Impact on practice
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Further changes to the pharmacy curriculum and pharmacist prescribing training program in Qatar are warranted in order to improve pharmacists’ competence in prescribing practice prior to its implementation.
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Prescribing models such as collaborative and supplementary prescribing are the most supported models and should be considered when developing prescribing frameworks for Qatar.
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Barriers to implementing pharmacist prescribing in Qatar must be addressed by various stakeholders to advance pharmacy practice and further optimize the utilization of pharmacy workforce.
Introduction
Aim of the study
Ethics approval
Methods
Study design and setting
Quantitative component: cross-sectional survey
Study sample and sampling technique
Survey instrument development
Qualitative component: focus groups discussions
Sampling and recruitment
Data collection
Data analysis
Results
Cross-sectional survey
Participants’ demographic characteristics
Parameters | n (%) |
---|---|
Age | |
18–20 years | 27 (25.7) |
21–23 years | 54 (51.4) |
24–26 years | 24 (22.9) |
Nationality | |
Qatari | 10 (9.5) |
Egyptian | 39 (37.1) |
Sudanese | 16 (15.2) |
Jordanian | 10 (9.5) |
Palestinian | 5 (4.8) |
Syrian | 7 (6.7) |
Others | 18 (17.1) |
Current year in pharmacy college | |
First professional year (P1) | 21 (20) |
Second professional year (P2) | 19 (18.1) |
Third professional year (P3) | 17 (16.2) |
Fourth professional year (P4) | 20 (19.0) |
Recent BSc graduates of the previous year | 28 (26.7) |
Number of clinical rotations completed so far during BSc and/or PharmD | |
0 | 40 (38.1) |
1 | 20 (19.0) |
2 | 1 (1.0) |
3 | 1 (1.0) |
4 | 1 (1.0) |
5 | 0 |
6 | 29 (27.6) |
More than 6 | 13 (12.4) |
Awareness regarding pharmacist prescribing and prescribing competencies
Statements | n (%) | ||
---|---|---|---|
Yes | No | Not sure | |
Assessing the patient (e.g. obtaining information to understand a person’s clinical needs, performing a comprehensive medicines assessment, generating and exploring possible diagnosis) | 94 (89.5) | 4 (3.8) | 7 (6.7) |
Considering treatment options (e.g. identifying and discussing appropriate, safe, effective, and evidence-based treatments for the patient) | 100 (95.2) | 4 (3.8) | 1 (1.0) |
Reaching a shared decision (e.g. negotiating therapeutic goals, reaching agreement about medicines to treat the person’s condition, and tailoring the treatment plan to meet the needs of the person)a | 94 (90.4) | 7 (6.7) | 3 (2.9) |
Prescribing medicine (e.g. prescribing with adequate, up-to-date awareness of medication actions, indications, dose, contraindications, interactions, cautions, and unwanted effects; prescribing within relevant frameworks for medicines use… etc.) | 74 (70.5) | 12 (11.4) | 19 (18.1) |
Providing information (e.g. providing information to other health professionals to ensure that the treatment plan is implemented safely and effectively)a | 95 (91.3) | 7 (6.7) | 2 (1.9) |
Monitoring and reviewing (e.g. obtaining and interpreting information to decide whether the therapeutic goals have been achieved whether to continue/stop treatment or refer the person to another health professional for further assessment) | 94 (89.5) | 4 (3.8) | 7 (6.7) |
Prescribing safely (e.g.: know and report prescribing errors, minimize risks, keep up-to-date with safety concerns) | 93 (88.6) | 6 (5.7) | 6 (5.7) |
Prescribing professionally (e.g. practicing in accordance with the relevant legislative, regulatory, professional, and organizational frameworks and applying quality use of medicines principles) | 65 (65.7) | 15 (14.3) | 25 (23.8) |
Improving prescribing practice (e.g. working to continually improve prescribing practice by reflecting and acting upon feedbacks, discussions, unsafe prescribing and understanding available tools to improve prescribing) | 69 (65.7) | 15 (14.3) | 21 (20) |
Prescribing as part of a team (e.g.: communicate and collaborate effectively with the person and other health professionals)a | 81 (77.9) | 10 (9.6) | 13 (12.5) |
Beliefs and views of future pharmacists about prescriptive authority and implementations of pharmacist prescribing in Qatar
Statements | n (%) | ||
---|---|---|---|
Disagree | Neutral | Agree | |
1. I think pharmacist can accurately assess and diagnose patients within their competencea | 11 (10.6) | 26 (25) | 67 (64.4) |
2. Overall, I believe pharmacists can accurately choose and initiate the optimal drug therapy for a patient’s diagnosis | 1 (1) | 12 (11.4) | 92 (87.6) |
3. I believe pharmacists can accurately adjust a medication regimen to improve patient outcomes | 0 | 5 (4.8) | 100 (95.2) |
