Pharmacists Prescribing in Australia: Evidence and Perspectives

This report explores the evidence and perspectives on pharmacists prescribing in Australia. It discusses the benefits, limitations, and barriers to expanding their role in healthcare delivery.

CAM538, Assignment 1
CAM538
TRANSLATIONAL RESEARCH AND HEALTH SCIENCE INNOVATION
Assignment 2: Pharmacists Prescribing
By Your Name
Pages:
15 Pages (including cover page and references)
Word Count
Approximately 2100 words (excluding in-text citations, tables, and references)

CAM538, Assignment 2
Background: Why Pharmacists Prescribing?
Prescribing by pharmacists is an established practice in many countries such as the USA, UK,
Canada, and New Zealand (Nissen et al. 2017). These countries find the practice appropriate and
beneficial because it improves access to medications and enhances the appropriate use of
healthcare resources without jeopardizing patient safety (Hale et al. 2016; Hanna et al. 2014;
Nissen et al. 2017). In the UK for instance, more than 90% of resident medical staff support the
use of pharmacist-led recommendations (Bourne, Baqir, & Onatade 2016). The interventions
have been deemed clinically safe and appropriate. With support from other professions,
pharmacists prescribing are pivotal in addressing the future needs of patients in the UK.
The widespread recognition is based on the fact that pharmacists are experts in medicines and
poisons. Their knowledge can be used to enhance safe medication practices. Patients also report
satisfaction and trust pharmacists prescribing and consultations (Hale et al. 2016; Hanna et al.
2014; McCann et al. 2015; Zhou et al. 2016). They, patients, report enhanced access to
pharmaceutical products when pharmacists prescribe.
In Australia, however, pharmacists continue to experience prescribing limitations (Bajorek et al.,
2015; Broom et al. 2015; Hale et al. 2016; Hanna et al. 2014; Nissen et al. 2017). But as their
colleagues in other country get the power to prescribe, Australian pharmacists have expressed a
desire for a role expansion. In order to make an informed decision on whether Australian
pharmacists should be allowed to prescribe, evidence on their prescribing competencies, accrued
benefits, and implications on practice need to be assessed. This report, therefore, attempts to
explore evidence relevant to pharmacists prescribing with a primary focus on Australia.

CAM538, Assignment 3
Part A: Pharmacists Prescribing in Australia
The Commonwealth of Australia has a large and diverse health workforce such as physicians
(medical practitioners), nurses, dentists, midwives, psychologists, physiotherapists, osteopaths,
podiatrists, chiropractors, optometrists, medical radiation practitioners, Chinese medicine
practitioners, indigenous health practitioners, and pharmacists (Moles & Stehlik 2015). However,
only authorized practitioners with appropriate training and accreditation such as physicians,
dentists, nurses, midwives, podiatrists, and optometrists can prescribe medicines to patients.
Pharmacists, on the other hand, are only allowed to supply drugs to a patient as ordered by the
medical practitioners (Moles & Stehlik 2015). They can also refill stocks in addition to releasing
selected over-the-counter drugs.
The limitations exist despite the intensive education pharmacists undertake before they allowed
to practice. Students must first complete a Bachelor of Pharmacy from an institution accredited
by the Australian Pharmacy Council (APC), or a two-year Master of Pharmacy (Moles & Stehlik
2015). This is followed by another year of APC supervised internship in an approved
organization. Afterward, the student must undertake a written exam followed by an oral
assessment overseen by the Pharmacy Board of Australia (PBA). If successful in both
examinations, the student applies to the Australian Health Practitioner Regulation Agency
(AHPRA). As of 2010, registered pharmacists must complete and document at least forty credits
of continuing professional developments, annually (Moles & Stehlik 2015).
The National Competency Standards Framework for Pharmacists in Australia (NCSFP) also
recognizes the training, education, and competencies of pharmacists (Moles & Stehlik 2015).
NCSFP stipulates pharmacists have the skills required to improve medical outcomes especially
by reducing medication errors. Their sound pharmaceutical knowledge plays a vital role in the

