Evaluation of Physiotherapist and Podiatrist Independent Prescribing, Mixing of Medicines and Prescribing of Controlled Drugs

This Department of Health funded study is the first to evaluate the effectiveness and efficiency physiotherapist and podiatrist independent prescribing (IP) in England. We found: found that: Patients and healthcare professionals were generally positive about physiotherapist and podiatrist independent prescribing. A majority of patients agreed that physiotherapists and podiatrists should be able to prescribe medicine, although a minority of patients would prefer a doctor to prescribe their medicine. Physiotherapist and podiatrist independent prescribers were more active than non-prescribers in most aspects of medicines management, including providing medicine and giving advice or information to patients about medicine. Among physiotherapists, the predominant activity was pain/movement control. Among podiatrists, the predominant medications used were antibiotics, antifungal/microbial topical creams, emollients and pain medication. Perceived benefits included: reduced patient journey, fewer GP appointments, streamlining service, enabling services to continue when a doctor was not available, increased choice and enhanced quality of advice and information given. Benefits for physiotherapist and podiatrist independent prescribers included: improved knowledge around medicine management and safety, enhanced professional reputation, facilitation of advanced practice roles, and improved clarity over legality of medicines management activity practice. Barriers to independent prescribing included: finding a suitable Designated Medical Practitioner, access to a prescribing budget and patient medical records, clinical governance support for monitoring and auditing prescribing practice.  Patients of physiotherapist and podiatrist independent prescribers received more information about how often to take medicines and more often intended to follow the advice of the physiotherapist and podiatrist independent prescribers than patients of non-prescribers. Additional benefits differed between the professions. Patients of physiotherapist independent prescribers received more information about their medicines, were more satisfied, able to understand and inclined to take their medicine than patients of physiotherapist non-prescribers. Patients of podiatrist independent prescribers were more satisfied with aspects of access to services than those of non-prescribing podiatrists. Health related quality of life, as measured by the EQ-5D-L, improved equally for patients in both independent prescriber and non-prescriber groups between baseline and two-month follow-up. Care delivery by physiotherapist and podiatrist independent prescribers was more resource intensive and costly than physiotherapist and podiatrist non-prescribers due to longer consultation duration and more frequent medicines management activities, however there are many limitations to the economic analysis so findings should be treated with caution.