4. I believe pharmacists should have prescribing training and accreditation or certification before being legally allowed to prescribe medicines within their competence | 3 (2.9) | 5 (4.8) | 97 (92.4) |
5. I believe all pharmacists should have prescriptive authority (i.e. legal authority to prescribe certain medicines) | 22 (21) | 17 (16.2) | 66 (62.8) |
6. Pharmacists are able to prescribe safely and effectively | 2 (1.9) | 11 (10.5) | 92 (87.7) |
7. Pharmacists are able to prescribe cost-effectively | 6 (5.8) | 10 (9.5) | 89 (84.7) |
8. Prescribing by pharmacists is likely to be acceptable to patients | 20 (19.1) | 25 (23.8) | 60 (57.1) |
9. Physicians are likely to be in favor of prescribing by pharmacists | 57 (54.2) | 22 (21) | 26 (24.7) |
10. Prescribing by pharmacists may potentially reduce medication errors in practicea | 4 (3.8) | 17 (16.3) | 83 (79.8) |
11. Pharmacist prescribing will increase better utilization of pharmacist’s skills and knowledge | 3 (2.9) | 5 (4.8) | 97 (92.4) |
12. Pharmacist prescribing will lead to improved patient access to medicines | 3 (2.9) | 14 (13.3) | 88 (83.8) |
13. Patients accessing prescribing by pharmacists will have better continuity of care | 2 (2) | 16 (15.2) | 87 (82.9) |
14. Prescribing authority for pharmacists will increase job satisfactions | 3 (2.9) | 8 (7.6) | 94 (89.6) |
15. Prescribing authority for pharmacists will increase self-confidence | 1 (1) | 5 (4.8) | 99 (94.3) |
16. Prescribing by pharmacists will reduce physician’s workload so they focus on more acute patients’ cases | 5 (4.8) | 16 (15.2) | 84 (80) |
17. Pharmacist prescribers must have access to the information in physician’s medical notes prior to prescribing | 0 | 3 (2.9) | 102 (97.1) |
18. Pharmacist prescribers must be able to record prescribing actions in medical recordsa | 0 | 4 (3.8) | 100 (96.2) |
19. I feel it is my professional duty and obligation to become a pharmacist prescriber upon graduation | 8 (7.6) | 14 (13.3) | 83 (79.1) |
20. Overall, I feel confident in my ability to become a pharmacist prescriber upon graduation | 4 (3.9) | 18 (17.1) | 83 (79) |
Future pharmacists’ perceptions regarding prescribing competencies covered in the current pharmacy curriculum with reference to WHO standards
Competency standard | n (%) | ||||
---|---|---|---|---|---|
Unprepared | Somewhat unprepared | Neutral | Somewhat prepared | Prepared | |
Assessing and defining patient’s problems (e.g. disease or disorder, sign of underlying disease, side effect of drugs, non-adherence to treatment) | 4 (4) | 5 (5) | 10 (9.9) | 35 (34.7) | 47 (46.5) |
Specifying therapeutic goals | 5 (5) | 1 (1) | 4 (4) | 24 (23.8) | 67 (66.3) |
Specifying alternative treatment (pharmacologic and non-pharmacologic) | 4 (4) | 1 (1) | 6 (5.9) | 16 (15.8) | 74 (73.3) |
Choosing a drug that is effective (by checking indication and convenience), safe (by checking contraindications, interactions and high-risk group) with low cost | 2 (2) | 3 (3) | 8 (7.9) | 18 (17.8) | 70 (69.3) |
Verifying suitable dose, route, dosage form, frequency and duration of drug for the patient | 2 (2) | 4 (4) | 6 (5.9) | 22 (21.8) | 67 (66.3) |
Writing a drug prescription independently | 7 (6.9) | 12 (11.9) | 18 (17.8) | 29 (28.7) | 35 (34.7) |
Educating and providing instructions about the use of the prescribed medication | 2 (2) | 2 (2) | 6 (5.9) | 10 (9.9) | 81 (80.2) |
Monitoring the outcome of drug therapy | 3 (3) | 4 (4) | 8 (7.9) | 26 (25.7) | 60 (59.4) |
Reviewing/altering prescription in the light of further investigations | 3 (3) | 6 (5.9) | 13 (12) | 20 (19.8) | 59 (58.4) |
Barriers and facilitators to implementation of pharmacist prescribing in Qatar
Focus group discussions
Participants’ demographics and themes
Themes | Categories |
---|---|
Benefits of pharmacist prescribing | Benefits to healthcare providers and system Benefits to pharmacy profession Benefits to patients |
Barriers to implementation of pharmacist prescribing | Pharmacist incompetency Pharmacist mindset Lack of accessibility and support Pharmacist burden Diversity of education and training background |
Level and model of prescribing | Knowledge of prescribing models Prescribing setting and restrictions Preferred models of prescribing |
Facilitators of pharmacist prescribing in Qatar | Healthcare provider-related factors Pharmacist and pharmacy profession related-factors Patient-related factors Others: including governmental factors |
Pharmacy curriculum | Participant’s awareness of prescribing guidelines Characteristics of current pharmacy program |
Gaps in the current pharmacy program | |
Implementation process | Characteristics of a training program |
Ways of implementation |
Theme 1: benefits of pharmacist prescribing
