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

Background: The COVID-19 pandemic alongside increased patient demand, enablement of scope, and government funding has accelerated the need and demand for pharmacist prescribing in Nova Scotia.

Methods: A sequential explanatory mixed-methods study was undertaken to understand barriers and facilitators to pharmacist prescribing in Nova Scotia, Canada. This consisted of: 1) a cross-sectional survey and 2) semistructured, qualitative interviews with pharmacists practising in the community. The survey and interviews were designed using the Behaviour Change Wheel that encompasses the Capability Opportunity Motivation Model of Behaviour Change (COM-B) and Theoretical Domains Framework version 2 (TDFv2).

Results: Of 190 survey respondents, the percentage who prescribed 15+ times/month increased from 49% before to 80% during the COVID-19 pandemic (P<0.001). Pharmacists identified knowledge, social norms/pressures, and rewards or consequences related to how and when to prescribe as facilitators (Knowledge, Social Influences, and Motivation TDFv2 domains, respectively). Barriers included the environmental context and fear of negative outcomes (Environmental Context and Resources and Beliefs about Consequences, respectively). Through the interviews, the presence of prescribing decision tools (Memory, Attention and Decision Processes) and a supportive organizational culture (Environmental Context and Resources) were facilitators. Worry was expressed about making mistakes (Beliefs about Consequences) and feeling significant pressure to meet patient demand (Social Influences) in a busy setting (Environmental Context and Resources).

Discussion: Supports to better enable pharmacist prescribing are described, with key messages for pharmacists, pharmacy owners/managers, educators, advocacy bodies, regulators, and government identified.

Conclusion: Pharmacist prescribing has increased significantly over a short period of time. Environmental supports (e.g., time, space, access to patient records), government funding, peer support, and public awareness are needed to optimize and fully implement these practice changes.