Objective

Given increasing patient populations, general practitioner (GP) workforce constraints and increasing demand for health services in New Zealand (NZ), the development and provision of pharmacist prescribing services may need to increase to improve people’s access to medicines. A discrete choice experiment (DCE) was utilised to determine community pharmacist preferences for prescribing services in primary care in NZ, and to understand how these factors could improve the provision of pharmacist prescribing services.

Methods

A D-efficient design generated 30 labelled choice questions in three blocks of ten, and three alternatives per choice question. The online DCE was emailed to practising community pharmacists in NZ. The DCE included two attributes with five levels (prescribing model, educational requirements) and three attributes with three levels (location, professional fee, change in income). A mixed multinomial logit model was used to estimate preferences.

Results

A total of 264 respondents completed the survey with 2640 observations for analyses. This DCE found pharmacists preferred pharmacy services with the following characteristics: ability to prescribe using minor ailments and independent prescribing models relative to the pharmacist-only medicines prescribing model; prescribing education by accredited learning modules relative to PGDipClinPharm + PGCertPharmPres; remuneration via a professional fee; and pharmacist prescribing services located in community pharmacies rather than in GP practices.

Conclusions

Prescribing policy could incorporate these pharmacist preferences to help develop accessible and effective pharmacist prescribing services that not only improve access to medicines, but also address inequity of access to medicines in NZ. These DCE results are encouraging as they signal that the community pharmacists also see themselves and their pharmacies as part of the prescribing team in primary care in NZ.

中文翻译：

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确定社区药剂师对新西兰初级保健处方服务的偏好：离散选择实验

客观的

鉴于新西兰 (NZ) 不断增加的患者人数、全科医生 (GP) 劳动力限制以及对卫生服务的需求不断增加，可能需要增加药剂师处方服务的开发和提供，以改善人们获得药物的机会。离散选择实验 (DCE) 被用来确定社区药剂师对新西兰初级保健处方服务的偏好，并了解这些因素如何改善药剂师处方服务的提供。

方法

一个 D 效率设计生成了 30 个标记的选择问题，分为三个一组，每组十个，每个选择问题有三个备选方案。在线 DCE 已通过电子邮件发送给新西兰的执业社区药剂师。DCE 包括五个级别的两个属性（处方模型、教育要求）和三个级别的三个属性（位置、专业费用、收入变化）。使用混合多项 logit 模型来估计偏好。

结果

共有 264 名受访者完成了调查，其中有 2640 个观察结果可供分析。该 DCE 发现，药剂师偏爱的药学服务具有以下特点：能够使用小病进行处方，并且相对于仅药剂师开药模式的独立开药模式；通过与 PGDipClinPharm + PGCertPharmPres 相关的认可学习模块进行教育；通过专业费用获得报酬；以及位于社区药房而非全科医生诊所的药剂师处方服务。

结论

处方政策可以将这些药剂师偏好纳入其中，以帮助开发可访问且有效的药剂师处方服务，不仅可以改善获得药物的机会，还可以解决新西兰获得药物的不公平问题。这些 DCE 结果令人鼓舞，因为它们表明社区药剂师也将自己和他们的药房视为新西兰初级保健处方团队的一部分。