Drennan Vari M, Grant Robert L, Harris Ruth
Faculty of Health, Social Care & Education, Kingston University & St George's, University of London, London, UK.
BMC Health Serv Res. 2014 Feb 6;14:54. doi: 10.1186/1472-6963-14-54.
A growing number of countries legislate for nurses to have medication prescribing authority although it is a contested issue. The UK is one of these countries, giving authority to nurses with additional qualifications since 1992 and incrementally widened the scope of nurse prescribing, most recently in 2006. The policy intention for primary care was to improve efficiency in service delivery through flexibility between medical and nursing roles. The extent to which this has occurred is uncertain. This study investigated nurses prescribing activities, over time, in English primary care settings.
A secondary data analysis of a national primary care prescription database 2006-2010 and National Health Service workforce database 2010 was undertaken.
The numbers of nurses issuing more than one prescription annually in primary care rose from 13,391 in 2006 to 15,841 in 2010. This represented forty three percent of those with prescribing qualifications and authorisation from their employers. The number of items prescribed by nurses rose from 1.1% to 1.5% of total items prescribed in primary care. The greatest volume of items prescribed by independent nurse prescribers was in the category of penicillins, followed by dressings. However, the category where independent nurse prescribers contributed the largest proportion of all primary care prescriptions was emergency contraception (9.1%). In contrast, community practitioner nurse prescribers' greatest volume and contribution was in the category of gel and colloid dressings (27%), medicated stockings (14.5%) and incontinence appliances (4.2%). There were slightly higher rates of nurse prescribing in areas with higher levels of socio-economic deprivation and fewer physicians per capita, but the correlations were weak and warrant further investigation.
The percentage of prescriptions written by nurses in primary care in England is very small in comparison to physicians. Our findings suggest that nurse prescribing is used where it is seen to have relative advantage by all stakeholders, in particular when it supports efficiency in nursing practice and also health promotion activities by nurses in general practice. It is in these areas that there appears to be flexibility in the prescribing role between nurses and general practitioners.
尽管存在争议，但越来越多的国家立法赋予护士处方权。英国是其中之一，自1992年起赋予具备额外资质的护士处方权，并逐步扩大护士处方的范围，最近一次是在2006年。初级保健的政策意图是通过医疗和护理角色的灵活性来提高服务提供效率。这一目标的实现程度尚不确定。本研究调查了英国初级保健机构中护士随时间推移的处方活动。
对2006 - 2010年全国初级保健处方数据库和2010年国民健康服务劳动力数据库进行二次数据分析。
在初级保健机构中，每年开具不止一张处方的护士人数从2006年的13391人增至2010年的15841人。这占获得雇主处方资质和授权护士人数的43%。护士开具的处方数量占初级保健机构总处方量的比例从1.1%升至1.5%。独立护士处方者开具数量最多的药品类别是青霉素类，其次是敷料类。然而，独立护士处方者在所有初级保健处方中占比最大的类别是紧急避孕药（9.1%）。相比之下，社区执业护士处方者开具数量最多且占比最大的类别是凝胶和胶体敷料（27%）、医用长袜（14.5%）和失禁用品（4.2%）。在社会经济贫困程度较高且人均医生数量较少的地区，护士处方率略高，但相关性较弱，值得进一步研究。
与医生相比，英国初级保健机构中护士开具的处方所占比例非常小。我们的研究结果表明，在所有利益相关者认为护士处方具有相对优势的情况下会采用这一方式，特别是当它有助于提高护理实践效率以及全科护士的健康促进活动时。在这些领域，护士和全科医生在处方角色上似乎存在灵活性。
