Effectiveness, safety, and cost-effectiveness of pharmacist prescribing
The HRB conducted a systematic review to synthesise evidence on the effectiveness, safety, and cost-effectiveness of pharmacist prescribing. This systematic review provides policy-makers in the Department of Health with evidence related to the safety, effectiveness, and cost-effectiveness of pharmacist prescribing compared with other prescribing healthcare professionals across primary, secondary, and tertiary healthcare settings.
This evidence review included 52 studies, of which 32 reported on effectiveness, 20 reported on safety, and 13 reported on cost-effectiveness outcomes.
The effectiveness and safety outcomes covered 15 healthcare population categories: diabetes; heart failure; stroke; dyslipidaemia; hypertension; coagulation disorders; chronic kidney disease; urinary tract infection; older people in long-term care; female contraceptive users; anaemia in pregnancy; chronic pain conditions; emergency department patients; surgery patients; people at risk of drug-related problems; and mixed health conditions.
In relation to safety and effectiveness, most evidence indicated significant improvement, or no significant difference, in pharmacist prescribing compared with other prescribing groups including medical doctors. The majority of effectiveness and safety outcomes were graded as very low certainty.
The cost-effectiveness studies covered 8 healthcare population categories: diabetes, hypertension, chronic kidney disease, urinary tract infection, common conditions, acute pharyngitis, female contraceptive users, and chronic pain conditions.
In relation to cost-effectiveness, most studies projected pharmacist prescribing models to be dominant (i.e. lower treatment cost, more effective), or cost-saving (i.e. lower treatment cost, equally effective), or had a better cost-benefit ratio when compared with alternative scenarios. Only one study on chronic pain reported that the general practice team was cost saving compared with the pharmacist prescribing model.
Based on the findings of this review, expanding the role of pharmacists in prescribing could be cost-effective while maintaining patient safety and treatment effectiveness outcomes. Continued research and policy development will contribute to determining the benefits of pharmacist prescribing and facilitating its effective integration into the Irish healthcare system. Future research in the Irish context – based on implementation, public and patient preferences, and cost-effectiveness – would provide valuable information for policy-makers.
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