Evaluation of Physiotherapist and Podiatrist Independent Prescribing, Mixing of Medicines and Prescribing of Controlled Drugs

In August 2013 UK legislative change came into effect permitting allied health professionals to practice as independent prescribers (IP). Recently the first physiotherapy and podiatry (PP) students have completed training and gained full accreditation. Although the introduction of PP-IP is widely supported, with service delivery and patient benefit anticipated, there is little evidence related to prescribing by PPs. Most of the reported benefits, such as cost savings, improved access, and quality of care relate mainly to prescribing by nurses and pharmacists. Equally, there are concerns surrounding the levels of support and governance structures in place for IP undertaken by AHPs, since organisational barriers and policy restrictions are known to affect implementation of the prescribing role. As the number of trained individuals increases and IP is incorporated into clinical practice, its comprehensive early evaluation will become increasingly important.

This study aims to evaluate the effectiveness and efficiency of independent prescribing by physiotherapists and podiatrists utilising a three-phase study informed by the principles of case study design, using mixed methods. This is work is funded by Department of Health and is a joint collaboration between Surrey University and University of Brighton.

Project aims

The project aims are to

  • Describe and classify the services provided by podiatrist and physiotherapist independent prescribers
  • Identify the factors that inhibit/facilitate the uptake and implementation of physiotherapist and podiatrist independent prescribing.
  • Evaluate the contribution of physiotherapist and podiatrist independent prescribing to the experience of patients and carers and its impact on choice, access, and self-reported health outcomes
  • Identify the medicines management activities that enable podiatrist and physiotherapist independent prescribers to contribute most effectively to successful care outcomes
  • Assess the quality, safety and clinical appropriateness of physiotherapist and podiatrist independent prescribing
  • Evaluate the impact of physiotherapist and podiatrist independent prescribing on cost, quality, effectiveness and organisation of care
  • Explore the prescribing models in current practice, their associated resources, and patient utility
  • Evaluate the appropriateness and effectiveness of physiotherapist and podiatrist independent prescribing educational programmes.

Method

Informed by the principles of case-study design1 the research enables key stakeholders to have a voice in the evaluative process and captures context at three levels of analysis (see appendix). These include:

  • Macro level: Literature review (Phase 1)
  • Meso level: Survey of key stakeholders, and analysis of key documents to explore physiotherapist and podiatrist independent prescribing at an organisation and delivery level (Phase 2)
  • Micro level: In depth analysis of practice settings in which physiotherapist and podiatrist independent prescribing is used within case studies (Phase 3)

Project 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 other countries who look to follow our experience.

Research team

Nicola Carey

Karen Stenner

Freda Mold

Heather Gage

Molly Courtenay

Peter Williams

Judith Edwards

Dr Simon Otter

Professor Ann Moore

Jane Brown

Output

Articles are in preparation

 

Partners

University of Surrey

University of Brighton

Liverpool John Moores University

Department of Health