Faculty of Health Sciences, University of Southampton, Southampton, UK.
J Health Serv Res Policy. 2012 Jul;17(3):149-56. doi: 10.1258/JHSRP.2012.011090. Epub 2012 Jun 25.
Legislation and health policy enabling nurses and pharmacists to prescribe a comprehensive range of medicines has been in place in the UK since 2006. Our objective was to evaluate the clinical appropriateness of prescribing by these professionals.
A modified version of the Medication Appropriateness Index (MAI) was used by 10 medical, seven pharmacist and three nurse independent raters to evaluate a sample of 100 audio-recorded consultations in which a medicine was prescribed by a nurse or pharmacist. Raters were current prescribers with recognized experience in prescribing. Consultations were recorded in nine clinical practice settings in England.
Raters' analysis indicated that, in the majority of instances, nurses and pharmacists were prescribing clinically appropriately on all of the ten MAI criteria (indication, effectiveness, dosage, directions, practicality, drug-drug interaction, drug-disease interaction, duplication, duration, cost). Highest mean 'inappropriate' ratings were given for correct directions (nurses 12%; pharmacists 11%) and the cost of the drug prescribed (nurses 16% pharmacists 22%). Analysis of raters' qualitative comments identified two main themes: positive views on the overall safety and effectiveness of prescribing episodes; and potential for improvement in nurses' and pharmacists' history-taking, assessment and diagnosis skills.
Nurses and pharmacists are generally making clinically appropriate prescribing decisions. Decisions about the cost of drugs prescribed and assessment and diagnostic skills are areas for quality improvement.
自 2006 年以来，英国出台了相关立法和卫生政策，使护士和药剂师能够开出处方药物的全部范围。我们的目的是评估这些专业人员处方的临床适宜性。
10 名医生、7 名药剂师和 3 名护士独立评估员使用经过改良的药物适宜性指数（MAI），评估了由护士或药剂师开出的 100 份录音咨询记录。评估员是有处方经验的现任从业者。咨询记录在英格兰的九个临床实践场所进行。
评估员的分析表明，在大多数情况下，护士和药剂师在所有十个 MAI 标准（适应证、疗效、剂量、用法、实用性、药物相互作用、药物与疾病相互作用、重复用药、持续时间、成本）上的处方都是临床适宜的。对正确用法（护士 12%；药剂师 11%）和所开药物的成本（护士 16%；药剂师 22%）给予了最高的“不适当”平均评分。对评估员定性意见的分析确定了两个主要主题：对处方事件整体安全性和有效性的积极看法；以及提高护士和药剂师问诊、评估和诊断技能的潜力。
护士和药剂师通常做出临床适宜的处方决策。在药物成本以及评估和诊断技能方面的决策是质量改进的领域。
