title: Medication decision making and patient outcomes in GP, nurse and pharmacist prescriber consultations.
abstract: Aim The aims of this study were twofold: (a) to explore whether specific components of shared decision making were present in consultations involving nurse prescribers (NPs), pharmacist prescribers (PPs) and general practitioners (GPs) and (b) to relate these to self-reported patient outcomes including satisfaction, adherence and patient perceptions of practitioner empathy.
  
  
  BACKGROUND
  There are a range of ways for defining and measuring the process of concordance, or shared decision making as it relates to decisions about medicines. As a result, demonstrating a convincing link between shared decision making and patient benefit is challenging. In the United Kingdom, nurses and pharmacists can now take on a prescribing role, engaging in shared decision making. Given the different professional backgrounds of GPs, NPs and PPs, this study sought to explore the process of shared decision making across these three prescriber groups.
  
  
  METHODS
  Analysis of audio-recordings of consultations in primary care in South England between patients and GPs, NPs and PPs. Analysis of patient questionnaires completed post consultation. Findings A total of 532 consultations were audio-recorded with 20 GPs, 19 NPs and 12 PPs. Prescribing decisions occurred in 421 (79%). Patients were given treatment options in 21% (102/482) of decisions, the prescriber elicited the patient's treatment preference in 18% (88/482) and the patient expressed a treatment preference in 24% (118/482) of decisions. PPs were more likely to ask for the patient's preference about their treatment regimen (χ 2=6.6, P=0.036, Cramer's V=0.12) than either NPs or GPs. Of the 275 patient questionnaires, 192(70%) could be matched with a prescribing decision. NP patients had higher satisfaction levels than patients of GPs or PPs. More time describing treatment options was associated with increased satisfaction, adherence and greater perceived practitioner empathy. While defining, measuring and enabling the process of shared decision making remains challenging, it may have patient benefit.
authors.affiliation: 1Professor,Department of Pharmacy & Pharmacology,University of Bath,Bath,UK.
authors.forename: Marjorie C
authors.initials: MC
authors.lastname: Weiss
authors.affiliation: 2Research Officer,Department of Pharmacy & Pharmacology,University of Bath,Bath,UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Platt
authors.affiliation: 3Research Officer,Centre for Academic Primary Care,School of Social and Community Based Medicine,University of Bristol,Bristol,UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Riley
authors.affiliation: 4Professor,School of Pharmacy,University of Wisconsin,Madison,WIUSA.
authors.forename: Betty
authors.initials: B
authors.lastname: Chewning
authors.affiliation: 5Senior Lecturer (Senior Medical Statistician),Department for Health,University of Bath,Bath,UK.
authors.forename: Gordon
authors.initials: G
authors.lastname: Taylor
authors.affiliation: 6Senior Lecturer Primary Care, Faculty of Health and Life Sciences,University of the West of England,Bristol,UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Horrocks
authors.affiliation: 7Director,Department of Pharmacy & Pharmacology,University of Bath,Bath,UK.
authors.forename: Andrea
authors.initials: A
authors.lastname: Taylor
mesh_terms: D000328:Adult; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data; D010358:Patient Participation / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010595:Pharmacists / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D006113:United Kingdom
keywords: consultation; doctor patient relations; general practitioners; health communication; nurse practitioners; pharmacists