The effects of pharmacist prescribing on patient outcomes in the hospital setting: a systematic review protocol

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Abstract

Review question/objective

The objective of this review is to determine the effects of pharmacist prescribing in the hospital setting.

Review question/objective

More specifically, the objectives are to quantitatively analyze the effectiveness of pharmacist prescribing on patient outcomes, including, but not limited to, the reduction of error rates and adverse events related to medication prescription in patients who present to hospital, either in the inpatient or outpatient setting.

Background

For conditions that can be medically managed, diagnosis is followed by prescribing of medications to treat a condition or alleviate symptoms associated with it. Traditionally, the act of prescribing has been mainly associated with medical practitioners.

Background

Non-medical prescribing is the extension of prescriptive rights provided to certain other professions apart from doctors, including nurses, pharmacists, optometrists and podiatrists. It was originally introduced to allow a more flexible system for the prescribing, supply and administration of medications in order to help improve patients' access to medications and ease the burden on general practitioners.1,2

Background

Nurse prescribing was first introduced in the United States of America in 1969.3 In the last two decades, legislation changes have also occurred in various countries around the world to allow for non-medical prescribing.3-5

Background

Pharmacist prescribing is currently legal in many countries, including Canada, New Zealand, the United Kingdom (UK) and the United States of America.2,6 In the UK, supplementary prescribing was first introduced in 2003, followed by independent prescribing in 2006.7

Background

Different models of pharmacist prescribing have been described in the literature.1,5,6 They include independent, dependent and collaborative prescribing.

Background

In independent prescribing, pharmacists are responsible for the assessment, diagnosis and clinical management of patients.

Background

Dependent prescribing places more restrictions on the activity using protocols or formularies. The different types of dependent prescribing include:

Background

In collaborative prescribing, there is a cooperative practice relationship between the pharmacist and physician, where the pharmacist may prescribe medications. The physician diagnoses and makes initial treatment decisions for the patient while the pharmacist selects, monitors, modifies, continues or discontinues the treatment as appropriate.

Background

While systematic reviews on nurse prescribing are available,8,9 there are currently no systematic reviews available to quantify the effects of pharmacist prescribing in the hospital setting. One review published in 2011 assessed the contribution of prescribing by nurses and allied health professionals, but this was limited to the primary care setting.3 In 2004, a review focusing on pharmacist prescribing was published, and included prescribing in both the community and hospital setting.10 This review identified only four studies with an experimental design and concluded that additional research was needed to establish the validity of pharmacist prescribing.

Background

In a review which evaluated the impact of pharmacists on mental health, some studies involving pharmacist prescribing were included but were not the main focus of the review.11 Other published reviews which have included pharmacist prescribing mainly relate to descriptions of its current practice (including existing policies and procedures) in a specific country or region, barriers to its successful implementation, or the perspectives of pharmacist prescribers, other healthcare professionals or patients on pharmacist prescribing.2,6,12 A systematic review on the effects of pharmacist prescribing on patient outcomes in the hospital setting is therefore warranted.

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