2023 Global Survey of Optometry: Defining Variations of Practice, Regulation and Human Resources Between Countries.

Purpose: To provide information on the demographics of optometrists and regulation of the optometry profession in countries who were members of the World Council of Optometry (WCO) during the period 2022-2023. Methods: A non-random, purposive sampling and a key informant strategy was employed to conduct a survey-based cross-sectional study on the professional landscape and distribution of optometrists; educational landscape; legislative aspects of the profession; and the scope of optometry practice in countries who were members of WCO during the period 2022-2023. Key informants were identified by WCO country members' leadership. Results: In the 39 countries surveyed, one optometrist serves 23,200 persons on average. Only 46.2% of the countries met the internationally suggested 1:10,000 optometrist-to-population ratio. The average male-to-female ratio was 45% males/55% females, with a division of average age as follows: under 45 years of age 46% as compared to above 45 years of age 54%. It was reported that optometry is not regulated in France, Portugal, India, Kenya and Cameron. Thirteen countries (33%) do not require a Bachelor's degree as a minimum to practice optometry. Use of diagnostic drugs is prohibited in 20% of the countries, with 25% of the countries limiting the use of therapeutic pharmaceutical agents. Conclusion: Many countries where optometry is recognized struggle to have an adequate number of optometrists; this hinders access to eye care. This is compounded by unregulated minimum levels of education for entry-level optometric practitioners. In addition, several countries limit or prohibit many optometric procedures that restrict the ability of optometrists to provide eye care and vision health services at the primary care level.

Perceptions of the role of dentists in human papillomavirus and COVID-19 vaccinations: Results of a cross-sectional validated survey of adults.

BACKGROUND: Human papillomavirus (HPV) and COVID-19 are contagious diseases for which effective vaccines exist. Dental care professionals' involvement in vaccination campaigns for these conditions has been proposed, but there is a lack of understanding of dentists' roles in vaccination, specifically assessing patients' attitudes around dentists as vaccinators for HPV and COVID-19. METHODS: Using a cross-sectional design and convenience sampling, a 12-item validated survey was distributed to community members to determine perceptions about dentists' roles in vaccination for HPV and COVID-19. Demographic characteristics, vaccination status, knowledge of the diseases, vaccination intentions, and willingness to receive education about, recommendations for, and administration of vaccine from a dentist were assessed. Responses were analyzed using bivariate and multivariate analysis. RESULTS: Of 618 participants, most were vaccinated previously against HPV and COVID-19 (n = 462 [75.6%] and n = 371 [61.0%], respectively). Participants responded more favorably to dentist involvement in educating, discussing, and administering COVID-19 vaccines than HPV vaccines (P < .05). Participants' knowledge of HPV was found to be low compared with that of COVID-19. There were significant differences across demographic groups, with race most frequently associated with differences in responses to COVID-19 and HPV-related questions. CONCLUSIONS: Formative data to develop interventions to support dentists' participation in vaccination campaigns are provided. Participants' acceptance of COVID-19 vaccination over HPV vaccination may reflect the public awareness of COVID-19 vs HPV due to daily relevance of this disease, or the lack of knowledge about HPV, particularly its oropharyngeal impacts. PRACTICAL IMPLICATIONS: The authors provide evidence to support dentists' involvement in vaccine education and distribution, expanding previous literature into evaluation of a new disease context (COVID-19). Lack of knowledge of HPV may affect willingness to receive the HPV vaccine, presenting an opportunity for education.

[Legal and Practical Solutions for the Expanding the Roles of Medical Support Staff Nurses].

