Identifying and measuring important outcomes for evaluating the impact of pharmacist prescribing in Ireland: A modified Delphi study

Background

Pharmacist role expansion, including pharmacist prescribing, is increasing globally. Assessing the impact of such role expansion is vital.

Purpose

To identify key outcomes to evaluate pharmacist prescribing within Ireland’s planned Common Conditions Service (CCS) and independent pharmacist prescribing contexts, and determine their measurability using existing health data sources.

Methods

In a three-round Delphi study, an expert panel (including pharmacists, pharmacy technicians, prescribers, public/patient contributors, policymakers, academics) rated the importance of outcomes, pre-identified via a rapid overview of reviews, using Likert scales. The research team involved public/patient team members throughout the study. Outcomes reaching consensus for inclusion (rated by ≥75% as critically important) or exclusion (<25%) after the second round were not re-rated. In the third round, remaining outcomes were re-rated and experts also rated the feasibility of measuring each outcome using existing health data sources.

Results

Thirty experts completed all rounds. For CCS, seven outcomes reached consensus as critically important: Patient experience and satisfaction, Access to care, Guideline concordance, Symptom improvement, or clinical cure, Re-consultation with other health care providers, Cost of care to the healthcare system, and Referral to other healthcare providers. For other independent prescribing contexts, ten outcomes were critically important, including Mortality, Clinical effectiveness, Adverse events, and Cost of care to patients. Important CCS outcomes varied in their measurability using existing data, with Prescribing rate (76% agreement) and Cost to patients (64% agreement) were most feasible.

Conclusions

This study identified priority outcomes for evaluating the impact of pharmacist prescribing, encompassing clinical, safety, economic, and patient perspectives.

Highlights

• Clinical, economic, safety, and patient-reported outcomes are key for assessing the impact of pharmacist prescribing.

• Seven priority outcomes were identified for Common Conditions Services, and ten for wider independent prescribing contexts.

• Existing health data can support outcome measurement, but enhancements are needed to improve interoperability and coverage.