Stakeholders' views and experiences of pharmacist prescribing: a systematic review

While prescribing has been traditionally been the domain of physicians, prescribing by pharmacists has been implemented successfully in countries across the world. Developments are supported by evidence of effectiveness and safety. To facilitate further development and implementation, there is a need to review the evidence of views and experiences of stakeholder groups both pre- and post-implementation. The aim of this review is to critically appraise, synthesise and present the available evidence on the views and experiences of stakeholders pre- and post-implementation of pharmacist prescribing globally. Setting and Method: A systematic review protocol was developed according to the PRISMA_P standards and registered on the PROSPERO database at the Centre for Reviews and Dissemination. Search databases were MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), International Pharmaceutical Abstracts, PsychArticles, and Google Scholar with no date limits. Studies selection, quality assessment and data extraction were conducted independently by at least two reviewers. A narrative approach to data synthesis was undertaken due to heterogeneity of study outcome measures. Main outcome measures: Views and experiences around pharmacist prescribing as well as the facilitators and barriers to its development and implementation. Results: Sixty-three studies were included in the review. The UK was the main country studies (n=34) compared to Australia (n=13), USA (n=5), Canada (n=5), Nigeria (n=3), New Zealand (n=1), Ireland (n=1) and India (n=1). In addition, different stakeholders were researched. The majority of papers investigated perceptions and views of pharmacists (n=25) while few discussed patients (n=12), general practitioners (n=6), the public (n=4), nurses (n=1), policy makers (n=1) or had multiple stakeholders (n=14). Positive findings were reported by the majority of studies. The main benefits described were improved access to healthcare services and patients' outcomes, better utilisation of pharmacists' skills and knowledge, improved job satisfaction and reduced physicians' workload. Lack of support for this role reported was mainly due to liability issues, poor pharmacists' diagnosis skills and access to medical records and lack of organizational and financial support. Conclusion: There is an accumulation of evidence around improving healthcare delivery and patients' outcomes with the introduction of competent pharmacist prescribers. While there may be issues to resolve such as liability and financial considerations, these findings may support developments of pharmacist prescribing.