Factors influencing independent prescribing by physiotherapists and pharmacists

Graham-Clarke, Emma Marjorie ORCID: 0000-0001-5657-778X (2022). Factors influencing independent prescribing by physiotherapists and pharmacists. University of Birmingham. Ph.D.

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Abstract

This thesis presents the results of an original research programme that set out to investigate the factors influencing the uptake and utilisation of independent non-medical prescribing by pharmacists and physiotherapists, and to determine if these factors affect both pharmacist and physiotherapist prescribers similarly or if there are differences. For the first time a systematic policy review has been conducted bringing together UK non-medical prescribing (NMP) policy documents. This review identifies the changing role for NMP, from improving access to medicines for patients to streamlining care by reducing duplication and ensuring that patients have access to the most appropriate person. In addition, the systematic policy review highlighted the impact that changes in government, and reorganisation of the NHS, had in delaying legislation and reducing policy document publication.
The policy review was followed by an exploration of the factors influencing the uptake and utilisation of NMP, employing three standalone and sequential research methods; systematic literature review and thematic synthesis, consensus technique and focus groups. The systematic review was the first to investigate and synthesise the literature regarding barriers and facilitators to NMP. The identified papers pertained to research mainly with nurse independent non-medical prescribers (INMP), with limited representation from pharmacist INMPs but none from any other NMP profession. A consensus technique, Delphi, was used to investigate barriers and facilitators experienced by pharmacist and physiotherapist INMPs (the latter a newer, and relatively unexamined, NMP profession) to identify perceived similarities and differences between them. The two professions were chosen because they were similar in size, and range of practice areas, but differed in the length of time since each profession gained prescribing rights. Focus group methodology then used the lived experiences of pharmacist and physiotherapist prescribers to understand how prescribers perceived the impact of outside influences on their practice.
The importance of this thesis is it defines two important themes influencing the utilisation of NMP. The first links to medical professionals and the wider clinical team, highlighting how support from the team enables successful NMP implementation. The second theme links to the INMP's role, which defined the knowledge they required, and thereby instilled confidence. The research identified the factors influencing NMP, which could be a barrier or a facilitator depending on circumstances, and their frequent interdependence. The Delphi and the focus groups described the experiences of the two professions, identifying differences between them, thus indicating that not all the identified factors affected each profession similarly.
Healthcare in the UK is evolving dramatically in response to workforce shortages, and this research has identified the role NMP now plays in healthcare provision to support continuing patient care. For the first time, not only have the factors that influence the utilisation of NMP been identified, and their frequent interdependence, but that they do not affect pharmacist and physiotherapist INMPs similarly. It cannot therefore be assumed that the factors influencing NMP apply equally to all NMP professions, and this should be recognised as NMP is expanded to other professions, such that mitigating strategies can be adopted. Likewise these factors should be considered when developing new NMP roles.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):