Abstract
Whilst the number of independent prescriber (IP) optometrists in the United Kingdom is increasing, there is limited evidence describing the experiences of these individuals. The Theoretical Domains Framework (TDF) provides an evidence-based approach to understand determinants of behaviour. This conceptual framework can enable mapping to the COM-B behaviour change model and the wider Behaviour Change Wheel to develop interventions to optimise behaviour-change and healthcare processes more systematically. The study aimed to use the TDF to identify the factors that influence independent prescribing behaviour, and to map these findings to the COM-B system to elucidate the relevant intervention functions, in order to identify the support required by optometrist prescribers. Using a qualitative design, semi-structured interviews based on the TDF were undertaken with independent prescriber optometrists. Thematic analysis was used to identify themes inductively, which were then deductively mapped to the TDF and linked to the COM-B. Sixteen participants (9 male, 7 female; median age 45years, range 28-65years), based in community (n=10) and hospital (n=6) settings, were interviewed. Eleven of the TDF domains were found to influence prescribing behaviour. Findings highlighted the need for good communication with patients (TDF domain: Skills, COM-B: Capability); confidence (TDF domain: Beliefs about capabilities, COM-B: Motivation); good networks and relationships with other healthcare professionals, e.g., general practitioners (TDF domain: Social influences, COM-B: Opportunity; TDF domain: Social/professional role and identity, COM-B: Motivation); the need for appropriate structure for remuneration (TDF domain: Reinforcement, COM-B: Motivation; TDF domain: Social/professional role and identity, COM-B: Motivation) and the provision of professional guidelines (TDF domain: Knowledge, COM-B: Capability; TDF domain: Environmental context and resources, COM-B Opportunity). Having identified theory-derived influencers on prescribing decisions by optometrists, the findings can be used to develop a structured intervention, such as a support package to help optimise prescribing by optometrists, with the ultimate goal of eye care quality improvement.
Highlights
Over the last two decades, the increasing burden on healthcare systems has brought about changes to prescribing policy for non-medical healthcare professionals, e.g., nurses and pharmacists, with the UK considered to be at the forefront of these changes.[1]
Prescribing against a restricted list of therapeutics was first introduced for community nurses in the UK in 1999.2 Later, prescribing rights were extended to further groups of registered nurses in 2001,3 with an independent prescriber defined as,[4,5]
The study adhered to the principles stated in the Declaration of Helsinki and informed consent was gained from each participant
Summary
Over the last two decades, the increasing burden on healthcare systems has brought about changes to prescribing policy for non-medical healthcare professionals, e.g., nurses and pharmacists, with the UK considered to be at the forefront of these changes.[1]. . a practitioner (e.g., doctor, nurse, pharmacist) responsible for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing.”. There is still limited evidence on the experiences of independent prescriber optometrists.[1] In a small number of papers, the use of quantitative surveying of therapeutic prescriber optometrists has been undertaken, in which the willingness of optometrists to undergo therapeutics training was described.[31,32,33] Those with therapeutics training were reportedly more confident in diagnosing and managing specific ocular conditions,[32] and in the high risk area of hospital emergency eye care there is evidence that trained and experienced independent prescriber optometrists make appropriate clinical decisions.[34] inappropriate remuneration, fear of litigation and time/cost of training were cited as barriers to undertaking therapeutics training.[31] lack of remuneration has been described as a barrier to prescribing.[31,33]
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