CAM538, Assignment 4
promotion of patient-centered care. Also, they have practical problem solving, communication,
and interpersonal skills needed to facilitate patient-centered care. Regardless of these
qualifications, the isolation of pharmacists from the rest of the healthcare and limiting their scope
of practice to medications custody, preparation, and dispensing, persists.
Owing to their professional education, training, ethics, and work attitude, the Health Workforce
Australia (HWA) Health Professionals Prescribing Pathway (HPPP) Project in 2013 started a
campaign that would grant pharmacists prescription powers (Hale et al. 2016). After an intensive
discussion with my colleagues on this endeavor, several interesting themes emerged.
Pharmacists in Australia are frustrated with the restriction and are willing to seek the necessary
accreditation to prove their prescribing competencies. They can play a more extended and
integrated role in the translation of research into practice. Their expertise in medicines positions
them as the most appropriate profession to prescribe as well as manage patient’s medications.
Besides, doctors’ availability in clinical settings is less compared to pharmacists. Physicians are
also hardly available at night or during weekends. Pharmacists are, however, available during
odd hours such as late nights and on weekdays. Because pharmacists have received
comprehensive training on pharmaceuticals, it was strongly agreed they have the required
competencies to prescribe medicines to incoming patients, particularly those with minor
ailments.
The beliefs concede with Freeman et al. (2016), pharmacists have the clinical competencies
required to reduce healthcare fragmentation, improve care delivery by enhancing medication
management, in addition to strengthening communication between patients and other
practitioners. Their role in clinical translation is vital because medication reconciliation is vital in
the improvement of medical and patient outcomes (Bourne et al. 2015; Broom et al. 2015;

CAM538, Assignment 5
Freeman et al. 2016). Their expertise in medicines and poisons enhances their ability to translate
research to practice thus allowing them to create an accurate medication plan for patients.
Vlasimsky et al. (2019) also posit pharmacists have the required competencies to independently
care for patients presenting with minor ailments.
The discussion went on to cover a recent co-design meeting held at the local primary health
network (PHN) to address the lack of access to healthcare professionals after hours, mainly due
to lack of GP access. Pharmacists felt the scarcity of general practitioners (GP) exacerbates
lower medical outcomes as patients have to queue for long hours to see a doctor for a
prescription. Because these patients have minor ailments such as cellulitis following insect bites,
possible ear infections, and eczema flare-ups, pharmacists felt ready to prescribe for such
conditions. They firmly believed that the practice would reduce the workload of other medical
practitioners, improve medical outcomes and patient satisfaction, as well as facilitate
consumption of medical resources. The inferences are in agreement with researches by Freeman
et al. (2016), Bajorek et al. (2015), and Bidwell and Thompson (2015) who suggest allowing
pharmacists to be more proactive in the healthcare delivery team would free other team
members, permitting them to focus on their core roles.
Another emerging theme was patient satisfaction with pharmacists’ prescribing capabilities.
Most of my colleagues reported patients trust pharmacist’s prescription skills. The accounts
correspond with the evidence on patient’s satisfaction with pharmacists’ prescription powers
(Hale et al. 2016; Hanna et al. 2014; Zhou et al. 2018). The concord provides further evidence on
the prescribing competencies of pharmacists. Combined with an improved use of scarce
healthcare resources, patient satisfaction and confidence in pharmacists prescribing is proof

CAM538, Assignment 6
pharmacists’ scope of practice needs expansion (Hale et al. 2016; Hanna et al. 2014; Mossialos
et al. 2015; Zhou et al. 2018).
When asked about perceived barriers to pharmacists prescribing, a fascinating discussion
followed. Some colleagues argued about possible territoriality from other medical practitioners.
They supposed doctors would feel threatened because pharmacists prescribing is more cost-
effective. On this belief, some researchers posit pharmacists can expect support from other
healthcare providers regarding their prescribing role expansion (Bidwell & Thompson 2015;
Bourne et al. 2016; Moles & Stehlik 2015; Mansoor et al. 2014).
Another obstacle worth mentioning is the pharmacy profession itself. According to Bourne et al.
(2016), expansion of pharmacy roles to include prescribing will require a change in the education
system. The process of implementation is also complex because they will need to establish a
framework for training and accrediting pharmacists with prescribing powers. Adding to other
hurdles such as limited finance and time resources, lack of support from other medical staff, and
resources needed to implement the strategy, pharmacists prescribing may take longer than
expected (Bourne et al. 2016; Moles & Stehlik 2015; Mansoor et al. 2014).
The issue of incurred costs also arose. Should the role of pharmacists be expanded, an increment
in salaries should also follow. Some studies also support this argument with others arguing
remunerating pharmacists is more cost-effective than other medical practitioners, particularly
GPs (Bourne et al. 2016; de Barra 2018; Moles & Stehlik 2015). However, more research is
needed to make the issue conclusive.

