School of Health Sciences, University of Southampton, Southampton, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Sociol Health Illn. 2020 Mar;42(3):643-659. doi: 10.1111/1467-9566.13050. Epub 2019 Dec 16.
Over the last quarter century, non-medical prescribing in the UK has grown significantly; eight non-medical professional groups now have authority to prescribe a wide range of medicines, suggesting it could be a potent driver of pharmaceuticalisation. In this article, we present data from a case study of physiotherapists' prescribing practices. UK physiotherapists have had legal rights to prescribe medicines since 2005, but relatively little is known about the contribution they make to expanding patient access to medicines. We approached our study through a lens of governmentality to capture the mentalities and micro-practices governing physiotherapist non-medical prescribing. Ethnographic methods were used to gather data from an outpatient orthopaedic service in an NHS Trust in England employing physiotherapist prescribers. From the data, we identified a grid of intelligibility - an organising framework formulated by powerful discourses and technologies of government through which physiotherapist prescribing was acted into being. A primary effect of this grid was the constitution of new physiotherapist subjectivities, mostly as non-prescribers of medicines contrary to policy intentions, underpinned by a familiar and enduring template of medical professionalism.
在过去的四分之一个世纪中，英国的非医疗处方显著增加；现在有八个非医疗专业团体有权开出广泛的药物处方，这表明它可能是药物化学的一个有力驱动因素。在本文中，我们展示了一项针对物理治疗师处方实践的案例研究的数据。自 2005 年以来，英国的物理治疗师就拥有了开具药物的合法权利，但对于他们在扩大患者获得药物的途径方面所做的贡献，人们知之甚少。我们通过治理的视角来研究我们的研究，以捕捉治理物理治疗师非医疗处方的心态和微观实践。我们使用民族志方法从英格兰的一家 NHS 信托机构的门诊骨科服务中收集了有处方权的物理治疗师的数据。从这些数据中，我们确定了一个可理解性网格——一个通过强大的治理话语和技术制定的组织框架，通过这个框架，物理治疗师的处方得以实施。该网格的主要影响是构成了新的物理治疗师主体，他们主要是非药物处方者，与政策意图背道而驰，这是由熟悉且持久的医学专业模板支撑的。
