Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. [Review]
Stewart, Derek C.
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WEEKS, G., GEORGE, J., MACLURE, K. and STEWART, D. 2016. Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. [Review]. Cochrane database of systematic reviews [online], Issue 11, article number CS011227. Available from: https://doi.org/10.1002/14651858.CD011227.pub2
The aim of this Cochrane review was to find out if prescribing by health professionals other than doctors delivers comparable outcomes to prescribing by doctors. Cochrane researchers collected and analysed all relevant studies to answer this question and found 46 studies. Key messages With appropriate training and support, nurses and pharmacists are able to prescribe medicines as part of managing a range of conditions to achieve comparable health management outcomes to doctors. The majority of studies focus on chronic disease management in higher-income counties where there is generally a moderate-certainty of evidence supporting similar outcomes for the markers of disease in high blood pressure, diabetes, and high cholesterol. Further high-quality studies are needed in poorer countries and to better quantify differences in prescribing outcomes for adverse events, and to determine health economic outcomes. Further studies could also focus more specifically on the prescribing component of care. What was studied in the review? A number of countries allow health professionals other than doctors to prescribe medicines. This shift in roles is thought to provide improved and timely access to medicines for consumers where there are shortages of doctors or the health system is facing pressures in coping with the burden of disease. In addition, this task shift has been supported by a number of governments as a way to more appropriately use the skills of health professionals, such as nurses and pharmacists, in the care of patients. We compared the outcomes of any healthcare workers who were prescribing with a high degree of autonomy with medical prescribers in the hospital or community setting in low-, middle- and high-income countries. What are the main results of the review? This review found 45 studies where nurses and pharmacists with high levels of prescribing autonomy were compared with usual care medical prescribers. A further study compared nurse prescribing with guideline support with usual nurse prescribing care. No studies were found with other health professionals or lay prescribers. Four nurse prescribing studies were undertaken in the low- and middle-income settings of Colombia, South Africa, Uganda, and Thailand. The remainder of studies were undertaken in high-income Western countries. Forty-two studies were based in a community setting, two studies were located in hospitals, one study in the workplace, and one study in an aged care facility. Prescribing was but one part of many health-related interventions, particularly in the management of chronic disease. The review found that the outcomes for non-medical prescribers were comparable to medical prescribers for: high blood pressure (moderate-certainty of evidence); diabetes control (high-certainty of evidence); high cholesterol (moderate-certainty of evidence); adverse events (low-certainty of evidence); patients adhering to their medication regimeans (moderate-certainty of evidence); patient satisfaction with care (moderate-certainty of evidence); and health-related quality of life (moderate-certainty of evidence). Pharmacists and nurses with varying levels of undergraduate, postgraduate, and specific on-the-job training related to the disease or condition were able to deliver comparable prescribing outcomes to doctors. Non-medical prescribers frequently had medical support available to facilitate a collaborative practice model.