Objective: To determine the readiness of registered nurses (RNs) who provide care for patients with diabetes in a primary care setting for RN prescribing. Setting: Canadian provinces and territories. Participants: Canadian RNs working in primary care settings who provide care to patients with diabetes. Methods: A cross-sectional survey design was used to examine the readiness of RNs by measuring the attributes of readiness (value, confidence and willingness). The survey included questions on the demographic profile of participants including their age, education level and whether or not they had obtained additional certifications. This data was used to describe the sample and to determine whether there were differences between RNs who were ready to prescribe and RNs who were not ready to prescribe. Results: Almost 75% of the respondents were "ready" for RN prescribing. There were high positive correlations between "value" and "confidence", "value" and "willingness", and "confidence" and "willingness". There were no statistically significant differences in age, level of education and certifications for respondents who were ready to prescribe compared to those who were not ready to prescribe. Conclusions: The results of the present study indicate that RNs who provide care for patients with diabetes in a primary care setting are ready for prescribing. This practice has the potential to make more effective use of health human resources, allowing RNs to work to their full potential and increase accessibility to care for patients with diabetes.

Objective: To determine the readiness of registered nurses (RNs) who provide care for patients with diabetes in a primary care setting for RN prescribing. Setting: Canadian provinces and territories. Participants: Canadian RNs working in primary care settings who provide care to patients with diabetes. Methods: A cross-sectional survey design was used to examine the readiness of RNs by measuring the attributes of readiness (value, confidence and willingness). The survey included questions on the demographic profile of participants including their age, education level and whether or not they had obtained additional certifications. This data was used to describe the sample and to determine whether there were differences between RNs who were ready to prescribe and RNs who were not ready to prescribe. Results: Almost 75% of the respondents were "ready" for RN prescribing. There were high positive correlations between "value" and "confidence", "value" and "willingness", and "confidence" and "willingness". There were no statistically significant differences in age, level of education and certifications for respondents who were ready to prescribe compared to those who were not ready to prescribe. Conclusions: The results of the present study indicate that RNs who provide care for patients with diabetes in a primary care setting are ready for prescribing. This practice has the potential to make more effective use of health human resources, allowing RNs to work to their full potential and increase accessibility to care for patients with diabetes.

Objective: To determine the readiness of registered nurses (RNs) who provide care for patients with diabetes in a primary care setting for RN prescribing. Setting: Canadian provinces and territories. Participants: Canadian RNs working in primary care settings who provide care to patients with diabetes. Methods: A cross-sectional survey design was used to examine the readiness of RNs by measuring the attributes of readiness (value, confidence and willingness). The survey included questions on the demographic profile of participants including their age, education level and whether or not they had obtained additional certifications. This data was used to describe the sample and to determine whether there were differences between RNs who were ready to prescribe and RNs who were not ready to prescribe. Results: Almost 75% of the respondents were "ready" for RN prescribing. There were high positive correlations between "value" and "confidence", "value" and "willingness", and "confidence" and "willingness". There were no statistically significant differences in age, level of education and certifications for respondents who were ready to prescribe compared to those who were not ready to prescribe. Conclusions: The results of the present study indicate that RNs who provide care for patients with diabetes in a primary care setting are ready for prescribing. This practice has the potential to make more effective use of health human resources, allowing RNs to work to their full potential and increase accessibility to care for patients with diabetes.

Yes / Background Recently, primary care in the United Kingdom has undergone substantial changes in skill mix. Non-medical prescribing was introduced to improve patient access to medicines, make better use of different health practitioners’ skills and increase patient choice. There is little evidence about value-based patient preferences for ‘prescribing nurse’ in a general practice setting. Objective To quantify value-based patient preferences for the profession of prescriber and other factors that influence choice of consultation for managing a minor illness. Design Discrete choice experiment patient survey. Setting and participants Five general practices in England with non-medical prescribing services, questionnaires completed by 451 patients. Main outcome measure Stated choice of consultation. Main results There was a strong general preference for consulting ‘own doctor’ for minor illness. However, a consultation with a nurse prescriber with positive patient-focused attributes can be more acceptable to patients than a consultation provided by a doctor. Attributes ‘professional’s attention to patients’ views’ and extent of ‘help offered’ were pivotal. Past experience influenced preference. Discussion and conclusion Respondents demonstrated valid preferences. Preferences for consulting a doctor remained strong, but many were happy to consult with a nurse if other aspects of the consultation were improved. Findings show who to consult is not the only valued factor in choice of consultation for minor illness. The ‘prescribing nurse’ role has potential to offer consultation styles that patients value. Within the study’s limitations, these findings can inform delivery of primary care to enhance patient experience and substitute appropriate nurse prescribing consultations for medical prescribing consultations. / Department of Health, Project 016/0108. NIHR, CDF/01/2008/009.

Independent and supplementary prescribing are the two main forms of non-medical prescribing (NMP) that have been practised in the UK since 2006. Most available studies have qualitatively investigated the impact of NMP, especially in primary care. This may be due to the fact that prescriptions are issued mainly by general practitioners in primary care. This PhD thesis aimed at investigating the clinical effectiveness of independent pharmacist and diabetes specialist nurse (DSN) prescribers in the management of patients with type 2 diabetes at outpatient clinics in hospitals. A literature review was firstly conducted to explore the current research on NMP around the world and the UK. A systematic review of the previously published randomised control trials (RCT) and non-RCT studies that focused on prescribing interventions of nurses and pharmacist was also conducted to explore the impact of their prescribing interventions in treating type 2 diabetes using HbA1c level as the primary outcome. A programme of work of three retrospective comparative database analytical studies was then carried out to investigate the impact of independent NMPs in type 2 diabetes care. This programme of work used electronic medical records of patients attending outpatient clinics of diabetes centres in two teaching hospitals in Manchester; one employed an independent pharmacist and the other employed DSN prescribers. A group of subjects seen by an NMP in place of a doctor during the study period were the study group and the control group were those who seen only by doctors. The primary outcome was the average yearly change of HbA1c amongst the two groups. Secondary outcomes were yearly change of total cholesterol, blood pressure and serum creatinine as well as body mass index. Five statistical models, which included multivariable regression, propensity score matching and sensitivity analyses, were utilised to control for confounding effects, and the nature of selection bias in the retrospectively comparative effectiveness research using secondary database resources. A total of 330 patients seen by a team including a pharmacist versus 975 by doctors only between January 2006 and January 2013 at one site; and 656 by a team including DSNs versus 3,746 patients seen by doctors only between January 2007 to December 2013 at the other. The studies found both prescribing pharmacists and DSNs are capable of achieving at least non-inferior improvements in diabetes outcome compared to doctors. The pharmacist achieved a mean 0.01% reduction in HbA1c level versus doctors who achieved slight increase (p<0.4). DSNs also achieved a mean 0.07% reduction compared to doctors. However, after adjustment with multivariate and propensity score as well as with propensity score matching, there were no significant differences between the two groups. These findings were consistent with the findings in the systemic review. Although an RCT is the only method that by definition would produce unbiased treatment effects, the use of propensity score methods here, have reduced the potential for bias that may remain unaccounted for in multivariate models without propensity scores. Adjusting for propensity scores using two different methods also gives more confidence that the results are as unbiased as possible. Nonetheless, caution in generalising the results is necessary because of the retrospective nature of the studies and deficiencies in the database used.

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