Identifying enablers and barriers to individually tailored prescribing: a survey of healthcare professionals in the UK

Joanne Reeve, Nicky Britten, Byng Richard, Jo Fleming, Janet Heaton, Janet Krska

Research output: Contribution to journalArticle

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Abstract

Background: Many people now take multiple medications on a long-term basis to manage health conditions. Optimising the benefit of such polypharmacy requires tailoring of medicines use to the needs and circumstances of individuals. However, professionals report barriers to achieving this in practice. In this study, we examined health professionals’ perceptions of enablers and barriers to delivering individually tailored prescribing.
Methods: Normalisation Process Theory (NPT) informed an on-line survey of health professionals’ views of enablers and barriers to implementation of Individually Tailored Prescribing (ITP) of medicines. Links to the survey were sent out through known professional networks using a convenience/snowball sampling approach. Survey questions sought to identify perceptions of supports/barriers for ITP within the four domains of work described by NPT: sense making, engagement, action and monitoring. Analysis followed the framework approach developed in our previous work.
Results: 419 responses were included in the final analysis (67.3% female, 32.7% male; 52.7% nurse prescribers, 19.8% pharmacists and 21.8% GPs). Almost half (44.9%) were experienced practitioners (16+ years in practice); around one third reported already routinely offering ITP to their patients. GPs were the group least likely to recognise this as consistent usual practice. Findings revealed general support for the principles of ITP but significant variation and inconsistency in understanding and implementation in practice. Our findings reveal four key implications for practice: the need to raise understanding of ITP as a legitimate part of professional practice; to prioritise the work of ITP within the range of individual professional activity; to improve the consistency of training and support for interpretive practice; and to review the impact of formal and informal monitoring processes on practice.
Conclusion: The findings will inform the ongoing development of our new complex intervention (PRIME Prescribing) to support the individual tailoring of medicines needed to address problematic polypharmacy.
Original languageEnglish
JournalBMC Family Practice
Volume19
Issue number17
DOIs
Publication statusPublished - 15 Jan 2018

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Health Care Surveys
Polypharmacy
Training Support
Professional Practice
Health
Health Surveys
Pharmacists
Nurses
Surveys and Questionnaires

Keywords

  • Polypharmacy, medicines optimisation, individually tailored care

Cite this

Reeve, Joanne ; Britten, Nicky ; Richard, Byng ; Fleming, Jo ; Heaton, Janet ; Krska, Janet. / Identifying enablers and barriers to individually tailored prescribing: a survey of healthcare professionals in the UK . In: BMC Family Practice. 2018 ; Vol. 19, No. 17.
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abstract = "Background: Many people now take multiple medications on a long-term basis to manage health conditions. Optimising the benefit of such polypharmacy requires tailoring of medicines use to the needs and circumstances of individuals. However, professionals report barriers to achieving this in practice. In this study, we examined health professionals’ perceptions of enablers and barriers to delivering individually tailored prescribing. Methods: Normalisation Process Theory (NPT) informed an on-line survey of health professionals’ views of enablers and barriers to implementation of Individually Tailored Prescribing (ITP) of medicines. Links to the survey were sent out through known professional networks using a convenience/snowball sampling approach. Survey questions sought to identify perceptions of supports/barriers for ITP within the four domains of work described by NPT: sense making, engagement, action and monitoring. Analysis followed the framework approach developed in our previous work.Results: 419 responses were included in the final analysis (67.3{\%} female, 32.7{\%} male; 52.7{\%} nurse prescribers, 19.8{\%} pharmacists and 21.8{\%} GPs). Almost half (44.9{\%}) were experienced practitioners (16+ years in practice); around one third reported already routinely offering ITP to their patients. GPs were the group least likely to recognise this as consistent usual practice. Findings revealed general support for the principles of ITP but significant variation and inconsistency in understanding and implementation in practice. Our findings reveal four key implications for practice: the need to raise understanding of ITP as a legitimate part of professional practice; to prioritise the work of ITP within the range of individual professional activity; to improve the consistency of training and support for interpretive practice; and to review the impact of formal and informal monitoring processes on practice. Conclusion: The findings will inform the ongoing development of our new complex intervention (PRIME Prescribing) to support the individual tailoring of medicines needed to address problematic polypharmacy.",
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Identifying enablers and barriers to individually tailored prescribing: a survey of healthcare professionals in the UK . / Reeve, Joanne; Britten, Nicky; Richard, Byng; Fleming, Jo; Heaton, Janet; Krska, Janet.