PURPOSE: Medical support staff nurses have traditionally performed various supportive tasks for physicians, often extending beyond standard nursing roles. Despite these long-standing practices, there is a notable lack of official recognition and legal protection for these expanded responsibilities, leading to increasing legal concerns. Therefore, there is a need for proposing a rational solution to address these issues. METHODS: The number of medical support staff nurses is rising, particularly as they fill gaps left by the 2024 resident physician strike. The study focuses on identifying potential challenges arising from this shift and developing strategic improvements to address these challenges effectively. RESULTS: This study proposed legally expanding the scope of nursing duties and creating a robust system for training and certifying nurses to handle these responsibilities effectively, by integrating these roles within the advanced practice nurse (APN) framework. CONCLUSION: Integrating these roles within the framework of APN can offer a sustainable and legally sound solution to the ongoing healthcare crisis, ensuring patient safety and safeguarding healthcare workers' legal rights.

Value of interventional radiology and their contributions to modern medical systems.

Interventional radiology (IR) is a unique specialty that incorporates a diverse set of skills ranging from imaging, procedures, consultation, and patient management. Understanding how IR generates value to the healthcare system is important to review from various perspectives. IR specialists need to understand how to meet demands from various stakeholders to expand their practice improving patient care. Thus, this review discusses the domains of value contributed to medical systems and outlines the parameters of success. IR benefits five distinct parties: patients, practitioners, payers, employers, and innovators. Value to patients and providers is delivered through a wide set of diagnostic and therapeutic interventions. Payers and hospital systems financially benefit from the reduced cost in medical management secondary to fast patient recovery, outpatient procedures, fewer complications, and the prestige of offering diverse expertise for complex patients. Lastly, IR is a field of rapid innovation implementing new procedural technology and techniques. Overall, IR must actively advocate for further growth and influence in the medical field as their value continues to expand in multiple domains. Despite being a nascent specialty, IR has become indispensable to modern medical practice.

Veterinary and pet owner perspectives on addressing access to veterinary care and workforce challenges.

Objectives: (1) Assess and compare the perceptions of pet owners and veterinary professionals pertaining to the extent of veterinary workforce and access to care challenges in 2023 in Colorado, and (2) Assess what programs, policies, and resources veterinary professionals and pet owners believe would be most effective at addressing access to care and workforce challenges in Colorado. Sample: 736 veterinarians, veterinary technicians, or practice/owner manager ("veterinary professionals") in Colorado. A total of 1,209 pet owners (919 from an online survey and 290 from in-person surveying). Procedures: Distribution of an online anonymous survey to veterinary professionals in Colorado. Pet owners were surveyed both online and in-person at pet pantry or shelter events. Results: Veterinary professionals reported significant workforce challenges, including having to frequently divert clients, clients forced to decline medical care or having to euthanize their pets due to cost. Veterinary professionals were especially supportive of policy efforts to enhance recruitment and retention of technicians, including through mechanisms such as clarifying their scope of practice, loan repayment programs, and enhancing career pathways. Colorado pet owners' responses pertaining to the scope of access to care challenges were similar to prior national research. Pet owners reported particularly needing low-cost emergency clinics in their community as well as resources to reduce the cost of care. Pet owners were generally supportive of expanding veterinary care access through telemedicine; indicating they would feel comfortable seeing a veterinarian via telemedicine, even for the first time, and that expanded use of telemedicine would increase their ability to obtain care. Conclusions and clinical relevance: Colorado pet owners and veterinary professionals both identified numerous access to care challenges as well as indicated support for the development of several potential initiatives to address the problem. Low-cost clinics that provide sick and emergency care was the resource rated as being most helpful among pet owners. Further exploration of grants, voucher programs, expansion of telemedicine, increased utilization and title protection for CVTs, and the creation of the veterinary professional associate position are all initiatives that were noted to be worthy of further exploration.

Tiered Licensure for Pharmacy Technicians: Is the Advanced Pharmacy Technician (APhT) License the Model for State Regulators?

