Academic Journal
Exploring pharmacist prescribing practices in general practices for atrial fibrillation in England: a qualitative study using the theoretical domains framework.
| Title: | Exploring pharmacist prescribing practices in general practices for atrial fibrillation in England: a qualitative study using the theoretical domains framework. |
|---|---|
| Authors: | Sharma R; Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK., Hasan SS; Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK., Conway BR; Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK., Ghori MU; Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK. M.Ghori@hud.ac.uk. |
| Source: | International journal of clinical pharmacy [Int J Clin Pharm] 2026 Jun; Vol. 48 (3), pp. 740-750. Date of Electronic Publication: 2025 Dec 10. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Springer Country of Publication: Netherlands NLM ID: 101554912 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2210-7711 (Electronic) NLM ISO Abbreviation: Int J Clin Pharm Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Dordrecht : Springer |
| MeSH Terms: | Atrial Fibrillation*/drug therapy , Atrial Fibrillation*/epidemiology , Pharmacists*/standards , General Practice*/methods , Drug Prescriptions*/standards , Professional Role* , Practice Patterns, Pharmacists'*, England/epidemiology ; Anticoagulants/therapeutic use ; Anticoagulants/administration & dosage ; Humans ; Male ; Female ; Qualitative Research ; Middle Aged ; Adult |
| Abstract: | Introduction: Pharmacist roles in primary care are evolving, with increasing involvement in long-term condition management. An example is their crucial role in the management of atrial fibrillation (AF), particularly in prescribing and monitoring oral anticoagulation therapy. However, their experiences and challenges in this area remain underexplored, particularly within the context of general practice. Aim: This study aimed to explore the experiences, perceptions, and challenges of independent prescribing pharmacists when managing and prescribing for AF within general practice, using the Theoretical Domains Framework (TDF) to guide enquiry and analysis. Method: We conducted a qualitative study underpinned by the Theoretical Domains Framework (TDF), which informed both the interview guide and the analytic coding framework. Independent prescribing pharmacists working in general practice in England were purposively recruited via professional networks; eligible participants were patient-facing and had experience prescribing for atrial fibrillation. One-to-one, semi-structured interviews were conducted via Microsoft Teams® in August 2024, audio-recorded, transcribed verbatim, and returned to participants for checking. Recruitment proceeded until thematic saturation. Two researchers independently applied the framework method, resolved discrepancies by consensus, and mapped final themes to relevant TDF domains. Results: Twenty pharmacists took part in the study (9 men, 11 women; age 25-52 years), providing perspectives from a range of experience levels. Four overarching themes emerged: (1) confidence and experience in prescribing, (2) perceived role and responsibilities, (3) barriers to effective prescribing, and (4) strategies for effective prescribing. Pharmacists with extensive AF experience demonstrated higher confidence, whereas less experienced pharmacists relied on guidelines and colleagues. Perceived roles ranged from central to supportive within multidisciplinary teams, with some uncertainty about role boundaries. Key barriers included incomplete access to patient records, limited training, and workload pressures. Strategies to support prescribing included continuous professional development, decision support tools, and peer consultation. Conclusion: The study emphasises the challenges pharmacists encounter in managing AF, highlighting the need for clearer role definitions, improved access to patient data and ongoing peer support. Addressing the identified barriers through targeted interventions could enhance the effectiveness of pharmacist-led AF management in general practice. Future research should evaluate interventions designed to support pharmacists in this evolving role. (© 2025. The Author(s).) |
