Valuing the extended role of prescribing pharmacist in general practice: results from a discrete choice experiment

Objectives: To quantify patients' preferences for new pharmacist independent prescribing services in general practice for managing common existing long-term conditions compared with usual medical prescribing.

Methods: A discrete choice experiment cross-sectional survey was conducted in five general practices in England (October-November 2009). Four service attributes reported on the length of consultation and aspects of patient-professional interaction. A choice between three alternatives-novel pharmacist independent prescribing service ("prescribing pharmacist"), "own (family) doctor" service, and "available (family) doctor" service-was presented. Alternative regression models were compared according to their goodness of fit, and the preferred one was used to inform policy analysis.

Results: A total of 451 patients completed questionnaires. Respondents preferred a "pharmacist" or "own doctor" compared with "available doctor," with a larger value given to own doctor. All attributes on patient-professional interaction were important in choosing how to manage diagnosed hypertension, while the "length of consultation" (P = 0.42) did not have any impact. The impact of introducing a pharmacist prescribing service into a general practice setting was estimated from these findings. Patients' preferences suggested that about 16% of consultations with a patient's own doctor can be switched to a prescribing pharmacist instead. Although there is a stronger preference for seeing own doctor, alternative combinations of attribute levels can be used to compensate and reconfigure a more preferred prescribing pharmacist service.

Conclusions: The pharmacist service is valued by patients as an alternative to doctor prescribing in primary care and therefore represents an acceptable form of service delivery when informing policy.