Investigating how pharmacists fit into the primary care non-medical prescribing landscape in New Zealand
Background Increasing demand for health services and resource constraints have affected access to prescribing services in primary care. Some countries, including New Zealand (NZ), have introduced non-medical prescribing (NMP) to facilitate timely access to medicines. This shift in roles utilises the skills of health professionals including pharmacists to improve patients’ access to prescribing services. NMP in NZ is a relatively new health service, and little is known about the uptake, utilisation and perceptions of this service from both the public and pharmacists. Aim To investigate non-medical prescribing in New Zealand, and how pharmacists fit into this prescribing landscape in primary care. Method This thesis was conducted in five stages: 1. A literature review to establish an overview of NMP research conducted in NZ, and to identify knowledge gaps. 2. A review of data from a variety of NZ sources (NZ legislation, information from professional and regulatory organizations, policy documents, information from education providers, and grey literature) to provide an updated overview of NMP in NZ. 3. A pharmacoepidemiology study, utilising the NZ National healthcare collections to identify NMP trends in NZ primary care. 4. A discrete choice experiment to determine community pharmacists’ preferences for providing prescribing services in primary care in NZ. 5. A discrete choice experiment to determine the NZ publics’ preferences for utilising pharmacist prescribing services in primary care in NZ. Main findings 1. There is a paucity of NZ research regarding non-medical prescribing. Little is known in NZ about the current state of NMP and how this service is being utilised. NZ research has yet to explore the place of pharmacist prescribers within primary care. 2. There is variation in the regulation, educational programmes and prescribing competencies used by the different prescribing health professionals involved in NMP in NZ. 3. NMP is not widely utilised in NZ, and nurse prescribers are the major NMP providers in primary care. Pharmacist prescribers are not well utilised and have the potential to contribute more to the NMP service in NZ. 4. NZ community pharmacists are willing to provide prescribing services in primary care in NZ using a variety of autonomous prescribing models in community pharmacies. 5. The NZ public are willing to use various models of pharmacist prescriber services in primary care if they are accessible when required, are open for longer hours, and cost less than a GP consultation. Conclusion Compared to the other countries, NMP in NZ is inconsistently implemented and underutilised. An overarching NMP policy should be developed to enable consistency in the various aspects of NMP. The DCEs signalled that NZ community pharmacists see themselves as part of the prescribing team, and that the NZ public are willing to utilise pharmacist prescribing services in primary care. As demand for healthcare in NZ increases, pharmacists have the potential to be part of the solution within the NMP framework in primary care. Policy makers and funders have the opportunity to utilise the outputs of this thesis to evolve the traditional role of pharmacists—to develop pharmacist prescribing services in NZ that enable equitable and timely access to prescribing for our communities.
Advisor: Smith, Alesha; Tordoff, June; Marra, Carlo A
Degree Name: Doctor of Philosophy
Degree Discipline: School of Pharmacy
Publisher: University of Otago
Keywords: Non-medical prescribing; pharmacist prescribing; New Zealand; health service research; workforce development; health preferences; discrete choice experiment; education; regulation
Research Type: Thesis