Assessing the contribution of prescribing in primary care by nurses and professionals allied to medicine: a systematic review of literature
BMC Health Services Research
Assessing the contribution of prescribing in primary care by nurses and professionals allied to medicine: a systematic review of literature
Sadiq Bhanbhro 0 1
Vari M Drennan 0 1
Robert Grant 0 1
Ruth Harris 0 1
0 Faculty of Health & Social Care Sciences, St. George's University of London & Kingston University , Grosvenor Wing, Cranmer Terrace, London, SW17 ORE , UK
1 Bissell P , Cooper, R., Guillaume, L., Anderson, C., Avery, A., Hutchinson, A., James, V., Lymn, J., Marsden, E., Murphy, E., Ratcliffe, J., Ward, P., and Woolsey , I: An Evaluation of Supplementary Prescribing in Nursing and Pharmacy. London: Department of Health 2008 
Background: Safe and timely access to effective and appropriate medication through primary care settings is a major concern for all countries addressing both acute and chronic disease burdens. Legislation for nurses and other professionals allied to medicine to prescribe exists in a minority of countries, with more considering introducing legislation. Although there is variation in the range of medicines permitted to be prescribed, questions remain as to the contribution prescribing by nurses and professionals allied to medicine makes to the care of patients in primary care and what is the evidence on which clinicians, commissioners of services and policy makers can consider this innovation. Methods: A integrative review of literature on non-medical prescribing in primary care was undertaken guided by dimensions of health care quality: effectiveness, acceptability, efficiency and access. Results: 19 papers of 17 empirical studies were identified which provided evidence of patient outcome of non medical prescribing in primary care settings. The majority were undertaken in the UK with only one each from the USA, Canada, Botswana and Zimbabwe. Only two studies investigated clinical outcomes of non-medical prescribing. Seven papers reported on qualitative designs and four of these had fewer than ten participants. Most studies reported that non medical prescribing was widely accepted and viewed positively by patients and professionals. Conclusions: Primary health care is the setting where timely access to safe and appropriate medicines is most critical for the well-being of any population. The gradual growth over time of legislative authority and in the numbers of non-medical prescribers, particularly nurses, in some countries suggests that the acceptability of nonmedical prescribing is based on the perceived value to the health care system as a whole. Our review suggests that there are substantial gaps in the knowledge base to help evidence based policy making in this arena. We suggest that future studies of non-medical prescribing in primary care focus on the broad range of patient and health service outcomes and include economic dimensions.
Safe and timely access to effective and appropriate
medication through primary care settings is a major concern
for all countries addressing both acute and chronic
disease burdens [
]. From the nineteenth century onwards,
governments have responded to concerns for public
protection and concerns about drug misuse through
medicine regulation legislation. By the twentieth
century, legislation started to incorporate prescriptive
authority restricted to a small number of occupational
groups such as doctors, dentists and vets for certain
classes of drugs [
]. Medicine regulation has developed
at different rates in high and low income countries, as
has the mechanisms to enforce them. The development
in the later part of the twentieth century of a more
effective range of medicines has seen a different set of
public health preoccupations which range from the
prevention of antibiotic resistance, to issues both of how to
fund and contain medicine costs in health care systems
and at the same time ensure equity of access for citizens
to basic health care and essential medicines [
country places different emphasis on these issues but in
many it has led to consideration of the use of other
health professional groups in addition to doctors to
prescribe regulated classes of medicines or medicines
provided through a state sponsored or funded health care
Non-medical prescribing (NMP) is one term that is
used to describe the extension of prescriptive authority
to professional groups other than the medical profession
such as nurses, midwives and allied health professions.
Data is not easily available on the extent of NMP for all
194 member states of the World Health Organisation.
We have identified, through internet searches, the
literature search described below and personal
communications, 22 countries which have legislation giving
prescriptive authority to nurses (see Table 1[
Some other countries, for example Spain, the
Netherlands, Finland, Jamaica and Hong Kong have initiated
efforts to introduce legalisation on NMP [
]. There is
great variety in the prescribing legislation of different
countries. Some countries legislate for the initial
qualification and registration of the nurse as sufficient to
undertake prescribing certain classes of medicines and
in certain situations, for example Kenya, while others
require further qualifications, for example Namibia.