Many pharmacists have the ability to do minor diagnosis for some minor illnesses… So this will decrease the workload on the physicians (FGD2, X4)
… If pharmacists had more control over the prescribing process, these errors would not happen … So that would really keep the health centers to focus on patients who really need physicians (FGD 1, X3)
I think the huge advantage is that the public would be more aware of our role. If you are proving this opportunity, the public will view pharmacy like not a dispensing machine … the expectations will be much higher (FGD 4, X3)
Better care provided for patients and again you know community pharmacies are really spread and they can find near to them so they can easily reach (FGD1, X1)
Theme 2: barriers to implementation of pharmacist prescribing
The pharmacists never looked at me and asked … he then gave me the medications. So, I mean this can be a disaster if we give such person the authority to diagnose and prescribe. (FGD1, X3)
For example, people from our college you see them they want to counsel and educate patients. However, you see people from outside who don’t have that? (FGD2, X4)
Because of the training … physicians are taking the whole load … But I don’t think pharmacists they have this mentality that can go actually diagnose and prescribe … (FGD1, X2)
…Lack of facilities also, such as physical structure of some settings. Counseling rooms are not available (FGD2, X3)
The patients and the physicians they will be resistant to the expansion of the role of pharmacists because they may feel threatened. (FGD4, X4)
I think that here in Qatar we have different pharmacy practitioners from different universities, not all of them have gone through the same thing (FGD 2, X5)
Theme 3: level and model of prescribing
[Pharmacist] can only change warfarin dose to increase or decrease… The physician will diagnose and tell that this patient is having heart failure…,and then the pharmacist will suggest the dose of warfarin … and adjust according to INR (FGD4, X5)
I think supplementary [prescribing] would work better. I think the idea of having a shared care plan is a nice way to ease the pharmacists’ role in prescribing. Because if we just suddenly start with independent, it is going to make the stigma more and relationship will be more complicated between health care providers and pharmacists (FGD3, X4)
I think we can go with supplementary, make people who are independent prescribers be more adapt to the idea that is not all on you, we can share the responsibility and if they get to the idea or the rationale… If that could be installed on their heads, we can go into more collaborative practices (FGD4, X3)
Theme 4: facilitators of pharmacist prescribing
I think we should have a pharmacy association or something or someone who can overlook the pharmacists and show that everything [including prescribing implementation] is going smoothly…. (FGD2, X8)
I think stakeholders and the governments, since they put rules and regulations, they should be the main support for the implementation of prescribing (FGD2, X6)
They [Pharmacists] are available so why not to use the manpower that you have (FGD1, X3)With the college focusing on prescribing, the pharmacists will not only have the knowledge for prescribing but also will grow accustomed to this mentality (FGD1, X3)
Theme 5: pharmacy curriculum
I believe one of the important skills that we learn in the undergraduate program is that we learn how to search and how to use guidelines and how to follow evidence-based practice. So that’s why maybe it is easier for us to know how to prescribe (FGD2, X3)
I found them [QU PharmD graduates] very competent to prescribe and even they suggest the chemotherapy protocols (FGD2, X5)
I think we have gaps in terms of the materials related to diagnosing. We don’t take enough courses related to diagnosis of different diseases. We have only patient assessment. We take two courses and they are not enough. They are focused to certain things, but not to all related to human beings and also for the prescription, we didn’t take what a legal prescription should look like. (FGD2, X4)
Theme 6: implementation process
For QU students, definitely integration, because I think we cover a lot of aspects of prescribing in other courses. If we integrated into one of the courses, it will be less load to the student but for outside of QU [graduates] definitely should be a course or training (FGD4, X3)
For me, I don’t think the pharmacists really need a course, prescribing is just knowing the knowledge and applying it for choosing the drug. I don’t think it needs a whole course (FGD1, x2)
I think it is being done already in other countries like diploma so I believe we need to have the same thing here for six months for examples. (FGD2, X3)