THE VALUE OF INDEPENDENT PRESCRIBING IN PHYSIOTHERAPY PRACTICE: EVIDENCE FROM A MULTI-SITE STUDY OF MUSCULOSKELETAL PHYSIOTHERAPIST PRESCRIBER ACTIVITY IN ENGLAND

T. Noblet^1,2, F. Jadhakhan³, C. McCrum^4,5, A. Bennett^6,7, A. Hensman-Crook⁸, S. O'Shea⁹, P. Regan¹⁰, L. Ronan¹⁰, P. Barrett¹⁰, D. Baker¹¹, A. Rushton¹²

¹St George's University Hospitals NHS Foundation Trust, London, United Kingdom, ²University of Birmingham, School of Exercise, Birmingham, United Kingdom, ³University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom, ⁴University of Brighton, Eastbourne, United Kingdom, ⁵Canberra Health Services, Rheumatology, Canberra, Australia, ⁶Sutton Health and Care Alliance, Epsom and St Helier NHS Trust, Epsom, United Kingdom, ⁷NHS England and NHS Improvement, London, United Kingdom, ⁸Ambleside Surgery, Cumbria, United Kingdom, ⁹Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom, ¹⁰Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom, ¹¹Complete Physio, London, United Kingdom, ¹²Western University, School of Physical Therapy, London, Ontario, Canada

Background: Physiotherapist independent non-medical prescribing (iNMP) is an important professional development in the UK that enables the opportunity to combine physiotherapy expertise with prescribing knowledge and capabilities in patient management. As yet, there is limited evidence on the ways in which these combined capabilities provide a positive benefit to patient care and higher quality healthcare. Previous evaluations have predominantly focused on the number of prescriptions provided as the measure of value. However, prescriber knowledge has an important role in medicines optimisation in an individual's personal context to maximise benefits and minimise harms of medicines for best benefit and outcomes. In the UK, physiotherapist iNMPs can prescribe, deprescribe and administer any medication (including unlicensed use) within their individual competence, scope and expertise for any healthcare problem, with some restrictions for certain recently rescheduled medications that require alternative prescribing mechanisms.

Purpose: To establish how advanced practice musculoskeletal physiotherapists were utilising iNMP capabilities and skills in daily clinical practice to inform an understanding of prescribing and prescriber activities undertaken in individual patient care.

Methods: A multi-site, prospective, descriptive observational study was conducted across seven clinical sites representative of advanced MSK practice in England. Settings included five contexts of MSK clinical services: first contact practice; Primary care; Community triage; Secondary care orthopaedics; Secondary care rheumatology; Private practice. Data collection was undertaken (October 2019-March 2020) of all medicines-related activity during a patient consultation, including medicines prescribing, administration, or recommendations, and other medicines optimisation activities in providing care. Explanatory open text comments on activities were also provided
Quantitative data was analysed using descriptive statistics for frequencies and associations of prescribing activity with pain mechanism, duration of condition, region affected and nature of prescribing activity. Qualitative thematic analysis was used to analyse prescriber comments.

Results: Prescribing activity for 2470 Msk patient encounters found that the most frequent activities were medicines optimisation (dose adjustment) (18.1%), over-the-counter medication recommendations (15.5%), combining medicines optimisation with non-pharmacological strategies (11.9%), de-prescribing/de-prescribing recommendations (13.8%), new prescription or prescription recommendation (10.7%). Most prescribing activity occurred in the first 2–6 weeks (34.1%) and prescribing was highest for nociceptive pain (51.3%) and inflammation (39.6%). Independent prescribing accounted for 90.6% of prescribing activity with only 3.3% by other mechanism. Qualitative data were synthesised into 4 themes: multimodal physiotherapeutic approach, joint decision making and patient choice, working with complexity, and legal and regulatory restriction.

Conclusions: Physiotherapist independent prescribing was used within all settings and combined prescriber capabilities with musculoskeletal assessment and management expertise as part of an enhanced multimodal approach that included medicines optimisation along with prescription access when indicated. The findings demonstrate the important and valuable role of physiotherapy iNMP in patient care beyond a prescription, and the value of combined prescribing and physiotherapy specialist expertise that may not be provided by other prescribing professions.

Implications: The findings of this study should be used by policymakers, legislators, managers and clinicians across the world to appreciate the value of physiotherapist iNMP in enhancing patient care and to inform decisions on enabling physiotherapist independent prescribing in their own healthcare context.

Funding acknowledgements: The research study was undertaken without funding

Keywords:
Non-medical Prescribing
Musculoskeletal
Physiotherapist prescribing

Topics:
Professional practice: other
Musculoskeletal
Service delivery/emerging roles

Did this work require ethics approval? Yes

Institution: University of Birmingham

Committee: Medical Sciences Human Research Ethics Committee University of Birmingham

Ethics number: Reference No: ERN_19-0994