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The Reading 2005 Conference: Delegate Application | Call for Abstracts | Programme (PDF)
Independent decisions regarding the supply of prescriptions: implications for pharmacist prescribing
Ghalamkari H, Faulkner A, Harvey I
Department of Social Medicine, University of Bristol, Bristol BS8 2PR

A number of reports have recommended a prescribing role for pharmacists e.g. making decisions regarding drug therapy once a diagnosis has been made or once a general treatment has been selected. Although such a role has not been implemented to any extent in practice, there are situations that arise in which pharmacists have to make decisions regarding drug therapy.

The extent of decision making regarding drug therapy by community pharmacists was investigated in a national survey (Response rate 58%, n = 442). The survey employed the use of a vignette which placed pharmacists in everyday scenarios which required them to make decisions regarding the substitution of an antibiotic. The general vignette is presented below. Table 1 presents the six scenarios and the reported actions.

General Vignette. It is 4.30 p.m. on a Saturday afternoon, a patient comes in with a prescription for a branded antibiotic. The patient explains that all other pharmacies in the vicinity have been contacted by 'phone and none of them stock this brand. The patient has not taken the medicine before and needs to take the medicine that day. You are satisfied that the request is genuine and that the patient needs to take the medicine immediately.

Table 1: Actions concerning the issue of a prescription under the conditions of the six scenarios

Scenarios(1)(2)(3)(4)(5)
1...you find that you do not have the brand. You do have the generic alternative.0.5%40.0%56.3%0.5%0.9%
2...but you do have a very similar antibiotic, with the same spectrum of action, there is no difference in the cost of the two antibiotics.0.5%3.4%72.4%10.9%11.8%
3...prescription is written by a doctor whom you get on with very well and who has approved of this type of substitution in the past.3.4%37.3%51.4%3.2%3.6%
4...prescription is written by a doctor whom you have had several disagreements with in the past.0.5%2.9%63.3%15.8%15.6%
5...you try and call but there are no doctors on the premises.0.9%21.5%9.3%32.4%28.5%
6...but the alternative antibiotic is £10 more expensive than the prescribed antibiotic.0.9%7.0%48.4%16.7%23.3%

(1) Dispense alternative, (2) tell patient then dispense alternative, (3) contact Dr, (4) obtain from elsewhere, (5) obtain on Monday.

These findings have implications for the future roles in prescribing. The vignette above has demonstrated that at present pharmacists are generally reluctant to make independent decisions regarding drug therapy. Qualitative analysis (reported elsewhere) revealed that their concerns stem from the fact that they are rarely required to make such decisions and the fact that their contract with the health authority actually forbids such decisions. They also report that there are no clear guidelines and that they are not sure if such decisions would be approved by the local doctors. There are also financial disincentives for pharmacists to make such decisions.

Presented at the HSRPP Conference 2000, Aberdeen