Prescribing and dispensing functions in medicine and pharmacy and the potential for pharmacist prescribing in Nigeria: a cross-sectional survey of pharmacists’ views [Poster Abstract - Walk 6]

Abstract

Introduction: In Nigeria, there is a separation of dispensing and prescribing functions among healthcare professionals. The legislation accords prescribing authority to medical doctors and dentists and dispensing authority to pharmacists.[1] However, patients’ access to prescription medicines can be seriously affected by the shortage of medical prescribers leading to longer waiting times to see a prescriber. In addition, the present arrangement creates professional division and causes fragmentation of patient care.
Objectives: This study was conducted to explore the views of Nigerian pharmacists on the separation of prescribing and dispensing functions and the potential barriers to granting prescribing authority to them.
Methods: Ethical approval was granted by the School of Healthcare Research Ethics Committee, University of Leeds, UK and the Plateau State Specialist Hospital Health Research Ethics Committee, Nigeria. An online cross-sectional survey was conducted from August to October 2014 among 775 members of the Pharmaceutical Society of Nigeria recruited through a simple random technique. This sample size represents about 5% of the approximately 16,000 pharmacists in Nigeria. The questionnaire for the survey was developed based on previous Nigerian studies.[2,3] It contained 62 items and had both closed and open ended questions. The questionnaire sought respondents’ views on pharmacist prescribing in Nigeria including the potential facilitators and barriers. The instrument was evaluated for content validity by two external pharmacy practice researchers and the reliability of items assessed using internal consistency tests. Quantitative data obtained were analysed using the SPSS while textual data from open ended questions were analysed using a thematic approach.
Results: The response rate was 40.6% (315/775). Many respondents (n= 256; 81.3%) reported that the current separation of prescribing as the doctors’ role and dispensing as the pharmacists’ role in Nigeria is not in the best interest of the patient. Almost all of these respondents (250 of 256; 96.7%) agreed that pharmacist prescribing would increase patients’ access to treatment. However, 195 (76.2%) of the 256 respondents reported that prescribing should be reserved for experienced pharmacists who are able to demonstrate certain competences. In addition, 242 (94.5%) of the 256 respondents reported that postgraduate clinical courses should be developed to prepare pharmacists for an extended role in prescribing. Of all the survey participants 151 (47.9%) made textual comments. Analysis of these comments identified a number of potential barriers to granting prescribing authority to pharmacists in Nigeria. These were classified into pharmacy-related factors including limited clinical education, pharmacists’ attitude to clinical roles and shortage of pharmacists; and external factors including opposition from the medical profession and policy barriers.
Discussion/Conclusion: This study revealed that the current prescribing arrangements in Nigeria do not sufficiently meet the needs of patients in terms of timely and convenient access to prescriptions. Pharmacist prescribing represents an opportunity to increase patients’ access to care and promote integration of care. However, the barriers identified in this study will need to be addressed in order for Nigerian pharmacists to extend their roles to include prescribing. Finally, this study has provided many avenues for future research including a survey of doctors’ perception of the potential for pharmacist prescribing in Nigeria.