Facilitators and barriers to extending prescribing authority to pharmacists in Nigeria: a mixed methods study

Background and aim: In Nigeria, only medical doctors, dentists and some nurses in primary care facilities have the legal right to prescribe medicines. Patients’ access to prescriptions can be seriously affected by the shortage of prescribers and waiting times in hospitals. This research was carried out to investigate the facilitators and barriers to extending pharmacists’ clinical roles to include prescribing in Nigeria. Methods: The research employed an exploratory sequential mixed methods design consisting of three studies: The first involved semi-structured interviews with 32 UK pharmacy staff to investigate the changes in the structure of pharmacy practice in order to identify lessons for the Nigerian context. The second was semi-structured interviews with 49 Nigerian stakeholders including policymakers, pharmacists, doctors and patient group representatives to explore their views on pharmacist prescribing in Nigeria. The third was a cross-sectional survey involving 775 Nigerian pharmacists. Results: The UK study suggests that changes in the traditional structure of pharmacy including a shift in the focus of pharmacy training to a patient orientated one, specialisation in practice, the development of a clinical career route, enhanced working relationship with doctors and the utilisation of pharmacy technicians could benefit the development of pharmacists’ clinical roles including prescribing. The two Nigerian studies showed a strong support for pharmacist prescribing especially by pharmacists and patient group representatives. The facilitators to pharmacist prescribing identified included pharmacists’ expert medicine knowledge, the positive attitude of pharmacists towards extended clinical roles, a positive relationship between doctors and pharmacists in some teaching hospitals and the potential benefits associated with pharmacist prescribing including increasing patients’ access to medicines. Barriers identified included lack of government support, medical opposition, pharmacists’ lack of confidence to do clinical roles, inadequate pharmacists’ skills in diagnosis and shortage of pharmacists. Conclusion: This research concludes that a change in the traditional structure of pharmacy would be necessary for the development of pharmacist prescribing in Nigeria. The key areas for change are enumerated in the recommendations of this thesis.