A Prescribing Implementation Framework (PIF) for Non-Medical Prescribing: A Review of Systematic Reviews

Abstract

Background: Non-medical prescribing is increasingly used to support workforce shortages that challenge global access to healthcare. Limited theoretical guidance exists on how to successfully undertake its implementation. This systematic review of reviews was used to (i) identify determinants to implementation of non-medical prescribing and (ii) develop a framework of factors that influence successful non-medical prescribing implementation.

Methods: Inclusion criteria were reviews reporting barriers and facilitators to non-medical prescribing. Six electronic databases were searched January 2010- May 2024 with results recorded using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Informed by principles of meta ethnography, data from included reviews were extracted and synthesised following a structured approach. Themes were mapped to four stages of implementation: preparation; training; transition and sustainment. Consideration was given as to whether they operated at the micro, meso or macro level. An overarching determinant for each theme was identified and used to populate the ‘Prescribing Implementation Framework’.

Results: Nineteen reviews fulfilled the inclusion criteria,7 focussed on independent prescribing and 12 independent and or supplementary prescribing reporting that non-medical prescribing is largely acceptable to both service users and healthcare professionals. The Prescribing Implementation Framework comprises 13 determinants of effective implementation, 7 of which are located in the preparation phase. Thirty six out of 72 identified macro, meso or micro level factors were in the preparation phase, 11 training, 15 transition and 11 sustainment.

Conclusion: There is pressing need to advance understanding of non-medical prescribing implementation by developing theoretically informed guidance to support the planning, execution and sustainability of its implementation globally. Our resultant multi-professional, systems-wide conceptual Prescribing Implementation Framework (PIF) emphasises the dynamic nature of determinants, change over time, and importance of interdependence. The newly develop PIF can help guide organisations with preliminary capacity/needs assessment, identify potential ‘pinch points’ and assist in formative evaluations of non-medical prescribing processes and outcomes to help enhance implementation in this area.