Two states-Connecticut and New Hampshire-have created or attempted to create advanced pharmacy technician (APhT) licenses. Both licenses, proposed and actual, have high barriers to entry, such as requiring 1 to 3 years of prior technician experience and passage of various assessments or trainings, such as a state-specific jurisprudence exam. Those obtaining APhT licensure are granted additional authority, such as performing final product verification (e.g., tech-check-tech) and vaccine administration. Compared with practices in other states, the APhT role in CT and NH provides minimal scope gains relative to the requirements imposed; as a result, there has been limited uptake (<1%) among current technicians. As such, it appears unlikely that tiered licensure for technicians will be the preferred mechanism for states to expand the role of pharmacy technicians in the future.

'The Emperor's new clothes?' Healthcare professionals' perceptions of the nursing associate role in two UK National Health Service hospitals: A qualitative interview study.

Background: The introduction of nursing associates in England in 2017 as a professional 'bridging' role aimed to mitigate chronic staffing shortages, enable career progression of healthcare assistants and release registered nurses to provide more complex care. Limited evidence exists about the alignment between the identity and purpose of nursing associate roles described by the UK independent regulator, the Nursing & Midwifery Council, and the expectations, obligations, and team dynamics encountered in practice. Purpose: Investigate the perceptions of nursing associate roles through the views and experiences of role holders, registered nurses, and healthcare assistants. Setting: Two British National Health Service (NHS) Hospital Trusts in London, England (UK). Methods: For this registered service evaluation, data were collected via in-person, semi-structured interviews. Verbatim transcripts were coded inductively. An adapted framework analysis method, suitable for use with Excel, was applied to support the identification of cross cutting themes. We used the Standards for Reporting Qualitative Research checklist for reporting this study. Results: Eleven registered nurses, five nursing associates, and five healthcare assistants participated. Their experiences seldom reflected the policy vision of the nursing associate role in practice. Several participants likened the nursing associate role to the fable of the 'Emperor's New Clothes' in which expectations and reality diverge. With this over-arching theme, four sub-themes were identified: (1) preparedness of organisational infrastructure to support this role; (2) credibility of the role in practice; (3) perceived organisational "blindness" to the ambiguities of the role and (4) increasing task orientation and segmentation in care delivery. Conclusion: There is a discrepancy between the identity of the nursing associate role as imagined in the policy agenda and its reality in practice. There is a need for more protected and well-defined training, clear role boundaries, and accessible career progression pathways for nursing associates. Moreover, honest dialogue at an organisational and policy level must continue, so that the challenges and opportunities of the nursing associate role are properly realised. Tweetable abstract: Emperor's new clothes! Experiences and views of new nursing associate roles in NHS (UK) acute hospitals @CarolynSpring3.

Overcoming Barriers to Healthcare Reform: A Call to Action.

The success of healthcare reform hinges on policymaker, regulator, and administrator actions that shape policies at various levels. These policies can either facilitate or hinder the practice of healthcare professionals and collaborative work environments. It is imperative for all healthcare professionals to fully utilize their education and certification, as fostering an equitable workplace culture is vital for retaining staff and improving access to care. Using nurse practitioners (NPs) as an exemplar, this article aims to specify systemic barriers to healthcare reform and call for policymakers, regulators, and clinical agency administrators to enact change. Barriers to NP practice include restrictive oversight by external stakeholders, financial incentives for indirect billing, and hierarchical constraints that limit NP contributions to the healthcare system. The growing healthcare provider shortage disproportionately impacts primary care and rural settings. NPs are increasingly more likely to fill these roles than medical doctors and have documented positive patient health outcomes. Removing systemic obstacles for NP practice increases access to care. Nursing-the largest healthcare workforce with diverse roles-operates under complex oversight from multiple organizations for licensure, accreditation, certification, and education. The recent trend of external stakeholders influencing and requiring additional oversight has created barriers to nursing practice. Despite national education, accreditation, and certification standards, nursing licensure and practice are increasingly negotiated with external stakeholders and supervised at the state and institutional levels. Supporting all healthcare professionals to practice according to their education and certification can advance healthcare reform, address workforce shortages, increase access to care, and improve health.