CAM538, Assignment 7
Part B: Evidence Supporting Pharmacists Prescribing in Australia
To assess the research on pharmacists prescribing in Australia, a literature review was conducted
to answer the question “is prescribing by pharmacist supported by evidence?”
For this study, primary and secondary sources of information were searched within multiple
databases. The first database was the Cochrane Library. Here, the keywords used was
prescribing by pharmacists and search settings adjusted to 2014-2019. The search returned 108
Cochrane Reviews which were assessed for relevance and credibility.
The purpose of this search was to find evidence on pharmacists prescribing from a global
perspective. Hence, reviews had to investigate the scientific evidence supporting or refuting the
role of pharmacists as prescribers. Articles covering the role of pharmacists in translational
medicine, accrued benefits of expanding pharmacists’ roles, and barriers and facilitators of the
proposition would also be included. Out of the 108 studies, only two, see the table below,
satisfied the established criterion.
Name Type of Study Objective Findings
De Barra et
al. 2018
Systematic review To examine the effect of
pharmacists' non‐dispensing roles
on non‐admitted patient
outcomes.
Pharmacists can positively impact the health of
patients such as enhanced blood pressure
management and physical functions.
Pharmacists did not reduce hospital admission or
visits.
There was no difference between the effectiveness
of pharmacist-led interventions and those provided
by other healthcare practitioners.
Pande et al.
2013
Systematic Review To study the impact of
pharmacist‐delivered non‐
dispensing activities on patient
outcomes, consumption of health
service and costs in low‐ and
middle‐income countries.
Pharmacist-led interventions had positive results in
blood pressure management, blood glucose, blood
cholesterol, and asthma.
There was also an improvement in the quality of
life.
Rate of admission and use of emergency rooms was
also reduced.
Evidence on cost-effectiveness was inconclusive.
Table 1: Summary matrix of Cochrane Reviews on pharmacists prescribing

CAM538, Assignment 8
Both reviews agreed pharmacists should have more roles in healthcare delivery. Their inclusion
has been associated with better healthcare outcomes. Pharmacists’ expertise in medicine allows
them to assess the safety and effectiveness of treatment plans (medications) and make decisions
on treatment commencement or completion. They can educate patients about their medications
and encourage them to adhere to medications effectively. Pharmacists can also train and help
patients self-administer drugs.
Both studies concur pharmacists need continued education to stay updated with the latest
prescribing skills. Pharmacists, particularly those with experience believed continuing
professional development could help them perform optimally. The new ones opted to refer
patients to GP and were comfortable in their role of custody, supply, and refilling medications.
The difference in opinion could be experience level. The more experienced a pharmacist is, the
higher their prescribing confidence and the vice versa is also true.
Another subject arising in the reviews is the cost-effectiveness of using pharmacist-initiated
interventions. Since both studies concur there is little and no difference between the prescribing
skills of physician and pharmacists, the latter can become a more sustainable and cost-effective
source of labor because pharmacists will provide the service at a more affordable price than other
medical practitioners. However, more evidence is needed to support the cost-effectiveness of the
pharmacist-led recommendations.
Due to the limited Cochrane Reviews on pharmacists prescribing, a second database, Google
Scholar, was added. To enhance the search results, advanced search on Google Scholar was used
with the exact keywords Pharmacists prescribing in Australia appearing anywhere in the article.
There were 23 search results, and only those with free access such as PDF or HTML format
proved useful. The purpose of this search was to determine how Australians perceived