Within a country there can also be variations between
the extent of classes of medicines nurses can prescribe
either as a result of different state legislation, for
example the United States of America (USA) or different
levels of prescribing qualifications, for example in the
United Kingdom (UK). In the UK ‘independent
prescribing’ qualifications allows almost all medicines to be
prescribed within the individual’s clinical competence and
‘community practitioner prescribing’ qualification gives
only authority over a small limited nurses formulary. In
addition, many countries have mechanisms whereby
individual nurses (or other professionals) have authority,
agreed by their employer and/or doctor responsible for
a service, to prescribe and dispense or administer a
specified list of medicines to a pre-defined group of
patients in specific circumstances and within specified
parameters. Common international examples of this are
within public health immunisation programmes [
These are known by a variety of names such as standing
orders. In the UK these are known as patient group
] and are used widely across the spectrum
of health services [
In the last fifty years different models of primary care
have developed in countries, influenced by health care
funding, government policies and the aspirations of
family medicine and general practice [
]. The extent to
which groups of professionals such as nurses and
pharmacists are present in the primary care system of each
United States of America Nurse Prescribing (NP) introduced in 1969. Fifty States allow some form of NMP. However, there is no uniformity in law,
(USA) language and regulations among States*.
In addition we are aware that NPM legislation exists in Cameroon, Zimbabwe, Rwanda, Swaziland, Malawi, Tanzania, Zambia, Ghana, Lesotho and
Ethiopia****, but were unable to identify the specific legislative documents.
*International Council of Nursing 2009 [
] ** Department of Health *** Personal communication **** Internet search
country is dependent on both history and these current
policy imperatives. This varies between countries even
neighbouring in the same continent, for example, the
UK has seen significant numbers of nurses employed in
general practice over the past thirty years [
], where as
there are small numbers of nurses employed in primary
care in France [
Extending prescribing authority in primary care is a
health care innovation driven by various factors in each
country. Addressing shortages of medical staff
particularly in remote and rural areas has been one driving
factor in North America, Africa and Australia [
African countries such as South Africa, Botswana,
Uganda and Zimbabwe, the aim has been to meet
community health care needs by improving access to
medicines . In Sweden, the UK and New Zealand; NMP
was commenced in order to improve the efficiency of
services for specific groups, such as elderly people or
those who receive nursing care in the community
]. In some countries, the aspirations of
professional groups have been significant in changes to the
legislation  but only when they have coincided with
other public health and health policy imperatives. In
summary, the key policy goals to date have been to
improve patient access in primary care settings to safe,
timely and effective medicines and increasing the
efficiency of health service delivery. However, NMP exists
in a minority of countries and the extent of prescriptive
authority is contentious in some [
]. A sociological
narrative review has explored these dimensions further
]. Other recent narrative reviews [
considered nurse prescribing in any setting without
acknowledging that prescribing in primary care is a very
different context from a hospital setting. In primary care
settings the prescriber may have little immediate access
to other professionals and may be seeing patients with
previously undiagnosed illnesses. Therefore the question
remains as to the contribution NMP makes to the care
of patients in primary care and what is the evidence on
which clinicians, commissioners of services and policy
makers can consider this innovation.
There is increasing interest in many health care
systems to evaluate interventions and innovations in terms
of the outcomes for patients, rather than just examine
structural and process elements. Donabedian defines the
outcome of care as “the effects of care on the health
status of patients and populations. Improvements in the
patient’s knowledge and salutary changes in the patient’s
behaviour are included under a broad definition of
health status, and so is the degree of the patient’s
satisfaction with care” [
], p. 1745. Donabedian
differentiates this from the structural elements i.e. the attributes
of the setting in which care occurs and the process
elements i.e. what is actually done in giving and receiving
]. This paper reports on an integrative review of
the empirical literature [
] which addressed the
question what is the effect of NMP in primary care and
community settings on patient outcomes?
A search strategy was devised to include published and
grey literature. The electronic data bases CINAHL,
MEDLINE, BNI, AMED, ISI Web of Knowledge and
Index to theses were searched. A search to retrieve grey
literature was also conducted of relevant websites:
Google scholar, the Royal College of Nursing, Royal
Pharmaceutical Society, NHS Modernisation Agency, King’s
Fund, National Institute of Clinical Excellence,
Department of Health, and National Prescribing Centre.