Pharmaceutical Activities, Services, Medicines, and Products at Community Pharmacies in the Qassim Region of Saudi Arabia: Findings and Implications for the Future.

Introduction  Community pharmacies are highly accessible and provide access to several services to patients and community members. Recently, several developments have been made in Saudi Arabia to enhance the roles and contributions of community pharmacists to the healthcare system, including expanding their scope of practice. This study aims to evaluate the current pharmaceutical activities, medicines, products, and services offered by community pharmacies.  Methods This was a cross-sectional questionnaire-based descriptive study. The questionnaire consisted of three sections. The first section comprised the demographic characteristics of the participants. The second section explored the types of pharmaceuticals and products sold by community pharmacies, while the third section explored the current professional services and activities offered by pharmacies. This study was conducted among community pharmacists in the Qassim region of Saudi Arabia. Results  Overall, 109/115 community pharmacies participated in the study, yielding a response rate of 94.78%. Most participants (97.25%) were men, and 42.20% were 31-40 years old. All pharmacies (100%) dispensed prescriptions and provided over-the-counter medicines, self-care therapeutics, vitamins, minerals, and dietary supplements. However, only a few pharmacies had controlled and narcotic medicine services (5.50%) and supplied vaccines (3.67%). Almost all pharmacies provided access to herbal products (97.25%), self-diagnostic test/home-test kits (97.25%), first-aid kits (95.41%), and medical equipment and devices and their accessories (89.91%). All pharmacies (100%) sold health-related products, including oral, skin, and hair care products. All pharmacists (100%) provided medication counseling. However, e-prescription services (Wasfaty) were provided in only 55.96% of the pharmacies. Most pharmacists provided health education and promotion (95.41%), management of minor ailments (88.99%), and patient training on the use of medical devices (92.66%). Other pharmaceutical activities included travel health advice (52.29%) and smoking cessation (31.19%). However, patient care services, including vaccination services (0.92%), patient assessment and monitoring services (0.92%), and point-of-care (POC) testing (0.92%), were limited. Additional services included online shopping (66.97%), home delivery of medicines (54.13%), and instant/live chat communication with pharmacies (70.64%). Conclusion  Community pharmacies play a crucial role in Saudi Arabia's healthcare system. These include providing access to medicines, medical equipment, and various products related to health and wellness. Community pharmacies provide public health services. However, their clinical services are limited. Consequently, a holistic strategy involving all stakeholders is required to further enhance the role of community pharmacists and better utilize their skills and training to provide preventive healthcare services and optimize medication therapy in primary care settings.

Prescription for Digital Evolution: Transformative Recommendations for Pharmacy Practice in the Digital Age.

Increased administrative tasks, evolving expectations of care and advancement in practice scope have rapidly advanced digital health. Health policy has acknowledged the need for evaluation to determine the technological needs of clinicians, including pharmacists, to practice to full and top of scope. There is an emergent need for recommendations to address the technological transformation to enable community pharmacists' practice. This study aimed to develop digital health recommendations, through expert consensus, for the government, pharmacy professional associations, pharmacy enterprises and software vendors, to facilitate community pharmacists' practice. A modified Delphi survey was conducted online in February-March 2024. Pharmacists with digital health expertise were purposively recruited. Participants were asked to rate their level of agreement with the initial 24 research-derived statements in round 1. Consensus was defined a priori as ≥80% of participants strongly agreeing or agreeing with a statement and a standard deviation of ≤1.00. Review of participants' free-text comments progressively reduced and refined the statements. All 22 participants completed the modified Delphi study in 3 survey rounds. Participants represented every Australian jurisdiction. Eighteen participants had more than 10 years of professional experience. Sixteen recommendations emerged: 6 for government, 2 for pharmacy professional associations, 4 for pharmacy enterprises and 4 for software vendors. The majority of recommendations require financial investment and harmonization of legislation across jurisdictions. Adoption of these recommendations, with significant investment across partners in the healthcare system and technology providers, will enable pharmacists to more effectively and safely practice utilizing technology solutions.

