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NIHR Signal

Nurses and pharmacists can prescribe as effectively as doctors

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A Cochrane review suggests that independent nurse prescribers are as effective as doctors in managing long-term conditions. This summary of an NIHR-funded study includes an online self-assessment

Introduction

An estimated 19,000 UK nurses are qualified as independent prescribers. A Cochrane review of 45 studies compared doctors’ prescribing with that of other independent prescribers. It found that patient outcomes after nurse or pharmacist prescribing were similar to those for medical prescribing. When nurses and pharmacists prescribed drugs for hypertension, patients had a lower systolic blood pressure than those prescribed drugs by doctors. Similar benefits were seen in patients with high cholesterol and diabetes.

Patient adherence to medication, satisfaction and quality of life were comparable between prescribing groups, but there was not enough evidence on whether independent prescribers used fewer resources, saved time or reduced adverse effects.

Independent prescribing was introduced to improve access to medicines and better use professionals’ skills. This review provides reassurance that independent prescribers can prescribe as effectively as doctors for patients with long-term conditions and may be a useful addition to chronic disease management services.

Expert commentary

Sandra Olive, respiratory nurse consultant and independent prescriber, Norfolk and Norwich University Hospitals Foundation Trust

Typically nurse independent prescribers have a comprehensive understanding of a relatively limited range of drugs used in their area of practice. Independent prescribing enables me to manage episodes of care holistically, including the provision of disease-modifying treatments, such as anti-fibrotic therapies in interstitial lung disease.

These patients require information and support about their diagnosis, symptom management, and potential side-effects and complications. Nurses can develop positive long-term therapeutic relationships with patients, maintaining continuity and empowering patients to raise concerns. Optimising pharmacological therapies is an integral part of care that reduces delays and the risk of prescribing errors.

This research confirms that independent prescribing benefits patient care, both clinically and in terms of satisfaction and treatment adherence.

Implications for practice

  • Prescribing in the UK by professions other than doctors is governed by legislation
  • Nurses and midwives, dentists, pharmacists, optometrists, podiatrists, physiotherapists and therapeutic radiographers can train to be independent prescribers
  • Independent prescribers can prescribe any drug (with the exception of opiates for treatment of addiction) within their own competencies
  • Appropriately trained nurse and pharmacist prescribers are as effective as doctors in managing patients with long-term conditions
  • As a result of their long-term therapeutic relationships with patients, nurses can empower them to raise concerns about medication early so their treatment can be optimised
  • Non-medical prescribers can help NHS organisations to meet care quality standards for the management of long-term conditions
  • Further research is needed to determine the impact of non-medical prescribing in terms of clinical, economic and patient-reported outcomes

NIHR Dissemination Centre: right evidence, better decisions

The National Institute for Health Research (NIHR) Dissemination Centre aims to put good evidence at the heart of decision making in health and social care. NIHR Signals are summaries of the most relevant and important research, published on the Discover Portal . You can sign up for NIHR Signals tailored to your area of interest and keep up with the latest research by following @NIHR_DC on Twitter. For more information, visit here

  • This article includes commentary from an independent expert that does not necessarily reflect the views of the NHS, the NIHR or the Department of Health.

Test your research awareness

To check your understanding of the research methodology in the NIHR Signal summarised above, take a quick self-assessment by clicking here

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