What prescribing means to pharmacists: a qualitative exploration of practising pharmacists in Alberta Christine A. Hughes, Mark Makowsky, Cheryl A. Sadowski, Theresa J. Schindel, Nese Yuksel and Lisa M. Guirguis Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada Keywords Canada; legislation; meaning; pharmacists; prescribing; qualitative Correspondence Dr Lisa M. Guirguis, 3-171 Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AB, Canada T6G 1C9. E-mail: lguirgui@ualberta.ca Received December 19, 2012 Accepted August 29, 2013 doi: 10.1111/ijpp.12079 Abstract Objective In 2007 Alberta, Canada, became the first North American jurisdiction to adopt prescribing legislation for pharmacists. In light of these legislative changes and expanded scope of pharmacy practice, we evaluated what ‘prescribing’ means to pharmacists in Alberta and the application of prescribing in pharmacy practice. Methods We invited pharmacists to participate in semi-structured telephone inter- views using closed and open-ended questions. Pharmacists working in community, hospital or other settings were selected using a mix of random and purposive sam- pling. Interviews were audiorecorded and transcribed, and data were entered into nVIVO 9 software. Transcriptions were analysed by two investigators using an inter- pretive description approach to identify themes. Key findings Thirty-eight pharmacists were interviewed, of whom 13 had addi- tional (independent) prescribing authorization. Prescribing had a wide breadth of meaning to the pharmacists in our study, which included writing a new prescription and extending an existing prescription, as well as advising on non-prescription medications. Pharmacists described prescribing in terms of the physical act of writing the prescription and as part of the patient care process as well as the legislated definition of pharmacist prescribing. The sense of increased responsibility associ- ated with prescribing was noted by many pharmacists. Conclusion Prescribing had diverse meanings to pharmacists in our study, and appeared to be context-specific. Understanding the meaning prescribing holds for individual pharmacists is important to explore whether pharmacist’s definition of this expanded scope has shaped pharmacists’ enactment of prescribing practice. Introduction Traditionally,only a few professions have had the authority to prescribe medications, most notably physicians. Prescribing represents clinical autonomy and has been one of the core activities which separated physicians from other professional groups. [1,2] More recently, the need to re-evaluate healthcare delivery in many parts of the world has resulted in legislation to enable other professional groups to prescribe with the overall aim to improve convenient patient access to services as well as better use of professional skills. [3] Several models of pharmacist prescribing have emerged over the past two decades ranging from independent prescribing to various forms of dependent prescribing such as prescribing by proto- col, formulary, repeat prescribing or collaborative prescribing models. [4] These models outline the diversity of prescribing particularly with respect to the pharmacists’ level of decision making, and responsibility for prescribing decisions. In understanding these models it is important to note that inde- pendent prescribing models reflect that pharmacists are inde- pendently and legally responsible for prescribing decisions, not that pharmacist prescribers work independently of other health team members. In the USA more than 75% of states have collaborative drug-therapy management programmes which allow quali- fied pharmacists to work within a defined protocol. [5] Florida is the only US state which has approved independent phar- macist prescribing from a limited formulary. In 2003, the UK approved pharmacist supplementary prescribing, a form of dependent prescribing, which allows pharmacists to pre- scribe any medication listed under a clinical management plan developed with an independent prescriber. [6] This was International Journal of Pharmacy Practice International Journal of Pharmacy Practice 2014, 22, pp. 283–291 Research Paper © 2013 Royal Pharmaceutical Society International Journal of Pharmacy Practice 2014, 22, pp. 283–291 Downloaded from https://academic.oup.com/ijpp/article/22/4/283/6101878 by guest on 20 August 2022