicines to patients and other healthcare professionals. In England, significant changes in the structure of hospital pharmacy practice began in the 1970s and currently hospital pharmacists are undertaking a number of advanced roles including prescribing. Objective This study investigated the facilitators to change in hospital pharmacy practice in England in order to identify lessons that might assist in the potential changes needed in other countries for extended clinical roles. Setting The study was conducted in England. Methods A qualitative study using semi-structured interviews was conducted with 28 participants, comprising 22 pharmacists and 6 pharmacy technicians from England. They were recruited through a snowball sampling technique. Transcribed interviews were entered into the QSR NVivo 10 software for data management and analysed thematically. Main outcome measure Pharmacists and pharmacy technicians’ perception of the facilitators to hospital pharmacy practice change in England. Result Three major themes emerged from this study: drivers for change, strategies for change and efficiency. Many of the drivers identified were linked to changes in the structure of hospital pharmacy including education and training; specialisation in practice and career structure. Strategies employed to achieve practice change included broadening the role of pharmacy technicians in order to free-up pharmacists’ time; seizing opportunities for extended roles; developing a relationship with the medical profession and professional leadership influence. Participants perceived that the development of pharmacists’ clinical roles have resulted in a more efficient healthcare provision where patients were offered seamless services. Conclusion Changes in the professional structure of pharmacy including education and training, specialisation, career structure and the roles of pharmacy technicians could benefit the development of pharmacists’ clinical roles in other countries.

Stakeholders’ views on granting prescribing authority to pharmacists in Nigeria: a qualitative study

Background In Nigeria, only medical doctors, dentists and some nurses in primary care facilities have the legal right to prescribe medicines to patients. Patients’ access to prescription medicines can be seriously affected by the shortage of prescribers leading to longer waiting times in hospitals. Objective This research was carried out to investigate stakeholders’ views on granting prescribing authority to pharmacists in Nigeria. Setting The study was conducted in Nigeria. Methods Qualitative, semi-structured interviews were conducted with 43 Nigerian stakeholders including policymakers, pharmacists, doctors and patient group representatives. Transcribed interviews were entered into the QSR NVivo 10 software and analysed using a thematic approach. Main outcome measure Stakeholders’ perception on the granting of prescribing authority to pharmacists in Nigeria. Results Three major themes emerged from the interviews: (1) prescribing as a logical role for pharmacists, (2) pharmacist prescribing- an opportunity or a threat and (3) the potential barriers to pharmacist prescribing. Many non-medical stakeholders including pharmacists and patient group representatives supported an extended role for pharmacists in prescribing while the majority of medical doctors including those in policy making were reluctant to do so. Generally, all stakeholders perceived that pharmacist prescribing represents an opportunity to increase patients’ access to medicines, reduce doctors’ workload and promote the utilisation of pharmacists’ skills. However, many stakeholders including pharmacists and doctors commonly identified pharmacists’ inadequate skills in diagnosis, medical resistance and shortage of pharmacists as potential barriers to the introduction of pharmacist prescribing in Nigeria. Conclusion The present study showed a split of opinion between participants who were medical doctors and those who were non-doctors in their support for pharmacist prescribing. However, all stakeholders acknowledged the potential of pharmacist prescribing to increase patients’ access to medicines in Nigeria.

Global access to antibiotics without prescription in community pharmacies: a systematic review and meta-analysis

OBJECTIVE To estimate the proportion of over-the-counter antibiotic requests or consultations that resulted in non-prescription supply of antibiotics in community pharmacies globally. METHODS We systematically searched EMBASE, Medline and CINAHL databases for studies published from January 2000 to September 2017 reporting the frequency of non-prescription sale and supply of antibiotics in community pharmacies across the world. Additional articles were identified by checking reference lists and a Google Scholar search. A random effects meta-analysis was conducted to calculate pooled estimates of non-prescription supply of antibiotics. RESULTS Of the 3302 articles identified, 38 studies from 24 countries met the inclusion criteria and were included in the review. All the included countries with the exception of one, classified antibiotics as prescription-only medicines. The overall pooled proportion of non-prescription supply of antibiotics was 62% (95% CI 53-72). The pooled proportion of non-prescription supply of antibiotics following a patient request was 78% (95% CI 59-97) and based on community pharmacy staff recommendation was 58% (95% CI 48-68). The regional supply of non-prescription antibiotics was highest in South America, 78% (95% CI 72-84). Antibiotics were commonly supplied without a prescription to patients with symptoms of urinary tract infections (68%, 95% CI 42-93) and upper respiratory tract infections (67%, 95% CI 55-79). Fluoroquinolones and Penicillins respectively were the most commonly supplied antibiotic classes for these indications. CONCLUSION Antibiotics are frequently supplied without prescription in many countries. This overuse of antibiotics could facilitate the development and spread of antibiotic resistance.

Pharmacist prescribing: a cross-sectional survey of the views of pharmacists in Nigeria

This study was carried out to: (1) explore the views of pharmacists in Nigeria on the extension of prescribing authority to them and determine their willingness to be prescribers and (2) identify the potential facilitators and barriers to introducing pharmacist prescribing in Nigeria.

