Medicines prescribed by independent non-medical prescribers in primary care in Wales: a 10-year longitudinal study from April 2011 to March 2021


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BMJ open. 2022 Feb 24;12(2):e059204. doi: 10.1136/bmjopen-2021-059204.


OBJECTIVES: The therapeutic classes of medicines prescribed by non-medical independent prescribers (NMIPs) working in primary care in Wales have not been studied in detail. The aim of this study was to conduct a 10-year longitudinal analysis of NMIP prescribing in Wales from April 2011 to March 2021. The study looked at the chapters of the British National Formulary (BNF) from which medicines were prescribed by the NMIPs, whether this changed over time, and whether there were variations in prescribing between geographical regions of Wales.

DESIGN: Retrospective secondary data analysis of primary care prescribing data. Monthly prescribing data for the National Health Service’s 10 fiscal years (April through March) from April 2011 through March 2021 was obtained from the Prescribing Audit Benchmarking System software. The data was analyzed according to the BNF chapter, in order to identify in which therapeutic areas the NMIPs were prescribing, and if this changed during the study period.

RESULTS: The number of items prescribed by NMIPs increased over the study period. From April 2011 to March 2021, prescriptions in seven chapters of the BNF accounted for approximately 80% of the total articles, with drugs for the cardiovascular system being the most prescribed. During the 2011-2012 fiscal year, the BNF chapters with the highest proportion of articles prescribed were infection (18%) and the respiratory system (13%), while in 2020-2021 those – these had passed to the cardiovascular (23%) and the nervous system (19%). The number of items prescribed in each health board in Wales varied, however, the BNF chapters contributing the highest percentages of items to the health board totals were broadly comparable.

CONCLUSIONS: The BNF chapter with the most prescribed items shifted from infection to cardiovascular over the study period, suggesting an increase in chronic disease management by NMIPs. The impact of this on primary care service delivery and patient outcomes is a focus for future work.

PMID:35210350 | DO I:10.1136/bmjopen-2021-059204


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