Physiotherapists prescribing non-steroidal anti-inflammatory drugs and analgesics

Background: Since August 2013, physiotherapists are able to become an independent prescriber in the UK. This legislation was based on the Allied Health Professionals Prescribing and Medicines Supply Mechanisms Scoping Project Report (2009) which recommended that physiotherapists should gain limited prescribing rights. The Department of Health (DOH) identified the benefits for patients, but there has been little research exploring the views of physiotherapists. This study sought to investigate student physiotherapists’ views to give a unique insight into their beliefs about the legislation and the impact that it may have on the physiotherapy profession. Purpose: This study aimed to explore physiotherapy student's opinions about the new legislation allowing physiotherapists to independently prescribe non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. Methods: Within the framework of qualitative research, two focus groups of nine participants were used to collect context rich information. The groups comprised of physiotherapy students with clinical experience. Convenience sampling with an element of snowball sampling was used. Participants were excluded from the study if: they were not final year physiotherapy students, did not speak fluent English or found social situations distressing. Information sheets explaining the legislation prior to the focus group were used to prime the group interviews. The interviews were facilitated by the researcher and independent observer. Final transcripts were analysed using thematic analysis and methods of peer review and member checking were used to ensure truthful and honest accounts from the participants. Results: The three emerging themes were: patient success and expectations, development of the profession and multi-disciplinary (MDT) development. Within patient success and expectations, participants highlighted patient benefits, issues with safety; such as drug interactions, and the effect on compliance. Development of the profession suggested that the reputation and trust of the physiotherapist may be jeopardized. The theme MDT development raised issues that may arise from independent prescribing such as role conflict and communication breakdown. An underlying theme of how patient and professionals perceptions could impact the extension of this scope was identified. Conclusion(s): Despite benefits for the patient being identified in both the study and by the DOH, student physiotherapists that took part in this study recognised that patients would receive enhanced holistic care which could lead to better prognosis. Participants have also acknowledged concerns for the profession and amongst the MDT. The reputation of the physiotherapist and the profession could be at risk and participants felt that patients and professionals may lose trust in physiotherapy due to the risk of errors and physiotherapists relying on medication as a form of intervention. Further exploration raised concerns regarding the potential for developing occupational stress due to the increased workload for independent prescribers. Implications: This research highlighted areas for concern that need consideration from appropriate governing bodies. Advice regarding medication continues to be a grey area for non-prescriber's which is further highlighted by the potential to become an independent prescriber. Patient safety is an area that will need addressing throughout training. Further consideration into reducing the potential for occupational stress is recommended.