Abstract
Introduction: Continuity of care is considered a fundamental and essential aspect of good quality primary care. Prescribers in general practice play a pivotal role in managing continuity of care and optimising medicines-related patient health outcomes. Legislative changes have resulted in nurses and pharmacists prescribing medicines alongside general practitioners (GP). There is a paucity of research internationally and in New Zealand (NZ), investigating how different prescribing disciplines view the management of continuity of care, from a medicine’s perspective. Gaining the views of clinicians directly involved in the prescribing process is important to guide future primary health service provision and provide better, sustainable, and more equitable medicines-related health outcomes, for New Zealanders.
Aim and objectives: To explore and describe how general practice prescribers in NZ perceive their role in managing medicines-related continuity of care. Key objectives include understanding current approaches, challenges experienced and strategies or areas for improvements, particularly when more than one prescriber is involved in a single patient’s care.
Methods: A qualitative approach was employed, using semi-structured in-depth interviews. Sixteen participants were recruited from eight North Island general practices (seven general practitioners, four pharmacist prescribers, four nurse practitioners and one registered nurse prescriber). Interviews were transcribed verbatim. NVivo software has been used to aid thematic analysis of interview transcripts, using an inductive approach to analysis of data.
Results: Data analysis identified three key themes (each with sub-themes). These include: (1) a patient-focused approach; (2) interdisciplinary teamwork and (3) optimising the medicine regimen.
Conclusion: Prescribers in this study believe that relational, informational, and management dimensions of continuity of care are interconnected and equally important to achieving safe and beneficial outcomes from medicines. Patient-prescriber relationships in general practice, and interdisciplinary relationships within and across health settings, were considered vital aspects of managing medicines-related continuity of care. Participants expressed concerns relating to increasing multimorbidity and clinical decision-making, time restraints and the non-integration of clinical records between health settings. There was a sense that medicines-related continuity of care is no longer solely the responsibility of general practice prescribers.