title: How have pharmacists in different practice settings integrated prescribing privileges into practice in Alberta? A qualitative exploration.
abstract: OBJECTIVE
  Since 2007, pharmacists in Alberta have had authority to adapt existing prescriptions and independently prescribe medications after a peer review process. This study aimed to explore and characterize how pharmacists incorporated prescribing into practice 3 years after this legislation was approved.
  
  
  METHODS
  We invited pharmacists to participate in semi-structured telephone interviews to discuss their prescribing practices. Pharmacists working in community, primary care network, hospital or other settings were selected using a mix of purposive and random sampling. Two investigators independently analysed each transcript using an Interpretive Description approach and thematically categorized prescribing practices according to the level of adoption.
  
  
  CONCLUSIONS
  Thirty-eight pharmacists (n = 13 independent prescribers) participated. Eighteen (47%) had a primary practice site from community practice, eight (21%) primary care, five (13%) hospital practice and seven (18%) from other settings including specialty clinics and long-term care. Twenty-eight participants were categorized as adopters and ten as non-adopters in their primary practice setting. Prescribing practices adopted were characterized as product focused, disease focused or patient focused. Sixteen (42%) described product-focused prescribing where they continued an existing therapy or substituted medications based on formulary guidelines. Seven (18%) described disease-focused prescribing where current therapies were adapted or initiated based on a protocol in a specific therapeutic area. Five (13%) described patient-focused prescribing where they initiated therapy based on patient needs and values, their assessment of the patient and best evidence. Non-adopters were not prescribing, but many described provision of disease or patient-focused care where they influenced prescribing by interacting with other members of the healthcare team. Most commonly, community pharmacists participated in product-focused prescribing, whereas hospital and primary care pharmacists practised disease-focused prescribing.
  
  
  CONCLUSIONS
  Our data suggest that there have been context-related differences in uptake across practice settings. Despite this, pharmacists in all studied settings engaged in prescribing activities using three approaches and many pharmacists who were not directly prescribing medications reported having involvement in drug therapy decision-making.
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.
authors.forename: L M
authors.initials: LM
authors.lastname: Guirguis
authors.forename: M J
authors.initials: MJ
authors.lastname: Makowsky
authors.forename: C A
authors.initials: CA
authors.lastname: Hughes
authors.forename: C A
authors.initials: CA
authors.lastname: Sadowski
authors.forename: T J
authors.initials: TJ
authors.lastname: Schindel
authors.forename: N
authors.initials: N
authors.lastname: Yuksel
mesh_terms: D000416:Alberta; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007885:Legislation, Pharmacy; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D010593:Pharmaceutical Services / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D010595:Pharmacists / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D055553:Prescription Drugs / Q000008:administration & dosage*; D011364:Professional Practice / Q000458:organization & administration; D024382:Professional Role
chemical_list: D055553:Prescription Drugs
keywords: pharmacists; prescribing; scope of practice