Pharmacists’ current and potential prescribing roles in primary care in the Netherlands: a case study

Figures & data

Figure 1. Data collection and analysis methods to explore the pharmacists’ current roles and potential for prescribing and how the findings are presented in this article.

^aIncluding field notes of observations, informal interviews and collected documents

HCP, healthcare professional.

Table 1. Case and participant characteristics.

Pharmacist workplace	Case 1	Case 2	Case 3	Case 4	Case 5	Case 6	Total, no.
	General practice	General practice	General practice	Community pharmacy	Community pharmacy	Community pharmacy
Practice size, no. of patients	14.000	12.000	11.000	8000^b	9000^b	11.000^b
Urban environment^c	Urban, city	Urban, city	Sub-urban, city	Rural, village	Sub-urban, town	Sub-urban, city
Participatory observation, no.
Pharmacists	1	1	1	2	1	2	8
Observation days	2	3	2	4	2	2	15
Documents collected	11	1	0	1	1	5	19
Interview participants, no.
Patients	3	3	2	2	2	2	14
Pharmacists	1	1	1	3^d	1	3^d	10
Physicians/nurses^e	2	2	1	1^f	2^g	2	10
Total	6	6	4	6	5	7	34

^aThis pharmacy consisted of two locations, located in two neighboring villages.

^bNumber of patients at the co-located general practice(s).

^cAccording to (Centraal Bureau voor de Statistiek [Statistics Netherlands], 2023).

^dIncluding one pilot interview participant.

^eAll general practitioners, except for where indicated otherwise.

^fOne nurse practitioner.

^gOne elderly care physician and one general practitioner.

Figure 2. Concept map of the practice-based pharmacists’ current roles in prescribing, with the tasks, processes, and contacts in relation to the different interacting stakeholders and systems. The pharmacists’ most prominent role in prescribing was (1) making treatment changes during patient consultation, and then (2) writing prescriptions in the EHR system (3) for the GP to authorize. EHR, electronic health record; GP, general practitioner; PTAM, pharmacotherapy audit meeting.

Figure 3. Concept map of the community pharmacists’ current roles in prescribing, with the tasks, processes, and contacts in relation to the different interacting stakeholders and systems. The pharmacists’ main roles in prescribing seemed (1) making treatment change proposals during patient consultation (2) for which the GP often was consulted to make treatment decisions that were then (3) reported back to the patient, and (A) collaborative agreements with GPs that allow (B) pharmacists and patients to decide on starting or substituting medications in specific situations. In those situations, (C) the pharmacist writes a prescription (D) for the GP to authorize. ^aDelegated to pharmacy assistant in case of less complex or routine situations. EHR, electronic health record; GP, general practitioner; PTAM, pharmacotherapy audit meeting.

Table 2. Themes, sub-themes, and categories related to the patient and healthcare professional perspectives on pharmacist prescribing.

Theme 1: Perspectives on potential pharmacist prescribing
Sub-theme	Category
Scope of practice	Collaborative prescribing agreements: after diagnosis by physician
	Minor ailments or uncomplicated health conditions
	Repeat prescriptions
	Deprescribing
Possible settings and level of organisation^a
Potential benefits	Decreased physician workload
	Efficiency and accessibility of health care
	Quality of health care
	Pharmacists’ job satisfaction (not identified in patient interviews)
Potential risks	Fragmentation of health care or loss of control by GP
	Medication errors
	Pharmacists’ conflict of interest

Theme 2: Conditions for the introduction of pharmacist prescribing in future practice
Defining tasks and responsibilities of pharmacist prescribing^a
Support for and knowledge of (new) pharmacist role^a
Collaboration and trust^a
Pharmacist workforce capacity and workload^a
Pharmacists’ competencies	Knowledge and skills
	Professional attitude and engagement
	Prescribing-related education and training
Interoperability of systems and shared patient information^a
Legislation, regulations, and reimbursement^a
Solution for potential conflict of interest (not identified in patient interviews)

^aNo categories under this sub-theme.

Centraal Bureau voor de Statistiek [Statistics Netherlands]. (2023, June 30). Kerncijfers wijken en buurten 2022 [Key figus districts and neighborhoods 2022]. CBS. https://www.cbs.nl/nl-nl/maatwerk/2023/14/kerncijfers-wijken-en-buurten-2022

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