Prescribing Competence and Confidence in Pharmacy and Medicine

• Author / Creator

  Woit, Cassandra

• In 2007, Additional Prescribing Authorization (APA) was introduced in Alberta, which allows pharmacists to independently initiate prescriptions and prescribe to manage ongoing therapy. Pharmacist prescribing has also been shown to have positive patient outcomes in a variety of health conditions. For physicians, prescribing is an expected activity, however recent studies show that many prescribing errors are made by junior physicians. It is important to ensure the University of Alberta is producing competent and confident prescribers, from both faculties of pharmacy and medicine.
  A scoping review of the literature was completed to explore studies investigating prescribing competence and confidence in pharmacy and medicine. Online databases MEDLINE, EMBASE, and Global Health were used to identify articles from inception to October 2018. Peer-reviewed articles describing either the competence or confidence of physician, pharmacist or student prescribing, including inappropriate prescribing and prescribing errors were included. After applying the inclusion and exclusion criteria and hand searching, 33 eligible articles remained.
  Many studies demonstrated that medical students and junior doctors are not competent in prescribing when they enter practice, although their perceived confidence is often higher than their assessed competence. While fewer studies investigate pharmacist competence and confidence, those that do described competent prescribers lacking confidence in their prescribing knowledge. Themes included self-awareness, lack of education and educational improvements, prescribing errors and resources, prescribing culture and barriers to prescribing, gender differences and benefits to prescribing. Results from the scoping review showed that prescribing competence is poorly correlated with prescribing confidence and has questioned whether undergraduate programs adequately prepare interns and junior practitioners for safe and rational prescribing.
  The goal of the research project was to investigate the differences is prescribing competence and self-rated prescribing confidence of fourth year pharmacy and medical students at the University of Alberta. A cross-sectional design was used to measure prescribing competence using five prescribing case scenarios, and explore prescribing confidence using a survey. All fourth-year pharmacy and medicine students at the University of Alberta were eligible to participate. Answers to the cases were graded based on therapeutic appropriateness and inclusion of all legal requirements. The confidence survey assessed confidence of both assessment and prescribing skills.
  Results of the study show that pharmacy students had significantly more appropriate prescriptions and fewer inappropriate prescriptions than the medical students. The majority of students from both faculties rated themselves as confident/very confident with prescribing. Pharmacy students were significantly more likely to include over 80% of the required legal elements of a prescription. This shows that there are differences between the two faculties with respect to prescribing and suggests that further investigation into prescribing competence is warranted to ensure the university is producing both confident and competent prescribers.
  In conclusion, this research has highlighted a gap in the literature regarding pharmacist confidence and competence with prescribing. Additional studies are needed to provide support for this expanded scope of pharmacy practice and to identify opportunities for improvement. Suggestions for educational initiatives have also been provided based on the findings.

• Subjects / Keywords

  • Prescribing
  • Competence
  • Medicine
  • Pharmacy
  • Confidence

• Graduation date

  Spring 2020

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-btgt-aa14

• License

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