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A SURVEY OF NURSE SUPPLEMENTARY PRESCRIBING IMPLEMENTATION IN PRIMARY
AND SECONDARY CARE IN ENGLAND.
Hobson R and Sewell G
Department of Pharmacy and Pharmacology, University Of Bath, Claverton
Down, Bath. BA2 7AY (R.J.Hobson@bath.ac.uk)
Introduction
There are currently 4,151/672,897 (0.62%) qualified nurse supplementary
prescribers (31st March 2005). Although supplementary prescribing (SP)
is a topical subject within healthcare professions, there is little information
available on how SP is being implemented within primary and secondary
care, and in which clinical areas.
The aim of this survey was to describe how SP was being implemented within
primary and secondary care in England. Only those results pertaining to
nurse supplementary prescribing will be presented here.
Method
A postal questionnaire survey of chief pharmacists within secondary
care (n=143) and primary care trust pharmacists in primary care (n=271)
in England was distributed in May 2004. A literature review, semi-structured
interviews and a focus group were used to design the questionnaire. It
contained open and closed questions.
The questionnaire was validated (n=4) by pharmacists in the target population,
and piloted in approximately 10% of the target population (n=17 chief
pharmacists and n=30 PCT pharmacists). Results from the pilot were not
included in the main results of the survey. Responses were coded and analyzed
using the statistical package for the social sciences (SPSS) version 11.
Results
The response rate was 68% for both the primary care (183/271) and
secondary care surveys (97/143). Fifty-eight per cent (n=56/97) of secondary
care chief pharmacists stated that they had trained nurse supplementary
prescribers working within their trust, compared to 75% (n=136/183) within
primary care trusts.
The top clinical areas for nurse supplementary prescribing are very similar
for primary and secondary care, with Asthma, Diabetes, COPD and Heart
Failure all appearing in the top five clinical areas. These conditions
are established areas for specialist nursing input. There was a wide range
of people reported to be responsible for taking forward supplementary
prescribing for nurses within primary care, but most commonly, it was
the director of nursing (52% n=95/182 (1=missing data)) followed by the
PCT non-medical prescribing group (38% n=70/182 (1=missing data)) and
the pharmaceutical adviser (31% n=56/182 (1=missing data)).
Conclusion
Nurse supplementary prescribing appears to be taking
longer to establish within secondary care. The reasoning for this finding
is likely to be multifactorial. Primary care has more experience of nurse
prescribing and the model of SP is tailored for chronic disease management.
Development of supplementary prescribing within primary care may be rather
fragmented given the wide range of people charged with taking nurse supplementary
prescribing forward. The lack of national strategy to guide which clinical
areas supplementary prescribers should practice in, or where areas of
expertise should be developed, may precipitate variability in patient
accessibility to healthcare across different parts of the UK, which is
relevant to pharmacist supplementary prescribers as well.
Presented at the HSRPP Conference 2006, Bath
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