Stewart Derek, Jebara Tesnime, Cunningham Scott, Awaisu Ahmed, Pallivalapila Abdulrouf, MacLure Katie
Robert Gordon University, Sir Ian Wood Building, Garthdee Road, Aberdeen, AB10 7GJ, UK.
Robert Gordon University, Aberdeen, UK.
Ther Adv Drug Saf. 2017 Jun;8(6):183-197. doi: 10.1177/2042098617693546. Epub 2017 Feb 1.
Many countries have implemented nonmedical prescribing (NMP) and many others are scoping prescribing practices with a view to developing NMP. This paper provides a future perspective on NMP in light of findings of an umbrella review of aspects of NMP. This is followed by coverage of the Scottish Government strategy of pharmacist prescribing and finally, consideration of two key challenges. The review identified seven systematic reviews of influences on prescribing decision-making, processes of prescribing, and barriers and facilitators to implementation. Decision making was reported as complex with many, and often conflicting, influences. Facilitators of NMP included perceived improved patient care and professional autonomy, while barriers included lack of defined roles and resource pressures. Three systematic reviews explored patient outcomes that were noted to be equivalent or better to physician prescribing. In particular, a Cochrane review of 46 studies of clinical, patient-reported, and resource-use outcomes of NMP compared with medical prescribing showed positive intervention-group effects. Despite positive findings, authors highlighted high bias, poor definition and description of 'prescribing' and the 'prescribing process' and difficulty in separating NMP effects from the contributions of other healthcare team members. While evidence of benefit and safety is essential to inform practice, for NMP to be implemented and sustained on a large scale, there needs to be clear commitment at the highest level. The approach being taken by the Scottish Government to pharmacist prescribing implementation may inform developments in other professions and countries. The vision is that by 2023, all pharmacists providing pharmaceutical care will be pharmacist-independent prescribers. There are, however, challenges to implementing NMP into working practice; two key challenges are the need for sustainable models of care and evaluation research. These challenges could be met by considering the theoretical basis for implementation, and robust and rigorous evaluation.
许多国家已经实施了非医学处方（NMP），还有许多国家正在审视处方实践，以期发展非医学处方。本文根据对非医学处方各方面的一项综合评价结果，对非医学处方提供了一个未来展望。接下来介绍了苏格兰政府的药剂师处方策略，最后讨论了两个关键挑战。该评价确定了七项关于影响处方决策、处方流程以及实施的障碍和促进因素的系统评价。据报告，决策过程很复杂，有许多影响因素，而且常常相互冲突。非医学处方的促进因素包括患者护理的改善和专业自主权，而障碍包括角色定义不明确和资源压力。三项系统评价探讨了患者结局，结果表明这些结局与医生处方相当或更好。特别是，一项Cochrane综述对46项比较非医学处方与医学处方的临床、患者报告及资源使用结局的研究进行了分析，结果显示干预组有积极效果。尽管有积极的研究结果，但作者强调存在高偏倚、对“处方”和“处方流程”的定义及描述不佳，以及难以将非医学处方的效果与其他医疗团队成员的贡献区分开来等问题。虽然益处和安全性的证据对于指导实践至关重要，但要大规模实施和维持非医学处方，最高层需要有明确的承诺。苏格兰政府实施药剂师处方的方法可能会为其他专业和国家的发展提供借鉴。目标是到2023年，所有提供药学服务的药剂师都将成为独立于医生的处方者。然而，将非医学处方应用于实际工作存在挑战；两个关键挑战是需要可持续的护理模式和评估研究。可以通过考虑实施的理论基础以及进行有力和严格的评估来应对这些挑战。