National Nursing and Midwifery Commission Act, 2023 in India: Issues and the Way Forward.

With the recent enactment of the National Nursing and Midwifery Commission (NNMC) Act, 2023, significant changes are anticipated in the scope of practice and autonomy for registered nurses and midwives in India. However, alongside these anticipated advancements, concerns have emerged regarding various aspects of the Act, necessitating critical examination. In this article, we aim to explore expected changes in nursing education and service and concerns about the NNMC Act, providing insights into the implications of the NNMC Act on the regulation and advancement of the nursing and midwifery profession in India. The Act is anticipated to introduce uniform standards, implement entry and exit examinations, recognize midwifery as a distinct discipline, and determine the scope of practice for nurses and midwives. Moreover, the implementation of the Nurse Practitioner Program and guidelines for its limited prescribing authority is anticipated. Concerns exist regarding the composition of the commission and board members, adequate stakeholder representation, lacking provisions for ensuring continued competence, working conditions of nurses and midwives, nomenclature, integrating new terms, and clearly defining roles. These concerns emphasize the need for viable career pathways, uniform cadres, and a streamlined registration system, crucial for advancing nursing and midwifery profession in India. The coexistence of concerns and anticipation highlights the complexity of enacting regulatory reforms in nursing and midwifery. Policymakers can lay the foundation for a comprehensive, inclusive regulatory system that promotes excellence in nursing and midwifery practice, ultimately benefiting both healthcare providers and patients.

Chronicling the pursuit for full practice authority in Tennessee: Recommendations for a path forward.

BACKGROUND: The quest for full practice authority (FPA) for Tennessee Advanced Practice Registered Nurses (APRNs) began with promise in the late 1960s. However, progress has stalled in the ensuing time, and prospects for advancing FPA do not look promising. PURPOSE: The purpose of this article is to chronicle the pursuit of FPA in Tennessee, offer reflections on what has transpired to date, and suggest a path forward. METHODS: Various data from various sources were used to chronicle the history of FPA in Tennessee, make the case for its need, and identify better approaches for success. DISCUSSION: As one of a dwindling number of states without FPA, access to primary care health services and the economic vitality of Tennessee communities are of concern. CONCLUSION: The path forward for achieving FPA in Tennessee necessitates changes in approach and players. Specific recommendations are offered.

Midwives' and registered nurses' role and scope of practice in acute early pregnancy care settings in Australia: A qualitative descriptive study.

PROBLEM: There is little documented evidence regarding the practice of midwives providing care for women with acute concerns in early pregnancy (< 20 weeks) in Australia. BACKGROUND: Women can experience unexpected complications at any gestation of pregnancy and may seek acute care in an emergency or gynaecology service, usually staffed by registered nurses (RNs). They may not receive care from specialised pregnancy clinicians, including midwives. The role and scope of practice of midwives working in acute early pregnancy settings in Australia has not been previously reported. This study provides an opportunity to document practice in an area of pregnancy care not often visible within maternity services in Australia. RESEARCH AIM: To describe midwives' and RNs perceptions, perspectives and experiences of role and scope of practice in acute early pregnancy care provision in Australia. METHODS: A qualitative descriptive approach was adopted. Midwives and RNs with acute early pregnancy knowledge and experience were recruited. Semi-structured interviews were conducted, and data analysed using inductive thematic analysis. FINDINGS: Fifteen participants were interviewed. Three themes were constructed from interview data: Personal and Professional Influences; Being There for Women; The Impact of Setting. DISCUSSION: Findings reinforce the lack of clarity around how midwives' scope is enabled in traditional acute early pregnancy care. Setting of care has influenced practice and seen a barrier for midwives who don't hold nursing registration from fulfilling professional scope. Results provide novel benchmarking evidence regarding a largely hidden area of midwifery, signposting areas for reform within education, policy and health service sectors.

