Medication Decision Making and Patient Outcomes in GP, Nurse and Pharmacist Prescriber Consultations

Marjorie Weiss, Jo Platt, Ruth Riley, Betty Chewning, Gordon Taylor, Susan Horrocks, Andrea Taylor

Research output: Contribution to journalArticle

4 Citations (Scopus)
75 Downloads (Pure)

Abstract


Aim
The aims of this study were twofold: (a) to explore whether specific components of shared decision making were present in consultations involving nurse prescribers (NPs), pharmacist prescribers (PPs) and general practitioners (GPs) and (b) to relate these to self-reported patient outcomes including satisfaction, adherence and patient perceptions of practitioner empathy.

Background
There are a range of ways for defining and measuring the process of concordance, or shared decision making as it relates to decisions about medicines. As a result, demonstrating a convincing link between shared decision making and patient benefit is challenging. In the United Kingdom, nurses and pharmacists can now take on a prescribing role, engaging in shared decision making. Given the different professional backgrounds of GPs, NPs and PPs, this study sought to explore the process of shared decision making across these three prescriber groups.

Methods
Analysis of audio-recordings of consultations in primary care in South England between patients and GPs, NPs and PPs. Analysis of patient questionnaires completed post consultation.

Findings
A total of 532 consultations were audio-recorded with 20 GPs, 19 NPs and 12 PPs. Prescribing decisions occurred in 421 (79%). Patients were given treatment options in 21% (102/482) of decisions, the prescriber elicited the patient’s treatment preference in 18% (88/482) and the patient expressed a treatment preference in 24% (118/482) of decisions. PPs were more likely to ask for the patient’s preference about their treatment regimen (χ 2=6.6, P=0.036, Cramer’s V=0.12) than either NPs or GPs. Of the 275 patient questionnaires, 192(70%) could be matched with a prescribing decision. NP patients had higher satisfaction levels than patients of GPs or PPs. More time describing treatment options was associated with increased satisfaction, adherence and greater perceived practitioner empathy. While defining, measuring and enabling the process of shared decision making remains challenging, it may have patient benefit.
Original languageEnglish
Article numberPHC-D-13-00056R4
Pages (from-to)513-527
Number of pages15
JournalPrimary Health Care Research & Development
Volume16
Issue number5
Early online date8 Dec 2014
DOIs
Publication statusPublished - 1 Sep 2015

Fingerprint

Pharmacists
General Practitioners
Decision Making
Referral and Consultation
Nurses
Patient Satisfaction
Therapeutics
Nurse Practitioners
Patient Preference
Patient Compliance
England
Primary Health Care

Keywords

  • consultation
  • doctor patient relations
  • general practitioners
  • health communication
  • nurse practitioners
  • pharmacists

Cite this

Medication Decision Making and Patient Outcomes in GP, Nurse and Pharmacist Prescriber Consultations. / Weiss, Marjorie; Platt, Jo; Riley, Ruth; Chewning, Betty; Taylor, Gordon; Horrocks, Susan; Taylor, Andrea.

In: Primary Health Care Research & Development, Vol. 16, No. 5, PHC-D-13-00056R4, 01.09.2015, p. 513-527.

Research output: Contribution to journalArticle

Weiss, M, Platt, J, Riley, R, Chewning, B, Taylor, G, Horrocks, S & Taylor, A 2015, 'Medication Decision Making and Patient Outcomes in GP, Nurse and Pharmacist Prescriber Consultations', Primary Health Care Research & Development, vol. 16, no. 5, PHC-D-13-00056R4, pp. 513-527. https://doi.org/10.1017/S146342361400053X
Weiss, Marjorie ; Platt, Jo ; Riley, Ruth ; Chewning, Betty ; Taylor, Gordon ; Horrocks, Susan ; Taylor, Andrea. / Medication Decision Making and Patient Outcomes in GP, Nurse and Pharmacist Prescriber Consultations. In: Primary Health Care Research & Development. 2015 ; Vol. 16, No. 5. pp. 513-527.
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AB - AimThe aims of this study were twofold: (a) to explore whether specific components of shared decision making were present in consultations involving nurse prescribers (NPs), pharmacist prescribers (PPs) and general practitioners (GPs) and (b) to relate these to self-reported patient outcomes including satisfaction, adherence and patient perceptions of practitioner empathy.BackgroundThere are a range of ways for defining and measuring the process of concordance, or shared decision making as it relates to decisions about medicines. As a result, demonstrating a convincing link between shared decision making and patient benefit is challenging. In the United Kingdom, nurses and pharmacists can now take on a prescribing role, engaging in shared decision making. Given the different professional backgrounds of GPs, NPs and PPs, this study sought to explore the process of shared decision making across these three prescriber groups.MethodsAnalysis of audio-recordings of consultations in primary care in South England between patients and GPs, NPs and PPs. Analysis of patient questionnaires completed post consultation.FindingsA total of 532 consultations were audio-recorded with 20 GPs, 19 NPs and 12 PPs. Prescribing decisions occurred in 421 (79%). Patients were given treatment options in 21% (102/482) of decisions, the prescriber elicited the patient’s treatment preference in 18% (88/482) and the patient expressed a treatment preference in 24% (118/482) of decisions. PPs were more likely to ask for the patient’s preference about their treatment regimen (χ 2=6.6, P=0.036, Cramer’s V=0.12) than either NPs or GPs. Of the 275 patient questionnaires, 192(70%) could be matched with a prescribing decision. NP patients had higher satisfaction levels than patients of GPs or PPs. More time describing treatment options was associated with increased satisfaction, adherence and greater perceived practitioner empathy. While defining, measuring and enabling the process of shared decision making remains challenging, it may have patient benefit.

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