Pharmacist Prescribing in England: Acting on History to Address Current Challenges in Pharmacy Practice

Historically, doctors prescribe and pharmacists dispense, but these clear lines are rapidly eroding. The view that pharmacists should work closely with general practitioners and hospital doctors is a reality: it is encouraged by surveys and major reports, such as that of Lord Carter. This shift is mediated by the need to balance the authority of doctors and patient safety with a shortage of doctors and a need to use the skills of pharmacists appropriately. As the population ages, more pharmacists, with the necessary skills and knowledge, will be required.

Prevalence and factors associated with the use of antibiotics in non-bloody diarrhoea in children under 5 years of age in sub-Saharan Africa

Objectives To estimate the prevalence and determine the factors associated with the use of antibiotics in the management of non-bloody diarrhoea in children under 5 years of age in sub-Saharan Africa (SSA). Methods We conducted a meta-analysis of demographic and health survey data sets from 30 countries in SSA. Pooled prevalence estimates were calculated using random effects model. Χ2 tests were employed to determine the factors associated with the antibiotic use. Results The pooled prevalence of antibiotic use among cases of non-bloody diarrhoea in children under 5 years of age was 23.1% (95% CI 19.5 to 26.7). The use of antibiotics in children with non-bloody diarrhoea in SSA was associated with (p<0.05) the source of care, place of residence, wealth index, maternal education and breastfeeding status. Conclusion We found an unacceptably high use of antibiotics to treat episodes of non-bloody diarrhoea in children under the age of 5 in SSA.

There is still a case for a generic qualitative approach in some pharmacy practice research

Pharmacy practice researchers are increasingly employing qualitative research to understand complex social problems.1 This is as a result of the value of qualitative research in exploring people’s experience, behaviour and emotions, and in understanding a phenomenon from the participants’ perspectives. Qualitative research involves a wide range of philosophies and approaches and has been variously classified and described in the literature. However, our experience in one of our studies still makes a case for a generic approach in some pharmacy practice research. We therefore present a brief overview of the two qualitative approaches, phenomenology and grounded theory that we thought could be applicable to our research.

Prescribing and dispensing functions in medicine and pharmacy and the potential for pharmacist prescribing in Nigeria: a cross-sectional survey of pharmacists’ views [Poster Abstract - Walk 6]

Introduction: In Nigeria, there is a separation of dispensing and prescribing functions among healthcare professionals. The legislation accords prescribing authority to medical doctors and dentists and dispensing authority to pharmacists.[1] However, patients’ access to prescription medicines can be seriously affected by the shortage of medical prescribers leading to longer waiting times to see a prescriber. In addition, the present arrangement creates professional division and causes fragmentation of patient care. Objectives: This study was conducted to explore the views of Nigerian pharmacists on the separation of prescribing and dispensing functions and the potential barriers to granting prescribing authority to them. Methods: Ethical approval was granted by the School of Healthcare Research Ethics Committee, University of Leeds, UK and the Plateau State Specialist Hospital Health Research Ethics Committee, Nigeria. An online cross-sectional survey was conducted from August to October 2014 among 775 members of the Pharmaceutical Society of Nigeria recruited through a simple random technique. This sample size represents about 5% of the approximately 16,000 pharmacists in Nigeria. The questionnaire for the survey was developed based on previous Nigerian studies.[2,3] It contained 62 items and had both closed and open ended questions. The questionnaire sought respondents’ views on pharmacist prescribing in Nigeria including the potential facilitators and barriers. The instrument was evaluated for content validity by two external pharmacy practice researchers and the reliability of items assessed using internal consistency tests. Quantitative data obtained were analysed using the SPSS while textual data from open ended questions were analysed using a thematic approach. Results: The response rate was 40.6% (315/775). Many respondents (n= 256; 81.3%) reported that the current separation of prescribing as the doctors’ role and dispensing as the pharmacists’ role in Nigeria is not in the best interest of the patient. Almost all of these respondents (250 of 256; 96.7%) agreed that pharmacist prescribing would increase patients’ access to treatment. However, 195 (76.2%) of the 256 respondents reported that prescribing should be reserved for experienced pharmacists who are able to demonstrate certain competences. In addition, 242 (94.5%) of the 256 respondents reported that postgraduate clinical courses should be developed to prepare pharmacists for an extended role in prescribing. Of all the survey participants 151 (47.9%) made textual comments. Analysis of these comments identified a number of potential barriers to granting prescribing authority to pharmacists in Nigeria. These were classified into pharmacy-related factors including limited clinical education, pharmacists’ attitude to clinical roles and shortage of pharmacists; and external factors including opposition from the medical profession and policy barriers. Discussion/Conclusion: This study revealed that the current prescribing arrangements in Nigeria do not sufficiently meet the needs of patients in terms of timely and convenient access to prescriptions. Pharmacist prescribing represents an opportunity to increase patients’ access to care and promote integration of care. However, the barriers identified in this study will need to be addressed in order for Nigerian pharmacists to extend their roles to include prescribing. Finally, this study has provided many avenues for future research including a survey of doctors’ perception of the potential for pharmacist prescribing in Nigeria.