Continued restrictions on nurse practitioners: A qualitative study of the early implementation of full practice authority in Massachusetts.

BACKGROUND: In January 2021, the Commonwealth of Massachusetts granted nurse practitioners (NPs) full practice authority (FPA). Little is known about how care delivery changed after FPA legislation. PURPOSE: To understand the NP perception of early implementation of FPA in Massachusetts. METHODS: Qualitative descriptive design using inductive thematic analysis of open-ended responses to a web-based survey of NPs in Massachusetts from October to December 2021. FINDINGS: Survey response rate was 50.3% (N = 144). Inductive thematic analysis of open-ended responses identified four themes, including: (a) internal and external barriers obstructed FPA implementation, (b) employer communication about scope-of-practice changes was minimal, (c) NPs led initiatives to implement FPA, and (d) some efforts effectively implemented FPA. DISCUSSION: Almost 1 year after FPA was passed, external policies persisted that financially incentivized employers to not change NP scope-of-practice. Concerted efforts are needed to ensure that federal and payer policies, such as incident-to billing, are aligned with state law to encourage the implementation of FPA.

Establishment and review of educational programs to train optometrists in laser procedures and injections.

Current scope of practice for optometrists in many countries include topical and oral medication with injectable and lasers being added more recently to scope in the United States (US), Canada, the United Kingdom (UK) and New Zealand (NZ). This expanded scope of optometric practice improves access to eyecare and is critical since an ageing population with a higher prevalence of vision disorders and higher healthcare costs looms. Expanded scope has been shown alongside strong safety records. This review paper aims to investigate the expansion of optometric scope of practice regarding lasers and injectables in the US, UK, Canada, Australia and NZ. The design and delivery of post-graduation educational programs, curriculum frameworks for advanced skills and the metrics of laser procedures performed by optometrists will be discussed. The State of Oklahoma in the US was first to authorise optometrists to use lasers and injectables in 1988. As of 2024, qualified optometrists in the UK, in twelve states in the US, and specialist optometrists in NZ perform laser procedures. However, lasers and injectables are not within the current scope of optometric practice in Australia and Canada. Training courses such as Northeastern State University Oklahoma College of Optometry Advanced Procedures Course and Laser Procedures Course have been successfully designed and implemented in the US to train graduate optometrists. The outcomes of over 146,403 laser procedures performed by optometrists across the US have shown only two negative outcomes, equating to 0.001%. These metrics outline the effectiveness of these procedures performed by optometrists and show strong support for future optometric scope expansion. Eye health professionals, relevant educational institutions, advocacy groups, and policymakers are called upon to work collaboratively to expand the optometric scope of practice globally.

Scope-of-Practice Expansions Associated with Reduced Racial Disparities in Pediatric Mental Health Care.

To examine the association between scope-of-practice (SoP) regulations and racial disparities in pediatric mental health services. We used the National Survey of Children's Health (2016-2020; n = 33,790) to examine racial disparities in unmet mental health care needs and receipt of mental health medication between states with and without SoP expansions for psychologists and nurse practitioners (NP). Our primary outcomes were (1) unmet mental health care needs and (2) receipt of mental health medication. We examined heterogeneous treatment effects of SoP expansion on the outcomes using logistic regression with interaction terms between SoP expansion and race/ethnicity. We estimated population-level racial disparities for both outcomes stratified by SoP expansion to identify differences in racial disparities. The psychologist SoP expansion-associated reduction in unmet need was 15.8 percentage-points (CI= -25.3, -6.2) larger for Other-race children than for White children. The psychologist SoP expansion-associated increase in medication was 5.1%-points (CI=. 0.8, 9.4) larger for Black children and 5.6%-points (CI = 0.5, 10.8) for Other-race children. No differences were found for NP SoP expansion. Racial disparities in both outcomes were lower in psychologist SoP expansion states but varied in NP SoP states. Expanded SoP was generally associated with lower racial disparities in pediatric mental health care access.