| Competing Interests: | Declarations. Conflicts of interest: The authors declare no competing interests. Ethics approval: The study was approved by the School of Applied Sciences Research Integrity and Ethics Committee, University of Huddersfield (reference: SAS-SRIEC-06.08.24–1; approved 06 August 2024). Consent to participate: Written informed consent was obtained from all participants prior to the interviews. |
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| Grant Information: | Reference: 0093-102021 Health Education England and City Health Bradford GP Federation for financial support |
| Contributed Indexing: | Keywords: Anticoagulants; Atrial Fibrillation; England; Pharmacists; Prescribing; Primary Health Care; Qualitative Research |
| Substance Nomenclature: | 0 (Anticoagulants) |
| Entry Date(s): | Date Created: 20251210 Date Completed: 20260514 Latest Revision: 20260517 |
| Update Code: | 20260517 |
| PubMed Central ID: | PMC13176180 |
| DOI: | 10.1007/s11096-025-02062-3 |
| PMID: | 41369786 |
| Database: | MEDLINE |
| FullText | Links: – Type: other Url: https://resolver.ebsco.com:443/public/rma-ftfapi/ejs/direct?AccessToken=41338BF5FC2E18AF92C4&Show=Object Text: Availability: 0 CustomLinks: – Url: https://dx.doi.org/doi:10.1007/s11096-025-02062-3 Name: EDS - Springer Nature Journals (s7799221) Category: fullText Text: View record at Springer |
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| Items | – Name: Title Label: Title Group: Ti Data: Exploring pharmacist prescribing practices in general practices for atrial fibrillation in England: a qualitative study using the theoretical domains framework. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AU" term="%22Sharma+R%22">Sharma R</searchLink>; Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK.<br /><searchLink fieldCode="AU" term="%22Hasan+SS%22">Hasan SS</searchLink>; Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK.<br /><searchLink fieldCode="AU" term="%22Conway+BR%22">Conway BR</searchLink>; Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK.<br /><searchLink fieldCode="AU" term="%22Ghori+MU%22">Ghori MU</searchLink>; Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK. M.Ghori@hud.ac.uk. – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22101554912%22">International journal of clinical pharmacy</searchLink> [Int J Clin Pharm] 2026 Jun; Vol. 48 (3), pp. 740-750. <i>Date of Electronic Publication: </i>2025 Dec 10. – Name: TypePub Label: Publication Type Group: TypPub Data: Journal Article – Name: Language Label: Language Group: Lang Data: English – Name: TitleSource Label: Journal Info Group: Src Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Springer%22">Springer </searchLink><i>Country of Publication: </i>Netherlands <i>NLM ID: </i>101554912 <i>Publication Model: </i>Print-Electronic <i>Cited Medium: </i>Internet <i>ISSN: </i>2210-7711 (Electronic) <i>NLM ISO Abbreviation: </i>Int J Clin Pharm <i>Subsets: </i>MEDLINE – Name: PublisherInfo Label: Imprint Name(s) Group: PubInfo Data: <i>Original Publication</i>: Dordrecht : Springer – Name: SubjectMESH Label: MeSH Terms Group: Su Data: <searchLink fieldCode="MM" term="%22Atrial+Fibrillation%22">Atrial Fibrillation*</searchLink>/<searchLink fieldCode="MM" term="%22Atrial+Fibrillation+drug+therapy%22">drug therapy</searchLink> <br /><searchLink fieldCode="MM" term="%22Atrial+Fibrillation%22">Atrial Fibrillation*</searchLink>/<searchLink fieldCode="MM" term="%22Atrial+Fibrillation+epidemiology%22">epidemiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Pharmacists%22">Pharmacists*</searchLink>/<searchLink fieldCode="MM" term="%22Pharmacists+standards%22">standards</searchLink> <br /><searchLink fieldCode="MM" term="%22General+Practice%22">General Practice*</searchLink>/<searchLink fieldCode="MM" term="%22General+Practice+methods%22">methods</searchLink> <br /><searchLink fieldCode="MM" term="%22Drug+Prescriptions%22">Drug Prescriptions*</searchLink>/<searchLink fieldCode="MM" term="%22Drug+Prescriptions+standards%22">standards</searchLink> <br /><searchLink fieldCode="MM" term="%22Professional+Role%22">Professional Role*</searchLink> <br /><searchLink fieldCode="MM" term="%22Practice+Patterns%2C+Pharmacists'%22">Practice Patterns, Pharmacists'*</searchLink><br /><searchLink fieldCode="MH" term="%22England%22">England</searchLink>/<searchLink fieldCode="MH" term="%22England+epidemiology%22">epidemiology</searchLink> ; <searchLink fieldCode="MH" term="%22Anticoagulants%22">Anticoagulants</searchLink>/<searchLink fieldCode="MH" term="%22Anticoagulants+therapeutic+use%22">therapeutic use</searchLink> ; <searchLink fieldCode="MH" term="%22Anticoagulants%22">Anticoagulants</searchLink>/<searchLink fieldCode="MH" term="%22Anticoagulants+administration+%26+dosage%22">administration & dosage</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Qualitative+Research%22">Qualitative Research</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Adult%22">Adult</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Introduction: Pharmacist roles in primary care are evolving, with increasing involvement in long-term condition management. An example is their crucial role in the management of atrial fibrillation (AF), particularly in prescribing and monitoring oral anticoagulation therapy. However, their experiences and challenges in this area remain underexplored, particularly within the context of general practice.<br />Aim: This study aimed to explore the experiences, perceptions, and challenges of independent prescribing pharmacists when managing and prescribing for AF within general practice, using the Theoretical Domains Framework (TDF) to guide enquiry and analysis.<br />Method: We conducted a qualitative study underpinned by the Theoretical Domains Framework (TDF), which informed both the interview guide and the analytic coding framework. Independent prescribing pharmacists working in general practice in England were purposively recruited via professional networks; eligible participants were patient-facing and had experience prescribing for atrial fibrillation. One-to-one, semi-structured interviews were conducted via Microsoft Teams® in August 2024, audio-recorded, transcribed verbatim, and returned to participants for checking. Recruitment proceeded until thematic saturation. Two researchers independently applied the framework method, resolved discrepancies by consensus, and mapped final themes to relevant TDF domains.<br />Results: Twenty pharmacists took part in the study (9 men, 11 women; age 25-52 years), providing perspectives from a range of experience levels. Four overarching themes emerged: (1) confidence and experience in prescribing, (2) perceived role and responsibilities, (3) barriers to effective prescribing, and (4) strategies for effective prescribing. Pharmacists with extensive AF experience demonstrated higher confidence, whereas less experienced pharmacists relied on guidelines and colleagues. Perceived roles ranged from central to supportive within multidisciplinary teams, with some uncertainty about role boundaries. Key barriers included incomplete access to patient records, limited training, and workload pressures. Strategies to support prescribing included continuous professional development, decision support tools, and peer consultation.<br />Conclusion: The study emphasises the challenges pharmacists encounter in managing AF, highlighting the need for clearer role definitions, improved access to patient data and ongoing peer support. Addressing the identified barriers through targeted interventions could enhance the effectiveness of pharmacist-led AF management in general practice. Future research should evaluate interventions designed to support pharmacists in this evolving role.