School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, Otago, New Zealand.
School of Public Health, University of Sydney, Sydney, NSW, Australia.
Appl Health Econ Health Policy. 2021 Mar;19(2):253-266. doi: 10.1007/s40258-020-00615-3. Epub 2020 Oct 19.
Given increasing patient populations, general practitioner (GP) workforce constraints and increasing demand for health services in New Zealand (NZ), the development and provision of pharmacist prescribing services may need to increase to improve people's access to medicines. A discrete choice experiment (DCE) was utilised to determine community pharmacist preferences for prescribing services in primary care in NZ, and to understand how these factors could improve the provision of pharmacist prescribing services.
A D-efficient design generated 30 labelled choice questions in three blocks of ten, and three alternatives per choice question. The online DCE was emailed to practising community pharmacists in NZ. The DCE included two attributes with five levels (prescribing model, educational requirements) and three attributes with three levels (location, professional fee, change in income). A mixed multinomial logit model was used to estimate preferences.
A total of 264 respondents completed the survey with 2640 observations for analyses. This DCE found pharmacists preferred pharmacy services with the following characteristics: ability to prescribe using minor ailments and independent prescribing models relative to the pharmacist-only medicines prescribing model; prescribing education by accredited learning modules relative to PGDipClinPharm + PGCertPharmPres; remuneration via a professional fee; and pharmacist prescribing services located in community pharmacies rather than in GP practices.
Prescribing policy could incorporate these pharmacist preferences to help develop accessible and effective pharmacist prescribing services that not only improve access to medicines, but also address inequity of access to medicines in NZ. These DCE results are encouraging as they signal that the community pharmacists also see themselves and their pharmacies as part of the prescribing team in primary care in NZ.
鉴于患者人数不断增加、全科医生（GP）劳动力短缺以及新西兰（NZ）对医疗服务需求不断增加，可能需要开发和提供药剂师处方服务，以改善人们获得药物的途径。本研究采用离散选择实验（DCE）来确定新西兰初级保健中社区药剂师对处方服务的偏好，并了解这些因素如何能够改善药剂师处方服务的提供。
D 有效设计生成了 30 个带有标签的选择题，分为三个 10 题的组块和每个选择题的三个选项。在线 DCE 通过电子邮件发送给新西兰的执业社区药剂师。DCE 包括两个具有五个水平的属性（处方模式、教育要求）和三个具有三个水平的属性（地点、专业费用、收入变化）。采用混合多项逻辑回归模型来估计偏好。
共有 264 名受访者完成了调查，共进行了 2640 次分析。该 DCE 发现，药剂师更喜欢具有以下特征的药房服务：与仅限药剂师的药物处方模式相比，使用小病和独立处方模式的能力；通过认可的学习模块进行处方教育，而不是 PGDipClinPharm + PGCertPharmPres；通过专业费用支付报酬；以及将药剂师处方服务设置在社区药房而不是 GP 诊所。
处方政策可以纳入这些药剂师的偏好，以帮助开发可及且有效的药剂师处方服务，不仅改善药物的可及性，而且解决 NZ 药物可及性的不平等问题。这些 DCE 结果令人鼓舞，因为它们表明社区药剂师也将自己及其药房视为 NZ 初级保健中处方团队的一部分。
