Clinical Pharmacist Nova Scotia Health Halifax, Canada
Background: With increasing demands on the Canadian health care system, there is need for clinical pharmacists to practice to their full scope, which includes pharmacist prescribing. Pharmacist prescribing involves independent renewal, adaptation, or therapeutic substitution of a prescription, as well as new prescription initiation in emergencies or when a primary diagnosis is provided. Research exploring pharmacist prescribing has largely focused on the community setting and few reports exist examining Canadian hospital pharmacists’ perspectives on facilitators and barriers to pharmacist prescribing.
Objectives: To explore pharmacists’ perspectives on facilitators and barriers to pharmacist prescribing for patients admitted to hospital within Nova Scotia Health (NS Health).
Methods: All clinical pharmacists who provide direct patient care on inpatient units in NS Health, Queen Elizabeth II Health Sciences Centre (QEII) were sent personalized invitational emails to participate in one-on-one, virtual semi-structured interviews. No incentives were offered. An interview guide was developed using the Theoretical Domains Framework, version 2 (TDFv2). Interviews were conducted by a pharmacy resident, audio-recorded online using Microsoft Teams, transcribed, mapped to the TDFv2 and analyzed using thematic analysis.
Results: Twelve interviews were conducted in March 2022 which included pharmacists with varying levels of education (BSc. Pharm, PharmD, Residency), experience (1 to over 20 years) and uptake of pharmacist prescribing. Using thematic analysis of the transcripts, barriers and facilitators were classified into four overarching themes: Collaboration and Communication, Pharmacist Reflection, Defining Pharmacist Role, and Resources. Predominant barriers and facilitators included pharmacists being more apt to prescribe on clinical topics they feel knowledgeable in, where they are integrated with the interprofessional team and in clinical areas where other pharmacists are prescribing. Pharmacists reported prescribing less when they feel they do not have enough time or support of other interprofessional team members to do so.
Conclusions: Facilitators (knowledge, and multiple pharmacists prescribing in the same clinical area) and barriers (lack of time, team integration, and interprofessional team support) to pharmacist prescribing will help to inform future policies, education and communication in NS Health and other hospitals.