Unlocking potential: a qualitative exploration guiding the implementation and evaluation of professional role substitution models in healthcare.

BACKGROUND: As role substitution models gain prominence in healthcare, understanding the factors shaping their effectiveness is paramount. This study aimed to investigate factors that impact the implementation and performance evaluation of professional role substitution models in healthcare, with a focus on understanding the variables that determine their success or failure in adoption, execution, continuity, and outcomes. METHODS: The exploratory qualitative study used semi-structured interviews with key opinion leaders, decision makers, facilitators, recipients, and frontline implementers, who had influence and involvement in the implementation of professional role substitution models. Data analysis was guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS: Between November 2022 and April 2023, 39 stakeholders were interviewed. Factors influencing implementation and evaluation of allied health professional role substitution models of care aligned with the five core CFIR domains (innovation, outer setting, inner setting, individuals, implementation process) and outcome domain incorporating implementation and innovation outcomes. The six themes identified within these CFIR domains were, respectively; i) Examining the dynamics of innovation catalysts, evidence, advantages, and disadvantages; ii) Navigating the complex landscape of external factors that influence implementation and evaluation; iii) Impact of internal structural, political, and cultural contexts; iv) The roles and contributions of individuals in the process; v) Essential phases and strategies for effective implementation; and vi) The assessment of outcomes derived from allied health professional role substitution models. CONCLUSIONS: The study highlights the complex interplay of contextual and individual factors that influence the implementation and performance evaluation of professional role substitution models. It emphasises the need for collaboration among diverse stakeholders to navigate the challenges and leverage the opportunities presented by expanded healthcare roles. Understanding these multifaceted factors can contribute to the development of an empowered workforce and a healthcare system that is more efficient, effective, safe, and sustainable, ultimately benefiting patients.

How do dental practices respond to changes in scope of practice regulations?

Regulations that restrict the tasks that credentialed workers are allowed to perform may affect a firm's input choices, output, and which part of the market the firm serves. Using dental practice survey data from 1989 to 2014 and a stacked difference-in-differences design, this paper examines the effects of state-level scope of practice regulations on the behavior of dental practices. Results suggest that scope of practice deregulation in regards to dental hygienists' ability to administer nitrous oxide or local anesthesia is associated with fewer dentist visits per week in the short-term, lower patient wait times, and an increased likelihood of treating lower revenue generating publicly insured patients. There is weak evidence that scope of practice deregulation alters a practice's labor inputs.

Pharmacists' current and potential prescribing roles in primary care in the Netherlands: a case study.

In some countries, pharmacists have obtained prescribing rights to improve quality and accessibility of care and reduce physician workload. This case study explored pharmacists' current roles in and potential for prescribing in primary care in the Netherlands, where prescribing rights for pharmacists do not exist. Participatory observations of pharmacists working in either general practice or community pharmacy were conducted, as were semi-structured interviews about current and potential practice. The latter were extended to patients and other healthcare professionals, mainly general practitioners, resulting in 34 interviews in total. Thematic analyses revealed that pharmacists, in all cases, wrote prescriptions that were then authorized by a physician before dispensing. General practice-based pharmacists often prescribed medications during patient consultations. Community pharmacists mainly influenced prescribing through (a) medication reviews where the physician and/or practice nurse often were consulted to make treatment decisions, and (b) collaborative agreements with physicians to start or substitute medications in specific situations. These findings imply that the pharmacists' current roles in prescribing in the Netherlands resemble collaborative prescribing practices in other countries. We also identified several issues that should be addressed before formally introducing pharmacist prescribing, such as definitions of tasks and responsibilities and prescribing-specific training for pharmacists.