Evolving prescribing responsibility: A constructivist grounded theory of pharmacist prescribing following independent...

Pharmacist independent prescribing has expanded internationally, yet authorization does not reliably translate into active prescribing practice. Although research has identified conditions shaping prescribing uptake, how actively prescribing pharmacists enact and develop prescribing responsibility following independent prescribing authorization has not been theorized.

The objective of this study was to generate a grounded theory explaining how actively prescribing pharmacists enacted prescribing following independent prescribing authorization during the early implementation of pharmacist prescribing in Alberta, Canada.

Charmaz's constructivist grounded theory approach was used. Twenty pharmacists holding Additional Prescribing Authorization (APA), which permits independent prescribing without a fixed drug list, participated in semi-structured interviews in 2014, representing community pharmacy, hospital, primary care, and specialty clinic settings. Purposive and theoretical sampling guided recruitment. Data collection and analysis proceeded concurrently using constant comparative methods, initial and focused coding, and analytic memo writing until theoretical sufficiency was achieved.

The grounded theory of evolving prescribing responsibility comprised three interrelated categories: recognizing prescribing responsibility, limiting and expanding prescribing responsibility, and balancing collaboration and independence in prescribing practice. Participants described prescribing responsibility as developing through prescribing enactment, documentation, negotiation of prescribing boundaries, and collaborative relationships. Collaboration and independence functioned as mutually reinforcing rather than opposing processes.

The theory conceptualizes prescribing responsibility as developing through practice rather than being fully realized at authorization. It provides an empirically grounded, process-level explanation of how pharmacists enact prescribing following authorization, with potential relevance for jurisdictions implementing or expanding independent pharmacist prescribing.