Searches also included follow up of reference lists and
key authors. Searching was conducted by SB according
to the inclusion and exclusion criteria, using terms of
The search terms employed were nurse prescribing,
non-medical prescribing, supplementary prescribing,
independent prescribing, pharmacist prescribing, allied
health professional prescribing, prescribing rights and
prescribing impact and outcomes. A combination of
these search terms was used. All items within each
terms section were combined with OR and then each
section was combined with AND for different
combinations of sections that produced the highest result. The
inclusion criteria and the exclusion criteria were as
Study contains empirical evidence of NMP from
any professional group with legislative authority
Study contains empirical evidence of outcomes
Setting: primary care and community
Search period: January 1970 - December 2010 for
the USA and October 1994 - December 2010 for the
UK and other countries. These timeframes reflect
the years when non-medical prescribing was
introduced in these countries.
Studies that did not meet inclusion criteria above
Commentaries, editorials, opinions, guidelines and
Papers that did not report the research design or
Abstracts were identified, screened by two researchers
and accepted or rejected based on the inclusion and
exclusion criteria. Full papers were obtained where the
abstract was unclear to enable an accurate decision. Full
papers were obtained for all included papers and data
on sample size, prescribing authority type, findings on
outcomes and process outcomes (as defined above) and
study limitations were extracted. Each study was
considered against the adapted quality checklists relevant to
the study design [
]. Regular meetings were held
between the researchers to discuss and agree
interpretations and to clarify any inconsistencies in the evidence.
Due to the heterogeneity of study methods,
participants and outcomes, an overall meta-analysis was not
appropriate. Instead data are presented narratively
through a synthesis framed by the dimensions of judging
health care suggested by Maxwell [
dimensions are of the effectiveness, acceptability, efficiency,
equity (fairness) and access to health care. The
definitions as described by Maxwell were used. Effectiveness
addresses questions of “whether the treatment or
intervention is the best available in the technical sense and
the overall result of the treatment” [
], p. 171.
Acceptability considers questions of patient’s perceptions.
Efficiency considers questions of “whether the output is
maximised for the given input or conversely whether
the input is minimised to achieve the stated output”
], p. 171. Finally, access considers the questions of
whether people receive treatment/service when they
need it [
The initial searches produced 1734 abstracts, of which
961 duplicate articles were removed. Titles and abstracts
were screened by SB and VMD. After reading titles and
abstracts 375 of the 773 papers were excluded. The
remaining 398 papers were classified into three
categories: empirical papers (n = 184), opinion papers (n =
209) and literature reviews (n = 5). The opinion papers
and reviews were excluded.
One hundred and three of the 184 empirical papers
were excluded as they did not relate to primary care
settings and 17 were excluded as they reported combined
primary and acute care data and it was not possible to
separate the data relating to primary care (see table 2
]). The full text of the remaining 64 papers were
read (SB, RG, RH and VMD) and categorised as to
whether they addressed questions of structure, process,
or outcomes of NMP in primary care. Those presenting
evidence only on the structure or process were excluded
(n = 41). In six of the twenty-three remaining papers
the research question and/or method were unclear or
omitted important information to enable the quality of
the paper to be assessed and were therefore excluded. A
total of 19 articles of 17 studies reporting on the
outcomes of NMP were included in the review (Figure 1).
Two studies used the same data for two publications.
Details of the papers are given in Additional File 1.
Most studies were conducted in the UK. The majority
investigated the contribution of nurses as a non-medical
prescriber with a small number investigating the more
recent development of pharmacists as non-medical
prescriber (Table 3). Of the 17 studies, seven used
qualitative methods only, eight quantitative methods and two
employed mixed methods designs. We now turn to
consider the evidence within the studies as grouped by
questions of effectiveness, efficiency, acceptability and
access. Issues of equity are considered within the section
Effectiveness addresses questions of whether the
treatment or intervention is the best available in the
technical sense and the overall result of the treatment [
Fifteen of the seventeen studies investigated some aspect
of the effectiveness of NMP in primary care. Of these 15
studies, thirteen investigated nurse prescribing and two
pharmacists prescribing. Six of these studies used
qualitative semi-structured and in-depth interviews [
seven used quantitative questionnaire surveys and
secondary data analysis [
] and two applied a mixed
methods approach [
]. The majority of studies
considered effectiveness of service delivery and only one of
the studies considered therapeutic effectiveness [
Four studies from UK, Canada, Botswana and
Zimbabwe, which analysed patient clinical accounts,
reported substantial increases in the prescription by
NMP of non-steroidal anti-inflammatory [
] and antibiotic medicines [
]. They give
an indication of both the conditions that non-medical
prescribers were encountering and also of the numbers
or confidence of non-medical prescribers to prescribe
these medicines. Only two studies presented
comparative data from general practitioners indicating similar
frequency of prescribing but not by groups of medicines
Three studies describing patient views [[
] and one of clinical consultation review [
reported that NMP were effective in improving the
provision of information, advice and understanding on
treatment, conditions, self-care and standard of care.
