Do pharmacists actively influence prescribing in UK general practice? An online survey

Problem

Although prescribers in general practice have access to wide range of clinical guidelines, they do not always follow them. Some variation in prescribing may be expected, since evidence-based guidelines do not apply in all scenarios, but previous studies have found that some variation is clinically unwarranted and associated with suboptimal patient outcomes.

Part of the impetus for including pharmacists in general practice teams is to promote rational prescribing. Previous examples show that pharmacists contribute to effective Audit and Feedback (A&F) interventions in primary healthcare settings, but little is known about the extent to which and how they currently influence evidence-based prescribing in UK general practice.

The aim of this cross-sectional study was to determine pharmacists’ current involvement in influencing prescribing in UK general practice. The objectives were to investigate:

• The range of tasks undertaken by pharmacists, focussing on activities promoting evidence-based prescribing

• Pharmacists’ beliefs about their influence on prescribing

• Pharmacists’ involvement with A&F to influence prescribing

Approach

The study comprised an online survey including 37 questions, informed by the literature and piloted with eight general practice-based pharmacists. The target respondents were pharmacists working in UK general practices. Multiple choice and free-text questions focussed on pharmacists’ attitudes to and perceived influence on prescribing, use and evaluation of guidelines, engagement with A&F. The link to the survey on JISC OnlineSurveys© was disseminated via social media e.g., Twitter©, pharmacist-relevant websites.

The survey was undertaken in Autumn 2021. Survey response data was exported to IBM SPSS v26© for screening and analysis. Descriptive statistics and frequencies were produced, and non-parametric tests employed to assess differences where descriptive results indicated this might be applicable.

Findings

Of 155 respondents, most were from southern England and employed by primary care networks (PCNs). Most had 2-5 years’ general practice experience and identified ‘influencing’ tasks among their responsibilities, e.g., prescribing audits (80.1%), education for colleagues (69%). Pharmacists working in PCNs were more likely to conduct prescribing audits). 76.2% of respondents reported that they were confident about influencing prescribing. Greater confidence was associated with training, use of A&F and positive attitudes towards guidelines.

Consequences

Some of the many tasks undertaken by pharmacists present an opportunity for them to promote evidence-based prescribing in general practice.

Despite extensive evidence of the effectiveness of A&F in modifying prescribing behaviour, few respondents reported formal engagement with this method as part of their practice role. Learning opportunities focussed on A&F and general practice configurations in which pharmacists work with colleagues from the same professional background may strengthen the practice pharmacist role in promoting evidence-based prescribing.

More work is needed to educate and convince pharmacists and general practice prescribers that patient outcomes can be improved by applying the most effective, evidence-based techniques.