An Evaluation of Evidence-Based Prescribing Support from Primary Care Prescribing Advisers on GP Prescribing Behaviour

Abstract

Evidence-based prescribing is promoted in national policy and is an essential component of good quality, effective and safe healthcare. Promotion of evidence-based prescribing is fundamental to the pharmacist prescribing advisor’s professional role in primary care. The aim of this study was to evaluate the impact of an intervention delivered by pharmacist prescribing advisers on GP prescribing. The intervention involved promotion of evidence-based prescribing utilising several approaches, which are known to be successful in influencing professional behaviour. Management of Type 2 diabetes and use of non-steroidal anti-inflammatory drugs were clinical areas targeted within the intervention.The study was designed and powered through quantitative methods to determine, the impact of the intervention on prescribing outcomes as measured using ePACT prescribing data. The impact on measurable patient-orientated outcomes was also assessed. The qualitative evaluation explored GP perceptions, attitudes and beliefs regarding evidence-based medicine and considered the impact of the intervention from the GP perspective through semi-structured interviews.The results provide clear evidence for the impact of primary care pharmacists in influencing GP prescribing behaviour. Statistically significant differences in achievement of primary prescribing outcome measures aimed at improving uptake of evidence-based prescribing (including reduction in diclofenac prescribing, p<0.05) were demonstrated in the intervention group compared with control. Statistically significant differences in patient-oriented outcomes were also demonstrated (HbA1c target ≤7.5%, p<0.01). This finding challenges a main criticism of evidence-based medicine in that evidence is lacking to demonstrate that incorporation of evidence-based research into clinical decision-making improves outcomes for patients. Both qualitative and quantitative evaluations indicated that GPs had internalised and incorporated key evidence-based messages into their clinical decision-making as promoted and supported by the pharmacists.The intervention was shown to be effective in promotion and implementation of evidence-based prescribing in practice and provides an indication of how primary care pharmacists might develop their future role.

Date of Award	6 May 2014
Original language	English
Awarding Institution	University of Bath
Supervisor	Marjorie Weiss (Supervisor)