Enabling pharmacist prescribing: Lessons learned in Nova Scotia using behaviour change theory

Area of Science:

• Pharmacy Practice
• Health Services Research

Background:

• The COVID-19 pandemic accelerated the demand for pharmacist prescribing in Nova Scotia due to increased patient needs, expanded scope of practice, and government funding.
• This created an urgent need to understand the factors influencing this practice shift.

Purpose of the Study:

• To investigate the barriers and facilitators impacting pharmacist prescribing in Nova Scotia.
• To inform strategies for optimizing and fully implementing pharmacist prescribing.

Main Methods:

• A sequential explanatory mixed-methods study was conducted.
• Utilized a cross-sectional survey and semi-structured qualitative interviews with community pharmacists.
• Employed the Behaviour Change Wheel, including the Capability Opportunity Motivation Model of Behaviour Change (COM-B) and Theoretical Domains Framework version 2 (TDFv2).

Main Results:

• Pharmacist prescribing frequency increased significantly, from 49% to 80% prescribing 15+ times/month during the pandemic.
• Facilitators included pharmacist knowledge, social influences, perceived rewards, prescribing decision tools, and supportive organizational culture.
• Barriers comprised environmental context, fear of negative outcomes, and pressure to meet patient demand in busy settings.

Conclusions:

• Pharmacist prescribing has seen substantial growth.
• Environmental supports, government funding, peer support, and public awareness are crucial for optimizing and implementing these practice changes effectively.