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    The prescribing needs of community practitioner nurse prescribers: a qualitative investigation using the theoretical domains framework and COM-B.

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    Authors
    Chater, Angel M.
    Williams, Jane
    Courtenay, Molly
    Affiliation
    University of Bedfordshire
    University College London
    Cardiff University
    Issue Date
    2019-08-18
    Subjects
    COM-B
    community practitioner nurse prescribers
    nurse prescribers’ formulary
    prescribing behaviour
    theoretical domains framework
    B790 Nursing not elsewhere classified
    
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    Abstract
    With several qualified community practitioner nurse prescribers (CPNPs) not prescribing, this research aimed to understand what influences this behaviour. A qualitative research design. Semi-structured interviews, based on the theoretical domains framework (TDF) were conducted with 20 CPNPs. Data collection took place between March-July 2018 and continued until data saturation was reached. Nine themes inductively explained prescribing behaviour: 1) 'Knowledge and experience'; 2) 'Consultation and communication skills'; 3) 'Professional confidence and identity'; 4) 'Wanting the best outcome'; 5) 'NHS versus patient cost'; 6) 'Emotion-led decisions'; 7) 'Time allocation'; 8) 'Formulary access' and 9) 'Supporting environment for patient-centred care'. Themes were then deductively mapped to the TDF and COM-B. There is an ongoing need to support community practitioner nurse prescribers' 'Capability' to prescribe in terms of knowledge and aquired skills; 'Opportunity' to make prescribing easier, such as access to a wider and up to date nurse formulary alongside effective clinical support; and 'Motivation' to feel confident in prescribing behaviour, highlighting positive patient outcomes while reducing perceived issues such as cost and non-adherence. Findings show that Capability, Opportunity and Motivation all influence the decision to prescribe. Those responsible for professional regulation and training should ensure community practitioner nurse prescribers have access to the relevant knowledge, skills and formulary to facilitate their prescribing behaviour. Professional confidence and identity as a prescriber should be encouraged, with acknowledgment of influences such as cost and emotion. An environment that allows for patient-centred care and the best outcome should be supported, this may mean increasing time allocated to consultations. AIM DESIGN METHODS RESULTS CONCLUSION IMPACT
    Citation
    Chater AM, Williams J, Courtenay M (2019) 'The prescribing needs of community practitioner nurse prescribers: a qualitative investigation using the theoretical domains framework and COM-B.', Journal of Advanced Nursing, 75 (11), pp.2952-2968.
    Publisher
    Wiley
    Journal
    Journal of Advanced Nursing
    URI
    http://hdl.handle.net/10547/623620
    DOI
    10.1111/jan.14170
    PubMed ID
    31423627
    Additional Links
    https://onlinelibrary.wiley.com/doi/full/10.1111/jan.14170
    Type
    Article
    Language
    en
    ISSN
    0309-2402
    EISSN
    1365-2648
    ae974a485f413a2113503eed53cd6c53
    10.1111/jan.14170
    Scopus Count
    Collections
    Health

    entitlement

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      Examining influences on antibiotic prescribing by nurse and pharmacist prescribers: a qualitative study using the Theoretical Domains Framework and COM-B.

      Courtenay, Molly; Rowbotham, Samantha; Lim, Rosemary; Peters, Sarah; Yates, Kathryn; Chater, Angel M.; Cardiff University; University of Sydney; Reading University; University of Manchester; et al. (BMJ, 2019-06-19)
      Respiratory tract infections are frequently managed by nurse and pharmacist prescribers, and these prescribers are responsible for 8% of all primary care antibiotic prescriptions. Few studies have explored antibiotic prescribing among these prescribers, and interventions to target their antibiotic prescribing behaviour do not exist. Research objectives were to: (1) use the Theoretical Domains Framework to identify the factors that influence nurse and pharmacist prescriber management of respiratory tract infections and (2) identify the behaviour change techniques (BCTs) that can be used as the basis for the development of a theoretically informed intervention to support appropriate prescribing behaviour. Qualitative design comprising semistructured interviews, using the Theoretical Domains Framework and Capability, Opportunity and Motivation for Behaviour. Primary care. Twenty one prescribers (4 pharmacists and 17 nurses). A range of factors across 12 domains of the TDF were found to influence prescriber behaviour, and 40 BCTs were identified as supporting appropriate prescribing. For example, patient expectations (social influence) was identified as a factor influencing prescribing decisions, and a number of BCTs (problem solving, goal setting and information about health consequences) were identified as supporting prescribers in managing these expectations. With increasing numbers of nurse and pharmacist prescribers managing infections in primary care, these findings will inform theoretically grounded interventions to support appropriate prescribing behaviour by these groups.
    • Thumbnail