One study describing data from the professional
viewpoints reported that NMP had enhanced concordance
with patients [
]. One study which analysed clinical
] reported that the NMP intervention
improved patient reported outcomes of treatment. None
of these studies present any other data as evidence to
support these viewpoints.
Most of the studies were not able to comment on the
effectiveness of NMP in primary care in relation to
safety and appropriateness of prescribing by nurses and
other professionals allied to medicine. However, there is
Latter S, Maben J, Myall M, Young A, Baileff A: Focus. Evaluating prescribing competencies and standards used in nurse
independent prescribers’ prescribing consultations: an observation study of practice in England. Journal of Research in
Nursing 2007, 12(1):7-28 [
Latter S, Maben J, Myall M, Young A: Evaluating the clinical appropriateness of nurses’ prescribing practice: method
development and findings from an expert panel analysis. Quality & Safety in Health Care 2007, 16(6):415-421 [
Courtenay M, Carey N, Burke J: Independent extended and supplementary nurse prescribing practice in the UK: a national
questionnaire survey. International Journal Of Nursing Studies 2007, 44(7):1093-1101 [
George J, McCaig DJ, Bond CM, Cunningham ITS, Diack HL, Watson AM, Stewart DC: Supplementary prescribing: early
experiences of pharmacists in Great Britain. The Annals Of Pharmacotherapy 2006, 40(10):1843-1850 [
Flenniken MC: Psychotropic prescriptive patterns among nurse practitioners in nonpsychiatric settings. Journal of the
American Academy of Nurse Practitioners 1997, 9(3):117-121 [
Batey MV, Holland JM: Prescribing practices among nurse practitioners in adult and family health. American Journal of Public USA
Health 1985, 75(3):258-262 [
some evidence from two studies in two different African
countries that some prescribing of antibiotics by those
nurses may have been inappropriate and not
]. Neither presents comparative data to
judge whether other professionals such as doctors in
that type of setting prescribed in similar or different
ways. A mixed methods survey of adherence to
treatment guidelines in primary health care facilities in
Botswana found that antibiotics were prescribed in 27% of
all 2994 consultations. The study reported that full
adherence to prescribing guidelines (defined as complete
adherence to national recommended treatment
guidelines) occurred in 44% of prescriptions, acceptable
compliance in 20%, acceptable but with one or more useless
although not dangerous drugs in 33% and insufficient or
dangerous treatment in 3% of the consultations . An
unspecified survey of antibiotic prescribing by nurses in
primary care clinics in Harare, Zimbabwe found that of
1000 patient (presumably records but not specified in
the paper) surveyed 543 were prescribed with
antibiotics. It was reported that 12.3% of patients were
prescribed antibiotics inappropriately [
]. The same study
referenced an unpublished paper reporting on a
previous small survey which was carried out in a paediatric
primary care clinic in Zimbabwe. The study reported
that 55% of children were treated with antibiotics when
seen by the nurses but only 22% when seen by a
Efficiency considers questions of whether the output is
maximised for the given input or conversely whether
Removed after reading titles & abstracts:
Removed opinion papers: 209
Literature Reviews: 05
Empirical studies: 184
Removed papers with combined data: 17
Removed not Primary Care: 103
Removed after quality check: 06
Included in this review: 17
the input is minimised to achieve the stated output [
Of the 17 studies nine considered questions of
efficiency; seven of them as a part of a broader study and
two considered only questions of efficiency using
] and quantitative  methods. All
these studies reported prescribing by nurses.
Four studies, one of patient [
] and three of
professional views [[
] and ], reported that NMP was
efficient in that it was viewed as easy, convenient and
timely without the need to wait for a GP appointment.
