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. 2018 Jan 15;19(1):17.
doi: 10.1186/s12875-017-0705-2.

Identifying enablers and barriers to individually tailored prescribing: a survey of healthcare professionals in the UK

Joanne Reeve  1 , Nicky Britten  2 , Richard Byng  3 , Jo Fleming  4 , Janet Heaton  5 , Janet Krska  6
Affiliations

Identifying enablers and barriers to individually tailored prescribing: a survey of healthcare professionals in the UK

Joanne Reeve et al. BMC Fam Pract. .

Abstract

Background: Many people now take multiple medications on a long-term basis to manage health conditions. Optimising the benefit of such polypharmacy requires tailoring of medicines use to the needs and circumstances of individuals. However, professionals report barriers to achieving this in practice. In this study, we examined health professionals' perceptions of enablers and barriers to delivering individually tailored prescribing.

Methods: Normalisation Process Theory (NPT) informed an on-line survey of health professionals' views of enablers and barriers to implementation of Individually Tailored Prescribing (ITP) of medicines. Links to the survey were sent out through known professional networks using a convenience/snowball sampling approach. Survey questions sought to identify perceptions of supports/barriers for ITP within the four domains of work described by NPT: sense making, engagement, action and monitoring. Analysis followed the framework approach developed in our previous work.

Results: Four hundred and nineteen responses were included in the final analysis (67.3% female, 32.7% male; 52.7% nurse prescribers, 19.8% pharmacists and 21.8% GPs). Almost half (44.9%) were experienced practitioners (16+ years in practice); around one third reported already routinely offering ITP to their patients. GPs were the group least likely to recognise this as consistent usual practice. Findings revealed general support for the principles of ITP but significant variation and inconsistency in understanding and implementation in practice. Our findings reveal four key implications for practice: the need to raise understanding of ITP as a legitimate part of professional practice; to prioritise the work of ITP within the range of individual professional activity; to improve the consistency of training and support for interpretive practice; and to review the impact of formal and informal monitoring processes on practice.

Conclusion: The findings will inform the ongoing development of our new complex intervention (PRIME Prescribing) to support the individual tailoring of medicines needed to address problematic polypharmacy.

Keywords: Individually tailored care; Medicines optimisation; Polypharmacy.

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Conflict of interest statement

Ethics approval and consent to participate

Our study was performed in accordance with the principles described in the Declaration of Helsinki. Ethical approval for our study was granted by Warwick Medical School BSREC REGO-2016-1749). The survey instrument (Additional file 1) informed potential participants that completion was voluntary, responses were anonymous and people could leave the survey at any point without their data being saved. Continued participation constituted consent to use anonymised data in the further development of this work.

Consent for publication

Individual consent for publication is not required as no personally identifiable information was collected. The invitation to complete the study informed participants that analysis of their anonymised data would be written up in an academic journal. Continued participation in the survey was taken as implied consent as agreed within our Ethics approval.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

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