      A theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers: an acceptability and feasibility experimental study using mixed methods

      Lim, Rosemary; Courtenay, Molly; Deslandes, Rhian; Farriday, Rebecca; Gillespie, David; Hodson, Karen; Reid, Nicholas; Thomas, Neil; Chater, Angel M.; ; et al. (BMJ, 2019-08-18)
      Introduction: Nurse and pharmacist independent prescribers manage patients with respiratory tract infections and are responsible for around 8% of all primary care antibiotic prescriptions. A range of factors influence the prescribing behaviour of these professionals, however, there are no interventions available specifically to support appropriate antibiotic prescribing behaviour by these groups. The aims of this paper are to describe (1) the development of an intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers and (2) an acceptability and feasibility study designed to test its implementation with these prescribers. METHOD AND ANALYSIS: Development of intervention: a three-stage, eight-step method was used to identify relevant determinants of behaviour change and intervention components based on the Behaviour Change Wheel. The intervention is an online resource comprising underpinning knowledge and an interactive animation with a variety of open and closed questions to assess understanding. Acceptability and feasibility of intervention: nurse and pharmacist prescribers (n=12-15) will use the intervention. Evaluation includes semi-structured interviews to capture information about how the user reacts to the design, delivery and content of the intervention and influences on understanding and engagement, and a pre-post survey to assess participants' perceptions of the impact of the intervention on knowledge, confidence and usefulness in terms of application to practice. Taking an initial inductive approach, data from interview transcripts will be coded and then analysed to derive themes. These themes will then be deductively mapped to the Capability, Opportunity, Motivation-Behaviour model. Descriptive statistics will be used to analyse the survey data, and trends identified.
    • Thumbnail

      Influences on antibiotic prescribing by non-medical prescribers for respiratory tract infections: a systematic review using the theoretical domains framework

      Chater, Angel M.; Family, Hannah; Lim, Rosemary; Courtenay, Molly; University of Bedfordshire; University of Bristol; University of Reading; Cardiff University (Oxford University Press, 2020-08-07)
      Background The need to conserve antibiotic efficacy, through the management of respiratory tract infections (RTIs) without recourse to antibiotics, is a global priority. A key target for interventions is the antibiotic prescribing behaviour of healthcare professionals including non-medical prescribers (NMPs: nurses, pharmacists, paramedics, physiotherapists) who manage these infections. Objectives To identify what evidence exists regarding the influences on NMPs’ antimicrobial prescribing behaviour and analyse the operationalization of the identified drivers of behaviour using the Theoretical Domains Framework (TDF). Methods The search strategy was applied across six electronic bibliographic databases (eligibility criteria included: original studies; written in English and published before July 2019; non-medical prescribers as participants; and looked at influences on prescribing patterns of antibiotics for RTIs). Study characteristics, influences on appropriate antibiotic prescribing and intervention content to enhance appropriate antibiotic prescribing were independently extracted and mapped to the TDF. Results The search retrieved 490 original articles. Eight papers met the review criteria. Key issues centred around strategies for managing challenges experienced during consultations, managing patient concerns, peer support and wider public awareness of antimicrobial resistance. The two most common TDF domains highlighted as influences on prescribing behaviour, represented in all studies, were social influences and beliefs about consequences. Conclusions The core domains highlighted as influential to appropriate antibiotic prescribing should be considered when developing future interventions. Focus should be given to overcoming social influences (patients, other clinicians) and reassurance in relation to beliefs about negative consequences (missing something that could lead to a negative outcome).
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