CAM538, Assignment 9
prescribing by pharmacists. The search returned five primary studies and one systematic review,
as seen in the table below.
Study Objective Findings
Hale et al. 2016 To explore patients’ perceptions of
pharmacist-initiated prescribing
model of care.
98% and 97% of patients in surgical pre‐admission clinic
(PAC) and sexual health clinic, respectively, reported
complete satisfaction and confidence in pharmacists’
consultation services.
92% found the information provided by the pharmacist
helped them prepare for their surgeries.
>90% of patients asserted pharmacists to have excellent
interpersonal and communication skills and their expertise of
medicines and treatment planning effective. They, however,
would prefer a doctor’s diagnostic.
82% of participants in the sexual health clinic felt
pharmacists should be allowed to prescribe.
PAC study participants showed greater ambivalence and
concern (14%) regarding independent pharmacist.
Most preferred doctor-pharmacist collaboration.
Hanna et al., 2014 To study the capacity for
community pharmacist prescribing
concerning effectiveness,
pharmacists’ self-confidence, and
suitability, in asthma management.
Community pharmacists can handle minor ailments such as
asthma.
81% of pharmacist-led interventions adhered to standard
practices.
53% of actions were found to be inappropriate.
Experienced pharmacists were confident in their prescribing
powers.
They believed continued learning is needed to reach optimal
standards of practice in prescribing.
Novel pharmacists preferred preferring their patients to GP
for diagnosis and prescribing.
Nissen et al., 2017 A report commissioned by the
Pharmacy Board of
Australia
44% of all reviewed learning outcomes (LO) supported the
learning required to prescribe.
The most substantial proportion of reviewed LO, more than
350, focus more on teaching students competence area two
(treatment options and how they support the patient’s clinical
needs), and H1 (professional practice).
Competence area four (coordination) is least covered.
Areas in need of strengthening include communication with
the patient in the process of care.
Rather than provide treatment options, students should be
taught about discussing and negotiating possible treatment
options with their patients.
The focus should be on teaching student patient preferences
and consideration when optimizing a treatment plan.
Should pharmacists be allowed to prescribe under a protocol
that will enable them to do a physical examination or other
forms of diagnosis, then students need further training on
information gathering from patients and family/caregiver.
The curricular also needs to emphasize on enhancing their
verbal communication skills in the healthcare delivery team.
Other areas in need of reinforcement are the application of
quality use of medicines (QUM) in the prescribing process
and CPD specific to prescribing practice.

CAM538, Assignment 10
Weight should be given on evidence-based treatment to
improve pharmacists’ clinical decision making.
Sinkala et al.,
2018
To study the degree of support for
"down-scheduling" certain
antibiotics and to assess factors
influencing the aptness of
community pharmacist prescribing
for a restricted array of infections,
as well as their decision to refer to
a doctor.
60% supported expanded prescribing of commonly used
antibiotics.
67.6% chose to treat the patient (89.2% preferred antibiotics,
77.2% opted for appropriate regimens)
32.4% preferred to refer patients to general practitioners.
80% decided to refer patients to doctors following no change
in 3 days or 24 hours for community-acquired pneumonia.
Younger pharmacists chose to refer patients to physicians.
Vlasimsky et al.
2019
To establish the ideal method of
provider education concerning the
application of a pharmacist-
initiated type 2 diabetes joint drug
therapy management practice.
To evaluate pharmacist and
provider contentment with the
protocol enactment
66.7% of pharmacists felt more satisfied with the inclusion
of the new (collaborative drug management) diabetes
protocol.
50% could not decide whether the newly implemented
practice enhanced their professional relationship with other
providers in the clinic.
50% found the new protocol relatively easy to apply.
50% found satisfaction in the expanded role in diabetes
management.
Zhou et al., 2016 To review the effect of
multidimensional pharmacist
involvements on antibiotic
prophylaxis in patients going
through clean or clean-
contaminated surgeries in
cardiothoracic department.
Pharmacists interventions resulted in enhanced adherence to
evidence-based treatment.
There increased prescribing effectiveness in regards to
dosage (proportion and duration), choice of antibiotics, time
of medication commencement. Unnecessary use of drugs,
replacements or combinations were reduced.
Pharmacist-led interventions improved healthcare outcomes
(reduced surgical site infection (SSI) rate, lowered
prophylactic antibiotic charges, and shortened length of stay
copied).
Table 2: Summary matrix of Google Scholar studies on pharmacists prescribing
Like the Cochrane Reviews, the evaluated primary studies on Google Scholar also agreed on
expanding the role of pharmacists in the healthcare teams. Zhou et al. (2018) for instance
concludes pharmacist-steered medical interventions play a decisive role in healthcare delivery,
particularly in the use of antibiotics. From calculating dosages and proportions of various drugs
to choosing the right medicine and combinations, time of commencement or completion,
pharmacists’ deserve a role of expansion. This study was similar to Broom et al. (2015) and
Bajorek et al. (2015) who also concluded pharmacists play a vital role in reducing antibiotic
misuse thus enhancing medical outcomes and reducing drug resistance.

