Valuing the extended role of prescribing pharmacist in general practice: results from a discrete choice experiment

To quantify patients' preferences for new pharmacist independent prescribing services in general practice for managing common existing long-term conditions compared with usual medical prescribing.

A discrete choice experiment cross-sectional survey was conducted in five general practices in England (October-November 2009). Four service attributes reported on the length of consultation and aspects of patient-professional interaction. A choice between three alternatives-novel pharmacist independent prescribing service ("prescribing pharmacist"), "own (family) doctor" service, and "available (family) doctor" service-was presented. Alternative regression models were compared according to their goodness of fit, and the preferred one was used to inform policy analysis.

A total of 451 patients completed questionnaires. Respondents preferred a "pharmacist" or "own doctor" compared with "available doctor," with a larger value given to own doctor. All attributes on patient-professional interaction were important in choosing how to manage diagnosed hypertension, while the "length of consultation" (P = 0.42) did not have any impact. The impact of introducing a pharmacist prescribing service into a general practice setting was estimated from these findings. Patients' preferences suggested that about 16% of consultations with a patient's own doctor can be switched to a prescribing pharmacist instead. Although there is a stronger preference for seeing own doctor, alternative combinations of attribute levels can be used to compensate and reconfigure a more preferred prescribing pharmacist service.

The pharmacist service is valued by patients as an alternative to doctor prescribing in primary care and therefore represents an acceptable form of service delivery when informing policy.