Two studies of nurses’ views reported that being able to
prescribe enabled them to provide seamless and patient
centred care [
]. A UK based observational survey
of clinical accounts reported that nurse prescribers fully
completed the episode of care, i.e. did not have to refer
on to a doctor, in 65% of patients presenting in the
same day appointments using a combination of advice
and prescriptions . In an American evaluation of
Advanced Nursing Practitioners (ANP) with prescriptive
authority 1,708 patients were seen and prescribed by 32
ANPs. An analysis of patient records found that patients
experienced short waiting times (63% waited 15 minutes
or less) [
]. A Canadian study which analysed two
years of prescription claims by older adults reported
that the number of prescriptions per nurse prescriber
doubled and cost per prescription increased
approximately 20% over the time period [
]. The authors
noted the increase in cost per prescription; however,
they did not interpret this in terms of efficiency. While
three studies describing the professional views [[
and ] reported that NMP was time saving for patient
and nurses only one study, which was conducted in the
UK, reported NMP as a cost-effective intervention [
Acceptability considers questions of suitability and
satisfaction from the perspective of both those receiving the
intervention (the patients) and others providing or
commissioning the service (the professionals and managers)
]. It therefore relates to perceptions of outcomes. Of
the 17 studies in the review, three reported views about
acceptability as a part of a broader study. Of these three
studies, two investigated nurse prescribing and one
pharmacist prescribing. The studies found that NMP
was widely accepted and viewed positively by patients
] and [
]]. A UK based qualitative study that
interviewed 50 patients from caseloads of health visitors
(n = 17), district nurses (n = 9) and a practice nurse (n
= 1) reported that 49 (98%) out of 50 study participants
were in favour of nurse prescribing and happy with the
consultation and information provided by the nurse
]. Similarly, another UK based study
interviewed a sample of 148 patients selected from the
caseloads of district nurses, health visitors and practice
nurses after the treatment episode involving
non-medical prescriber. The majority of patients interviewed post
prescribing implementation, were in favour of nurse
prescribing and 55% of patients interviewed had sought
advice from a nurse prescriber in preference to the GP
Access considers the questions of whether people
receive a treatment or service when they need it and
whether there are any identifiable barriers to service
]. Five studies considered the question of
access as a part of a broader study. Four studies
considered nurse prescribing and one pharmacist prescribing
from UK. Four patient views studies [[
]] and one clinical consultation review analysis [
reported that introduction of NMP has improved access
to medicines and health care professionals. A UK based
qualitative study, which interviewed 41 patients from
caseloads of seven nurse prescribers, reported that they
thought that their access to medicine had improved
during non-routine/non-emergency appointments [
Similarly, another UK study interviewed 305 patients
selected from the caseloads of nurse prescribers
reported that patients appreciated the nurses being
accessible resulting in no delay in starting medication
]. A questionnaire study investigating the patients’
experience (n = 127) of pharmacist-led supplementary
prescribers in a UK primary care setting reported that
86% of respondents stated that they are able to make
appointments easily, which resulted in improved access
to medicines [
While there have been previous published reviews of
non-medical prescribing, none have considered the
evidence from one setting, in this case primary care, or
have focused on outcomes.
In this review, 19 papers of 17 empirical studies (two
studies published two articles each) were identified
which provided evidence of patient outcome of NMP in
primary care settings. The majority were undertaken in
the UK with only one each from the USA, Canada,
Botswana and Zimbabwe. Seven papers report on UK
studies of nurse prescribing from a limited nurses’
formulary. Seven papers reported on qualitative designs
and four of these had fewer than ten participants. Two
reported on surveys of opinion and experience. Eight
papers reported on record reviews of prescriptions or
clinical consultation by NMPs. Those studies that
provide objective measures are mainly descriptive. Only
one provided some comparative evidence of another
type of prescriber, GPs, by which to judge the impact
on patient outcomes or outcomes on the efficiency for
the health system [
]. While there may be a publication
bias in reporting positive outcomes present in those
identified, many of the studies included in the review
had design weaknesses and limitations, both as indicated
by the authors and evident through critical appraisal of
the papers. The strength of evidence they provide on
the whole is limited.
The review findings from stakeholders’ perspectives
suggest that NMP in primary care effectively improves
patients’ understanding of treatment, condition and
selfcare and provides a better level of care. As the literature
suggests that concordance is a major issue in the
effective use of medicines in primary care settings [
impact of additional information and advice may be
significant in considering which type of prescriber is
effective for which particular patient groups. This
proposition requires further testing and investigation.
