Pharmacist prescribing in the Australian context: development and validation of competency standards and identification of pharmacists’ educational needs

Significant changes have been observed in the development of nonmedical prescribing globally, especially in the United Kingdom. Development of appropriate competency standards is important in ensuring pharmacists are well equipped to perform the task and in informing the development of educational programmes for pharmacist prescribing. The first aim of this study was to develop and validate a draft set of competency standards for pharmacist prescribing in the Australian context (“the standards”). Areas important in prescribing were identified from the UK Competency Framework and Competency Standards for Pharmacists in Australia documents. “The standards” were developed by identifying gaps in the Australian document with regards to competencies required for prescribing, as articulated in the UK document, and were formatted to be compatible with the Australian document. Expert panel discussions among pharmacists and medical practitioners were conducted to refine “the standards” and to identify barriers to implementation of pharmacist prescribing. “The standards” were validated by medical practitioners within Victoria who found all the areas listed in “the standards” to be important for prescribing. The second aim was to identify educational needs to inform the development of educational programmes for pharmacist prescribing in the Australian context. Pharmacists’ perceptions of their knowledge and clinical skills in the areas important for prescribing were ascertained and factors influencing their perceptions were identified. Pharmacists’ perceived that they possess the knowledge and clinical skills in most of the areas. Those with extra qualifications were more confident in their knowledge and clinical skills. Generally, pharmacists felt they needed further training in performing clinical assessment and using appropriate techniques and equipment. Case study vignettes were used to compare medical practitioners’ and pharmacists’ approaches to patient management. In general, pharmacists were found to be confident in history taking and patient management within their area of practice defined by the current legal limits. Pharmacists were more receptive to accepting cases with a confirmed diagnosis and would gather history related to the confirmed diagnosis. They were confident in managing acute simple cases and were capable of prescribing medications within their legal scope or according to protocol and of managing a confirmed case of stable chronic disease. This is the first study to identify and validate the required competencies for Australian pharmacists to perform the extended role of prescribing and to develop appropriate competency standards. This is also the first study to make direct comparisons of patient management approaches between pharmacists and medical practitioners, in addition to surveying pharmacists’ opinions. It is recommended that:  - “the standards” be used to inform policy development regarding nonmedical prescribing;  - educational programmes be developed based on the available overseas literature,findings from this research and further discussion with relevant stakeholders; and  - recognition of prior learning and acknowledgement of a recognised level of skills and experience should be considered prior to a pharmacist commencing an educational programme.