Title: Evaluation of Physiotherapist and Podiatrist Independent Prescribing, Mixing of Medicines and Prescribing of Controlled drugs
Funder: Department of Health (England)

Abstract: Background Physiotherapists and podiatrists (PPs) will soon be able to independently prescribe (IP), offering improved service efficiency, access to medicines, and maximum use of their knowledge and skills. There is little evidence related to prescribing by PPs. Reported benefits, such as cost savings, improved access, and quality of care relate mainly to prescribing by nurses and pharmacists. There are ongoing concerns surrounding levels of support, governance structures, and barriers such organisational and policy restrictions known to affect implementation of the prescribing role. Introduction of PP-IP is widely supported, with improvements to service delivery and standards of care keenly anticipated. Aim: The aim is to evaluate the effectiveness and efficiency of independent prescribing by physiotherapists and podiatrists. The objectives are to: (1) Describe and classify services provided by PP-IPs (2) Identify factors that inhibit/facilitate uptake and implementation of PP-IP (3)Evaluate the contribution of PP-IP to patient experience and its impact on choice, access, and self-reported health outcomes (4) Identify medicines management activities that enable PP-IP to contribute most effectively to successful care outcomes (5) Assess quality, safety and clinical appropriateness of PP-IP (6) Evaluate the impact of PP-IP on cost, quality, effectiveness and organisation of care: (7) Explore prescribing models in current practice, their associated resources, and patient utility (8) Evaluate appropriateness and effectiveness of PP-IP educational programmes. Plan of Investigation A three phase study informed by the principles of case study design, using mixed methods. Phase 1 (months 1-3) involves a literature review and will inform phases 2 and 3 . Analysis of key documents and survey of trainee PP-IPs (139) will be undertaken in Phase 2 (months 4-20) and explore implementation of PP-IP at an organisation and delivery level. This will include developing and piloting the questionnaires (months 1-4) and obtaining the necessary approvals (months 1-12). Phase 3 (months 7-19) will comprise a comparative case study of 6 sites where physiotherapists or podiatrists use IP and 6 non-prescribing PP sites. Tools will be developed (months 1-6) to provide an in-depth analysis of these 8-12 case sites selected from Phase 2 and approvals sought (months 1-12). At each case-study site data will be collected as follows i) Semi-structured interviews with PP-IP/NP-PP & Team members (n-2-3) ii) A researcher will observe PP-IPs and NP-PPs engaged in real-time service delivery over one working week (maximum 5 working days) and use electronic diaries to collect information on medicines management activities and work activities ( approximately 60-80 patients) iii) Patient questionnaires (n-30) iv) Audio-recorded consultations (n-5) v) Audit of patient records (n-15) Analysis (months 14-22) will comprise initial analysis of individual units of data, followed by consideration of convergent evidence across sites, and the case-study as a whole. Resource implications of different models of care will be assessed. Write up and dissemination to all interested stakeholders will take place months 23-24. Research Team The unique nature of our highly experienced team of researchers, combining specialist knowledge in NMP, with professional expertise in physiotherapy, podiatry, pharmacy, and health economics, provides a great opportunity to explore the effectiveness, efficiency and quality of PP-IP. Impact Describing the services provided by PP-IPs and determining the impact of these services, on effectiveness, efficiency, quality and cost of services, will create evidence to inform those engaged in policy development and commissioning services, guide professional bodies, healthcare commissioners and managers and support wider implementation of the role. It will allow informed decision making about the extension of prescribing rights to other healthcare professionals and non-medical professionals in other countries who look to follow our experience.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE