Perspectives on potential pharmacist prescribing in an outpatient dialysis center: qualitative interviews with patients and clinicians
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Introduction
Pharmacist prescribing is expanding across care settings, supported by pharmacists’ expertise in pharmacology, therapeutics, disease management, and medication optimization. In settings where pharmacists can prescribe, patients and providers report positive outcomes. However, limited research has examined pharmacist prescribing in dialysis centers.
Aim
This study explored patient and clinician perspectives on potential pharmacist prescribing in the outpatient hemodialysis unit at Toronto General Hospital, University Health Network (TGH-UHN) in Toronto, Canada.
Method
Semi-structured, one-on-one interviews were conducted with English-speaking adults receiving hemodialysis, and clinicians, including nephrologists, pharmacists, dietitians, and nurse practitioners in the outpatient hemodialysis unit at TGH-UHN. Patient interviews focused on experiences receiving and filling prescriptions, interactions with pharmacists in the hemodialysis unit, and views on potential pharmacist prescribing in the unit. Clinician interviews explored the strengths and limitations of the current prescribing process in the hemodialysis unit, pharmacists’ role in the unit, perceived benefits and challenges of potential pharmacist prescribing, and strategies for implementation. Participants were recruited through convenience sampling until data saturation was reached. Interviews were audio-recorded, transcribed, and analyzed thematically using an inductive approach.
Results
Eleven patients and 11 clinicians (six nephrologists, two pharmacists, two dietitians, and one nurse practitioner) were interviewed in June and July 2025. Reported challenges of the current prescribing process included communication gaps and delays in care, while accessibility of prescribers and interdisciplinary collaboration were identified as strengths. Pharmacists were recognized as valuable care team members for their expertise in medication management and rapport with patients. Anticipated benefits of pharmacist prescribing included improved medication optimization, workflow efficiency, timely care, and pharmaco-economic savings. Limited prescribing knowledge among some pharmacists was noted as a barrier. Implementation considerations included a collaborative approach, maintaining physician oversight, restricting prescribing to specific clinical areas, phased rollout, patient and clinician buy-in, adequate resources, and clearly defined roles and communication.
Conclusion
Patients and clinicians were generally supportive of potential pharmacist prescribing in the hemodialysis unit, contingent on several considerations for implementation. Interviews with additional stakeholders in other dialysis care settings could further inform strategies for broader adoption.
