Title:
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A study of factors influencing the implementation of pharmacist prescribing in hospitals
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The aim of this research was to explore the factors that influence the implementation of pharmacist
prescribing in secondary care. A two-phased, mixed methods study was conducted. The first phase
comprised a small qualitative study to investigate the views of clinicians, patients and NH5 managers
and a survey of doctors, nurses and pharmacists to quantify those views. It was conducted in one NHS
trust before pharmacist prescribing had been introduced. In the second phase, which used
documentary analysis, focus groups and interviews, case studies of non-medical prescribing
implementation were carried out in five hospital trusts.
Factors identified in the first phase qualitative study, included the attitudes of clinical staff and
patients, and adequacy of resources. Pharmacists were perceived by some stakeholders to be "drug
experts" but there were reservations about their diagnostic skills and not "knowing" a patient in the
same way as doctors and nurses do. The survey showed different levels of support for pharmacist
prescribing from doctors (58%), nurses (68%) and pharmacists (96%). Nurses (40%) were more
supportive of pharmacist independent prescribing than doctors (18%) but were more likely to support
prescribing roles for themselves than pharmacists.
The case studies found that experiences from 'doing' pharmacist prescribing became influential in
shaping professional views of whether and how implementation should proceed. Views from the two
phases overlapped but some differences emerged between the more theoretical considerations in
the first phase of the research and experiential learning in the second, concerning, for example, the
relative merits of supplementary and independent prescribing. A model by Greenhalgh et al (2004) of
adoption of innovations proved useful in understanding the complexity of how and why there was
mediation of the effects of the different factors. How factors influenced implementation varied
according to culture/context/policy at a micro- and a macro- level.
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