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Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review

OBJECTIVES: To support workforce deficits and rising demand for medicines, independent prescribing (IP) by nurses, pharmacists and allied health professionals is a key component of workforce transformation in UK healthcare. This systematic review of qualitative research studies used a thematic synth...

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Autores principales: Edwards, Judith, Coward, Melaine, Carey, Nicola
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9185484/
https://www.ncbi.nlm.nih.gov/pubmed/35676011
http://dx.doi.org/10.1136/bmjopen-2021-052227
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author Edwards, Judith
Coward, Melaine
Carey, Nicola
author_facet Edwards, Judith
Coward, Melaine
Carey, Nicola
author_sort Edwards, Judith
collection PubMed
description OBJECTIVES: To support workforce deficits and rising demand for medicines, independent prescribing (IP) by nurses, pharmacists and allied health professionals is a key component of workforce transformation in UK healthcare. This systematic review of qualitative research studies used a thematic synthesis approach to explore stakeholders’ views on IP in primary care and identify barriers and facilitators influencing implementation. SETTING: UK primary/community care. PARTICIPANTS: Inclusion criteria were UK qualitative studies of any design, published in the English language. Six electronic databases were searched between January 2010 and September 2021, supplemented by reference list searching. Papers were screened, selected and quality-appraised using the Quality Assessment Tool for Studies with Diverse Designs. Study data were extracted to a bespoke table and two reviewers used NVivo software to code study findings. An inductive thematic synthesis was undertaken to identify descriptive themes and interpret these into higher order analytical themes. The Diffusion of Innovations and Consolidated Framework for Implementation Research were guiding theoretical anchors. PRIMARY AND SECONDARY OUTCOME MEASURES: N/A. RESULTS: Twenty-three articles addressing nurse, pharmacist and physiotherapist IP were included. Synthesis identified barriers and facilitators in four key stages of implementation: (1) ‘Preparation’, (2) ‘Training’, (3) ‘Transition’ and 4) ‘Sustainment’. Enhancement, substitution and role-specific implementation models reflected three main ways that the IP role was used in primary care. CONCLUSIONS: In order to address global deficits, there is increasing need to optimise use of IP capability. Although the number of independent prescribers continues to grow, numerous barriers to implementation persist. A more coordinated and targeted approach is key to overcoming barriers identified in the four stages of implementation and would help ensure that IP is recognised as an effective approach to help alleviate workforce shortfalls in the UK, and around the world. PROSPERO REGISTRATION NUMBER: CRD42019124400.
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spelling pubmed-91854842022-06-16 Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review Edwards, Judith Coward, Melaine Carey, Nicola BMJ Open Health Services Research OBJECTIVES: To support workforce deficits and rising demand for medicines, independent prescribing (IP) by nurses, pharmacists and allied health professionals is a key component of workforce transformation in UK healthcare. This systematic review of qualitative research studies used a thematic synthesis approach to explore stakeholders’ views on IP in primary care and identify barriers and facilitators influencing implementation. SETTING: UK primary/community care. PARTICIPANTS: Inclusion criteria were UK qualitative studies of any design, published in the English language. Six electronic databases were searched between January 2010 and September 2021, supplemented by reference list searching. Papers were screened, selected and quality-appraised using the Quality Assessment Tool for Studies with Diverse Designs. Study data were extracted to a bespoke table and two reviewers used NVivo software to code study findings. An inductive thematic synthesis was undertaken to identify descriptive themes and interpret these into higher order analytical themes. The Diffusion of Innovations and Consolidated Framework for Implementation Research were guiding theoretical anchors. PRIMARY AND SECONDARY OUTCOME MEASURES: N/A. RESULTS: Twenty-three articles addressing nurse, pharmacist and physiotherapist IP were included. Synthesis identified barriers and facilitators in four key stages of implementation: (1) ‘Preparation’, (2) ‘Training’, (3) ‘Transition’ and 4) ‘Sustainment’. Enhancement, substitution and role-specific implementation models reflected three main ways that the IP role was used in primary care. CONCLUSIONS: In order to address global deficits, there is increasing need to optimise use of IP capability. Although the number of independent prescribers continues to grow, numerous barriers to implementation persist. A more coordinated and targeted approach is key to overcoming barriers identified in the four stages of implementation and would help ensure that IP is recognised as an effective approach to help alleviate workforce shortfalls in the UK, and around the world. PROSPERO REGISTRATION NUMBER: CRD42019124400. BMJ Publishing Group 2022-06-08 /pmc/articles/PMC9185484/ /pubmed/35676011 http://dx.doi.org/10.1136/bmjopen-2021-052227 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Health Services Research
Edwards, Judith
Coward, Melaine
Carey, Nicola
Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review
title Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review
title_full Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review
title_fullStr Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review
title_full_unstemmed Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review
title_short Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review
title_sort barriers and facilitators to implementation of non-medical independent prescribing in primary care in the uk: a qualitative systematic review
topic Health Services Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9185484/
https://www.ncbi.nlm.nih.gov/pubmed/35676011
http://dx.doi.org/10.1136/bmjopen-2021-052227
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