<br /> (© 2025. The Author(s).) – Name: Abstract Label: Competing Interests Group: Ab Data: Declarations. Conflicts of interest: The authors declare no competing interests. Ethics approval: The study was approved by the School of Applied Sciences Research Integrity and Ethics Committee, University of Huddersfield (reference: SAS-SRIEC-06.08.24–1; approved 06 August 2024). Consent to participate: Written informed consent was obtained from all participants prior to the interviews. – Name: Ref Label: References Group: RefInfo Data: Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020;42(5):373–498. https://doi.org/10.1093/eurheartj/ehaa612 . (PMID: <searchLink fieldCode="PM" term="%2210%2E1093%2Feurheartj%2Fehaa612%22">10.1093/eurheartj/ehaa612)</searchLink><br />Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 study. Circulation. 2014;129(8):837–47. https://doi.org/10.1161/CIRCULATIONAHA.113.005119 . (PMID: <searchLink fieldCode="PM" term="%2210%2E1161%2FCIRCULATIONAHA%2E113%2E00511924345399%22">10.1161/CIRCULATIONAHA.113.00511924345399)</searchLink><br />Casselman F, Coca A, De Caterina R, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893–962. https://doi.org/10.1093/eurheartj/ehw210 . (PMID: <searchLink fieldCode="PM" term="%2210%2E1093%2Feurheartj%2Fehw210%22">10.1093/eurheartj/ehw210)</searchLink><br />National Institute for Health and Care Excellence (NICE). Atrial fibrillation: diagnosis and management. NG196. 2021. Available from: https://www.nice.org.uk/guidance/ng196 . Accessed 2 Oct 2024.<br />NHS England. NHS England’s work on stroke. Available from: https://www.england.nhs.uk/ourwork/clinical-policy/stroke . Accessed 2 Oct 2024.<br />NHS England. NHS Long Term Plan: cardiovascular disease. Available from: https://www.longtermplan.nhs.uk/areas-of-work/cardiovascular-disease . 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(PMID: <searchLink fieldCode="PM" term="%2210%2E1186%2Fs13012-016-0396-4270011074802575%22">10.1186/s13012-016-0396-4270011074802575)</searchLink> – Name: GrantInfo Label: Grant Information Group: Grant Data: Reference: 0093-102021 Health Education England and City Health Bradford GP Federation for financial support – Name: SubjectMinor Label: Contributed Indexing Group: Data: <i>Keywords: </i>Anticoagulants; Atrial Fibrillation; England; Pharmacists; Prescribing; Primary Health Care; Qualitative Research – Name: NumberCAS Label: Substance Nomenclature Group: ID Data: 0 (Anticoagulants) – Name: DateEntry Label: Entry Date(s) Group: Date Data: <i>Date Created: </i>20251210 <i>Date Completed: </i>20260514 <i>Latest Revision: </i>20260517 – Name: DateUpdate Label: Update Code Group: Date Data: 20260517 – Name: PubmedCentralID Label: PubMed Central ID Group: ID Data: PMC13176180 – Name: DOI Label: DOI Group: ID Data: 10.1007/s11096-025-02062-3 – Name: AN Label: PMID Group: ID Data: 41369786 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1007/s11096-025-02062-3 Languages: – Code: eng Text: English PhysicalDescription: Pagination: StartPage: 740 Subjects: – SubjectFull: England epidemiology Type: general – SubjectFull: Anticoagulants therapeutic use Type: general – SubjectFull: Anticoagulants administration & dosage Type: general – SubjectFull: Humans Type: general – SubjectFull: Male Type: general – SubjectFull: Female Type: general – SubjectFull: Qualitative Research Type: general – SubjectFull: Middle Aged Type: general – SubjectFull: Adult Type: general – SubjectFull: Atrial Fibrillation drug therapy Type: general – SubjectFull: Atrial Fibrillation epidemiology Type: general – SubjectFull: Pharmacists standards Type: general – SubjectFull: General Practice methods Type: general – SubjectFull: Drug Prescriptions standards Type: general – SubjectFull: Professional Role Type: general – SubjectFull: Practice Patterns, Pharmacists' Type: general Titles: – TitleFull: Exploring pharmacist prescribing practices in general practices for atrial fibrillation in England: a qualitative study using the theoretical domains framework. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Sharma R – PersonEntity: Name: NameFull: Hasan SS – PersonEntity: Name: NameFull: Conway BR – PersonEntity: Name: NameFull: Ghori MU IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 06 Text: 2026 Jun Type: published Y: 2026 Identifiers: – Type: issn-electronic Value: 2210-7711 Numbering: – Type: volume Value: 48 – Type: issue Value: 3 Titles: – TitleFull: International journal of clinical pharmacy Type: main |
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