Identification of the relationship between barriers and facilitators of pharmacist prescribing and self-reported prescribing activity using the theoretical domains framework

Abstract

Background: The scope of pharmacist practice has expanded in many jurisdictions, including Nova Scotia, Canada, to include prescribing of medications.

Objective: To identify the relationship between barriers and facilitators to pharmacist prescribing and self-reported prescribing activity using the Theoretical Domains Framework version 2 (TDF(v2)).

Methods: The study was a self-administered electronic survey of all registered pharmacists (approximately 1300) in Nova Scotia, Canada. The questionnaire was developed using a consensus process that mapped facilitators and barriers to prescribing with the 14 domains of the TDF(v2). The questionnaire captured information about the type and rate of pharmacists' prescribing activities, pharmacists' perceptions of their prescribing role at the patient, pharmacist, pharmacy organization and health system level, and pharmacist demographics and practice settings. A 5-point Likert scale was used for most TDF(v2) domains. Cronbach's alpha was used to study the internal consistency of responses within each of the TDF(v2) domains and simple logistic regression was used to measure the relationship between TDF(v2) domain responses and self-reported prescribing activity. Open-ended questions were analyzed separately.

Results: Eighty-seven pharmacists completed the questionnaire. The majority of respondents were female (70 %), staff pharmacists (52 %) practicing pharmacy for a mean of 18 years. The three domains that respondents most positively associated with prescribing were Knowledge (84 %), Reinforcement (81 %) and Intentions (78 %). The largest effect on prescribing activity was the Skills domain (OR 4.41, 95% CI, 1.34-14.47).

Conclusions: We determined the TDF(v2) domains associated with pharmacist self-reported prescribing behaviours. This understanding can assist the development of policy and program interventions at the pharmacist, pharmacy, and health system levels, to increase the uptake of pharmacist prescribing. Further work is needed to develop and implement interventions based on the domains identified, and to test these in pilot settings and then in large-scale interventions.