We found very limited evidence in relation to other
indicators of effectiveness of NMP outcomes such as of
patient safety and clinical outcomes. The overall number
of research-based studies to evaluate impact and
outcome of NMP was low given that NMP was introduced
in many countries over 30 years ago. In part this
reflected the number of papers excluded as it was not
possible to separate primary care related data from
secondary care related data but it may also be that NMP is
seen as producing positive outcomes in situations where
there are no alternative prescribers. This may explain
the absence of empirical outcome evidence from low
income countries in particular, although this may also
reflect the review search strategy, which did not search
country specific journals not indexed on the major
electronic databases. Given that it is a minority of countries
that have given prescribing authority to professionals
other than doctors and dentists, it may be that it is this
type of evidence that would be of value to policy makers
and requires further investigation and publication.
In relation to efficiency of NMP in primary care, the
review suggests that patients received services that were
timely, seamless and of high quality from nurse and
pharmacist prescribers. One study reported opinions
that NMP was cost effective in primary care. We were
unable to find any papers from a health economics
perspective or that modelled the efficiency impact from
either patient or the health services perspective. We
suggest that this is an aspect that warrants further
All the studies investigating acceptability of NMP
indicated that NMP was well accepted and favoured by
patients, nurses, pharmacists and other health care
professionals. The gradual growth over time of
legislative authority to NMP and also of the numbers of
nonmedical prescribers, particularly nurses, in countries
such as the USA and the UK, suggests that the
acceptability is based not just on immediate levels of
satisfaction with the clinical encounter but perceived value to
the health care system as a whole.
The review findings also report that patients
considered it was easier, quicker and convenient to get an
appointment with NMP and their access to medicine
and health care professionals was improved. For all
countries the issue of timely access to appropriate
medicines has health service and public health ramifications.
For countries with well developed primary care services
such as the UK, the ability of primary care professionals
other than doctors to provide consultations that include
prescribing may improve waiting times to consult and
help manage demand and potential dissatisfaction. The
issue of equitable access to safe and affordable medicine
is critical for lower-income countries where the access
to medicines is compromised by insufficient health
facilities and staff, low investment in health and the high
cost of medicines [
]. In these settings if legislative
authority to prescribe is not extended to groups other
than doctors and dentists, using mechanisms such as
patient group directions or standing orders for
community health workers for a specified essential drug list and
immunisation list may have significant and critical
public health impact. The contribution of these types of
mechanisms with a broader group of community health
staff is not within the scope of this review but warrants
This review has limitations in that it included only
English language studies and those accessed through
electronic sources and therefore may have excluded
evidence from many Scandinavian, African, South East
Asian and South American countries. However, our
review of countries that have legislated for prescribing
authority for professionals other than doctors and
dentists would suggest that researchers from many of these
countries are likely to publish evidence in English
language journals, although not necessarily ones that are
indexed through the databases we searched.
Our focus on patient and health service outcomes has
been both a strength and a weakness: while outcomes
are important, the small number of studies finally
included demonstrate how limited the evidence is. We
argue that it is these aspects that most urgently need
investigation. Our focus on solely primary care has also
meant that we have had to exclude some more recent
studies providing evidence from mixed primary and
secondary care settings, aspects such as clinical
appropriateness of NMP, e.g. Drennan et al, 2009, Latter et al,
2010, and Bissell et al, 2008 [
]. In many of these
studies there were substantial numbers of NMP in
primary care settings. We suggest that secondary data
analysis of some of these studies by health care setting may
be invaluable to providing evidence for service planners,
commissioners and managers.
NMP has been implemented and evolved differently in
different countries. Around twenty countries out of 193
member states of the World Health Organisation
(WHO) provide legal authority to nurses and other
professionals allied to medicine to prescribe medicines at a
certain level and others are considering introducing
legislation. This suggests that internationally twenty first
century policy makers are beginning to look as to how
to move beyond twentieth century established
professional boundaries for the benefit of both public health
and their health care economy. Primary health care is
the setting where timely, and equitable, access to safe
and appropriate medicines is most critical for the
wellbeing of any population. Our review suggests that there
are substantial gaps in the knowledge base to help
evidence based policy making in this arena. We suggest
that this review indicates there is a need for secondary
data analysis of existing studies and commissioning of
new studies that address questions of non-medical
prescribing in primary care across a broad range of patient
and health service outcomes, including economic
Additional file 1: Non-medical prescribing outcomes based papers
grouped by patient views, professional views and clinical accounts.
Details of the papers included in the review.
No external funding was received for the study.
VMD conceived the study. All designed the study. SB undertook the search
and initial reading. All undertook second reading and quality checks. SB
produced the first draft of the paper and all contributed to revisions. All
authors read and approved the final manuscript.
The authors declare that they have no competing interests.
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