CAM538, Assignment 11
Another arising theme is patient satisfaction and confidence in pharmacists prescribing. The
study by Hale et al. (2016) concluded patients had complete faith in the role of pharmacists in the
healthcare delivery team. The population found pharmacists have good communication,
listening, and other interpersonal skills to professional care, empathy, and expertise in medicine,
the essential elements of enhanced patient satisfaction. This finding concurs with the NCSFP
which establishes pharmacists have the competencies required to improve medical outcomes and
reduce fragmentation in healthcare delivery (Moles & Stehlik 2015).
Collaborative healthcare delivery is another focus worth mentioning. The primary studies in the
table agree pharmacists should be an active member of the healthcare delivery team. One of the
most recommended partnership is doctor-pharmacist. As the doctor diagnoses, the pharmacist
proposes the most appropriate treatment plan and continues to assess the patient’s response to
suggested medications. The partnership increased pharmacists’ job satisfaction and enhanced
their inclusion in patient care. The collaboration has found significant support from other
medical staff, pharmacists, and patients and is definitely worth implementing (Bajorek et al.,
2015; Hales et al. 2016; Vlasimsky et al. 2019; Zhou et al. 2016).
Conclusion
To this end, it appears there is a concession regarding expanding the role of pharmacists. Their
professional expertise has been deemed beneficial to improved patient-safety and medical
outcomes. Patients have also established pharmacists provide useful services. In countries where
pharmacists’ roles have been expanded to include prescribing, the practitioners received
intensive training, framework for prescribing, and role clarifications. Similarly, pharmacists in
Australia will need high-quality education and training particularly in implementing evidence-
based treatment. This should be followed by more controlled studies on pharmacist-directed

CAM538, Assignment 12
interventions to solidify their expertise and reinforce confidence in the patient population.
Pharmacists will have to commit more time continuing professional development (CPD).
Advanced research is also needed to establish the cost-effectiveness of using pharmacists in
primary care settings.

CAM538, Assignment 13
References
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Bidwell, S. and Thompson, L., 2015. GPs, community pharmacists and shifting professional
boundaries. NZ Med J, 128(1414), pp.19-26.
Bourne, R.S., Baqir, W. and Onatade, R., 2016. Pharmacist independent prescribing in secondary
care: opportunities and challenges. International journal of clinical pharmacy, 38(1), pp.1-6. doi:
10.1007/s11096-015-0226-9
Broom, A., Broom, J., Kirby, E., Plage, S. and Adams, J., 2015. What role do pharmacists play
in mediating antibiotic use in hospitals? A qualitative study. BMJ open, 5(11), p.e008326.
de Barra, M., Scott, C.L., Scott, N.W., Johnston, M., de Bruin, M., Nkansah, N., Bond,
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Expectations, 19(1), pp.49-61. doi:10.1136/bmjopen-2013-003027

CAM538, Assignment 14
Hanna, T., Bajorek, B., Lemay, K. and Armour, C.L., 2014. Using scenarios to test the
appropriateness of pharmacist prescribing in asthma management. Pharmacy practice, 12(1).
McCann, L.M., Haughey, S.L., Parsons, C., Lloyd, F., Crealey, G., Gormley, G.J. and Hughes,
C.M., 2015. A patient perspective of pharmacist prescribing:‘crossing the specialisms‐crossing
the illnesses’. Health Expectations, 18(1), pp.58-68.
Moles, R. J. & Stehlik, P. 2015. Pharmacy Practice in Australia. The Canadian Journal of
Hospital Pharmacy, 68(5), 418–426.
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I., 2015. From “retailers” to health care providers: transforming the role of community
pharmacists in chronic disease management. Health policy, 119(5), pp.628-639.
Mansoor, S.M., Aslani, P. & Krass, I., 2014. Pharmacists’ attitudes and perceived barriers to
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Nissen, L., Lynne, T., Cardiff, L. and Bettenay, K., 2015. Pharmacist prescribing in Australia. A
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Pande, S., Hiller, J.E., Nkansah, N., Bero, L., 2013. The effect of pharmacist‐provided non‐
dispensing services on patient outcomes, health service utilisation and costs in low‐ and middle‐
income countries. Cochrane Database of Systematic Reviews, (2). doi:
10.1002/14651858.CD010398.

CAM538, Assignment 15
Sinkala, F., Parsons, R., Sunderland, B., Hoti, K. and Czarniak, P., 2018. A survey of the views
and capabilities of community pharmacists in Western Australia regarding the rescheduling of
selected oral antibiotics in a framework of pharmacist prescribing. PeerJ, 6, p.e4726.
Al-Omar, L.T., Cizmic, A.D., Anderson, S.l., and Vlasimsky, T.B., 2019. Implementation of a
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