A comparative case study of prescribing and non-prescribing physiotherapists and podiatrists

Nicola Carey,Simon Otter,Judith Edwards,Molly Courtenay,Heather Gage,Peter Williams,Karen Stenner,Ann Moore

doi:10.1186/s12913-020-05918-8

Abstract

BackgroundIncreasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights for medicines: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists.Aimto compare outcomes of physiotherapist and podiatrist Independent Prescriber (PP- IP) patients with those of physiotherapist and podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications.Design: a mixed method comparative case study.MethodsUsing mixed methods of data collection, outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015–2016).Results489 patients were recruited: n = 243 IP sites, and n = 246 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p > 0.05) and patient satisfaction (p ≤ 0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than PP-NP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 min).ConclusionThis study provides new knowledge that PP-IPs provide high levels of care. PP-IP care delivery was found to be more resource intensive. Further research is required to explore cost effectiveness. A more focussed exploration within each profession using targeted outcome measures would enable a more robust comparison, inform future developments around the world and help ensure non-doctor prescribing is recognised as an effective way to alleviate shortfalls in the global workforce.

Highlights

Increasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights for medicines: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers
Physiotherapist & Podiatrist (PP)-Independent Prescribing (IP) care delivery was found to be more resource intensive than physiotherapist and podiatrist non-prescribers (PP-NPs), with longer consultation duration for IPs, and a higher proportion of physiotherapy patients discussed with medical colleagues
Sites were based across 8 Academic Health Science Networks in England, provided adult services, a mixed range of settings, including private practice (n = 2), primary care (n = 6), secondary care (n = 6), social enterprise (n = 2) and were well matched by professional role, care setting and agenda for change banding

Summary

Introduction

Increasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights for medicines: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists. Recent data from the United Kingdom (UK), United States (US) and across Europe confirms 25% of adults take three or more medicines each day [2, 5] and that by 2020 the world’s population will receive 4.5 trillion doses of medicine each year [5,6,7]. Inadequacies with traditional doctor/physician-led care systems mean that in order to maintain patient access to prescription medicines, new approaches are imperative [9, 10]. Pharmacists or dentists), e.g. therapeutic radiographers, paramedics, podiatrists and physiotherapists (AHP) have in particular been identified as having an integral role to the required transformational change [11]

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