Analysis of the Cochrane Review: Non-medical Prescribing versus Medical Prescribing for Acute and Chronic Disease Management in Primary and Secondary Care. Cochrane Database Syst Rev. 2016;11:CD011227.

Abstract

In countries with diverse socioeconomic levels, in order to address the health care demands, the consideration of a wide array of strategies is needed; among these, non-medical prescription can be included. The objective of this revision was to ascertain whether non-medical prescription results in comparable clinical and patient-related outcomes to medical prescription. This systematic review was conducted in compliance with the standard Cochrane methodology. Clinical outcomes were compared between prescription carried out by non-medical health professionals and doctors, provided that the non-medical health professional prescribed with a high degree of autonomy, both in hospital and community practice, in countries with low, medium and high socioeconomic level. The review included 46 clinical trials, with different designs, with 37 337 participants overall. Most studies were based on the management of chronic disease in higher income countries, where the evidence supports comparable outcomes for the markers of disease relative to high blood pressure (moderate-certainty of evidence), diabetes control (high-certainty of evidence); high cholesterol (moderatecertainty
of evidence), among others. Prescription by pharmacists and nurses with different levels of undergraduate, specific and postgraduate education could provide comparable outcomes to medical prescription, specifically with regards to adherence to therapy, adverse events, overall satisfaction, quality of life, and resource utilisation (hospitalisations, visits to the emergency department, and consultations). Non-medical prescribers frequently had medical support available to facilitate a collaborative practice. With appropriate training and support, non-medical prescription by nurses and pharmacists can be as effective as when carried out by doctors.