Perspectives on pharmacist prescribing in an outpatient dialysis center: Qualitative interviews with patients and clinicians

Introduction: Pharmacist prescribing is expanding across care settings, supported by their 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 explores patient and clinician perspectives on 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 qualitative interviews were conducted with English-speaking adults on hemodialysis, and clinicians, including nephrologists, pharmacists, dietitians, and nurse practitioners in the outpatient hemodialysis unit at TGH-UHN. 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, one nurse practitioner) were interviewed in June and July 2025. Participants noted communication gaps and delays as challenges of the current prescribing process, and accessibility of prescribers and interdisciplinary collaboration as strengths. Pharmacists were recognized as valuable care team members given their expertise in medication management and rapport with patients. Potential benefits of pharmacist prescribing included enhanced medication optimization, improved workflow efficiency, timely care, and pharmaco-economic savings. Barriers included limited prescribing knowledge among some pharmacists. Implementation considerations included a collaborative approach, maintaining physician oversight, limiting prescribing to specific clinical areas, phased rollout, patient and clinician buy-in, adequate resources, and clearly defined roles and communication. Conclusion While patients and clinicians were generally supportive of pharmacist prescribing in the hemodialysis unit, they identified several considerations for implementation. Interviews in additional hemodialysis care settings could offer further insight to guide implementation strategies.