Abstract
BackgroundSafe and timely access to effective and appropriate medication through primary care settings is a major concern for all countries addressing both acute and chronic disease burdens. Legislation for nurses and other professionals allied to medicine to prescribe exists in a minority of countries, with more considering introducing legislation. Although there is variation in the range of medicines permitted to be prescribed, questions remain as to the contribution prescribing by nurses and professionals allied to medicine makes to the care of patients in primary care and what is the evidence on which clinicians, commissioners of services and policy makers can consider this innovation.MethodsA integrative review of literature on non-medical prescribing in primary care was undertaken guided by dimensions of health care quality: effectiveness, acceptability, efficiency and access.Results19 papers of 17 empirical studies were identified which provided evidence of patient outcome of non medical prescribing in primary care settings. The majority were undertaken in the UK with only one each from the USA, Canada, Botswana and Zimbabwe. Only two studies investigated clinical outcomes of non-medical prescribing. Seven papers reported on qualitative designs and four of these had fewer than ten participants. Most studies reported that non medical prescribing was widely accepted and viewed positively by patients and professionals.ConclusionsPrimary health care is the setting where timely access to safe and appropriate medicines is most critical for the well-being of any population. The gradual growth over time of legislative authority and in the numbers of non-medical prescribers, particularly nurses, in some countries suggests that the acceptability of non-medical prescribing is based on the perceived value to the health care system as a whole. Our review suggests that there are substantial gaps in the knowledge base to help evidence based policy making in this arena. We suggest that future studies of non-medical prescribing in primary care focus on the broad range of patient and health service outcomes and include economic dimensions.
Highlights
Safe and timely access to effective and appropriate medication through primary care settings is a major concern for all countries addressing both acute and chronic disease burdens [1]
This paper reports on an integrative review of the empirical literature [22] which addressed the question what is the effect of Non-medical prescribing (NMP) in primary care and community settings on patient outcomes?
The majority were undertaken in the United Kingdom (UK) with only one each from the United States of America (USA), Canada, Botswana and Zimbabwe
Summary
Safe and timely access to effective and appropriate medication through primary care settings is a major concern for all countries addressing both acute and chronic disease burdens. The development in the later part of the twentieth century of a more effective range of medicines has seen a different set of public health preoccupations which range from the prevention of antibiotic resistance, to issues both of how to fund and contain medicine costs in health care systems and at the same time ensure equity of access for citizens to basic health care and essential medicines [1]. Each country places different emphasis on these issues but in many it has led to consideration of the use of other health professional groups in addition to doctors to prescribe regulated classes of medicines or medicines provided through a state sponsored or funded health care provision
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