In: BMC Family Practice, Vol. 19, No. 17, 15.01.2018.

Research output: Contribution to journalArticle

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T1 - Identifying enablers and barriers to individually tailored prescribing:

T2 - a survey of healthcare professionals in the UK

AU - Reeve, Joanne

AU - Britten, Nicky

AU - Richard, Byng

AU - Fleming, Jo

AU - Heaton, Janet

AU - Krska, Janet

N1 - © The Author(s) 2018

PY - 2018/1/15

Y1 - 2018/1/15

N2 - Background: Many people now take multiple medications on a long-term basis to manage health conditions. Optimising the benefit of such polypharmacy requires tailoring of medicines use to the needs and circumstances of individuals. However, professionals report barriers to achieving this in practice. In this study, we examined health professionals’ perceptions of enablers and barriers to delivering individually tailored prescribing. Methods: Normalisation Process Theory (NPT) informed an on-line survey of health professionals’ views of enablers and barriers to implementation of Individually Tailored Prescribing (ITP) of medicines. Links to the survey were sent out through known professional networks using a convenience/snowball sampling approach. Survey questions sought to identify perceptions of supports/barriers for ITP within the four domains of work described by NPT: sense making, engagement, action and monitoring. Analysis followed the framework approach developed in our previous work.Results: 419 responses were included in the final analysis (67.3% female, 32.7% male; 52.7% nurse prescribers, 19.8% pharmacists and 21.8% GPs). Almost half (44.9%) were experienced practitioners (16+ years in practice); around one third reported already routinely offering ITP to their patients. GPs were the group least likely to recognise this as consistent usual practice. Findings revealed general support for the principles of ITP but significant variation and inconsistency in understanding and implementation in practice. Our findings reveal four key implications for practice: the need to raise understanding of ITP as a legitimate part of professional practice; to prioritise the work of ITP within the range of individual professional activity; to improve the consistency of training and support for interpretive practice; and to review the impact of formal and informal monitoring processes on practice. Conclusion: The findings will inform the ongoing development of our new complex intervention (PRIME Prescribing) to support the individual tailoring of medicines needed to address problematic polypharmacy.

AB - Background: Many people now take multiple medications on a long-term basis to manage health conditions. Optimising the benefit of such polypharmacy requires tailoring of medicines use to the needs and circumstances of individuals. However, professionals report barriers to achieving this in practice. In this study, we examined health professionals’ perceptions of enablers and barriers to delivering individually tailored prescribing. Methods: Normalisation Process Theory (NPT) informed an on-line survey of health professionals’ views of enablers and barriers to implementation of Individually Tailored Prescribing (ITP) of medicines. Links to the survey were sent out through known professional networks using a convenience/snowball sampling approach. Survey questions sought to identify perceptions of supports/barriers for ITP within the four domains of work described by NPT: sense making, engagement, action and monitoring. Analysis followed the framework approach developed in our previous work.Results: 419 responses were included in the final analysis (67.3% female, 32.7% male; 52.7% nurse prescribers, 19.8% pharmacists and 21.8% GPs). Almost half (44.9%) were experienced practitioners (16+ years in practice); around one third reported already routinely offering ITP to their patients. GPs were the group least likely to recognise this as consistent usual practice. Findings revealed general support for the principles of ITP but significant variation and inconsistency in understanding and implementation in practice. Our findings reveal four key implications for practice: the need to raise understanding of ITP as a legitimate part of professional practice; to prioritise the work of ITP within the range of individual professional activity; to improve the consistency of training and support for interpretive practice; and to review the impact of formal and informal monitoring processes on practice. Conclusion: The findings will inform the ongoing development of our new complex intervention (PRIME Prescribing) to support the individual tailoring of medicines needed to address problematic polypharmacy.

KW - Polypharmacy, medicines optimisation, individually tailored care

U2 - 10.1186/s12875-017-0705-2

DO - 10.1186/s12875-017-0705-2

M3 - Article

VL - 19

JO - BMC Family Practice

JF - BMC Family Practice

IS - 17

ER -