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Noblet T.1,2, Marriott J.3, Graham-Clarke E.3, Rushton A.1
1University of Birmingham, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom, 2Macquarie University, Department of Health Professions, Faculty of Medicine and Health Sciences, Sydney, Australia, 3University of Birmingham, Institute of Clinical Sciences, Birmingham, United Kingdom
Background: Physiotherapist Independent prescribing was introduced in the United Kingdom in 2012. Physiotherapists in Australia are working towards non-medical prescribing (NMP); commencing national processes to evaluate potential clinical need, quality and safety issues. For the profession to develop in this innovative field, factors acting as barriers/facilitators to the successful incorporation of independent prescribing by the profession must be acknowledged. Given the contemporary nature of physiotherapy independent prescribing, effective implementation and utilisation strategies must therefore be learnt from other NMP professions.
Purpose: To establish an evidence base identifying previously reported existing barriers to, or facilitators of, the implementation and/or utilisation of independent NMP.
Methods: A pragmatic mixed methods systematic review utilising a sequential exploratory approach was designed and registered with PROSPERO (CRD42015017212). The review was conducted according to a pre-defined protocol and reported in accordance with PRISMA. Pre-defined search terms and combinations were utilised to search electronic databases. Hand searches of reference lists, key journals and grey literature were completed, alongside consultation with authors and experts. Studies investigating independent non-medical prescribers from any profession or stakeholders engaged with NMP services, were eligible for inclusion. Two reviewers independently completed searches, assessment for eligibility, quality assessed papers using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) and data extraction. Final decisions were made in consensus meetings with a third reviewer to settle disputes. An iterative, team based, thematic analytical approach enabled synthesis of qualitative data, and a textual narrative analysis of quantitative evidence was undertaken. Evaluation of the level of agreement between the qualitative and quantitative data was assessed via an integration matrix.
Results: 43 qualitative and 7 quantitative studies from 3 countries (n=12,117 participants) were included. QATSDD scores varied from 9-35. Identified barriers and facilitators from the qualitative studies were synthesised into four themes (subthemes): systems (government & political, organisational, formulary); education and support (NMP courses, CPD, support requirements); personal and professional (medical profession, NMP professions, service users); and financial factors. Data from the quantitative studies corroborated qualitative themes. Integration of the qualitative themes and quantitative data enabled the development of a NMP implementation framework reflecting all key themes.
Conclusion(s): Barriers to, and facilitators of the implementation and utilisation of NMP are evident within the literature, and demonstrate multifactorial and context specific variables within four explicit themes. It is clear that when factors are acknowledged and planned for they become facilitators, but when they are not, they may become barriers. The resulting NMP implementation framework may therefore be useful to aid the safe and successful implementation and utilisation of NMP.
Implications: Politicians, policy and healthcare managers, and clinical professionals internationally may use the evidence from this review when considering the introduction or use of physiotherapy prescribing in the future.
Funding acknowledgements: None
Topic: Professional issues
Ethics approval: Not required.
All authors, affiliations and abstracts have been published as submitted.
