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Prescribing Practices and Behaviours of Advanced Practice Nurses and Pharmacists: A Nationwide Cross‐Sectional Survey

ABSTRACT

Aim

To explore the prescribing practices and behaviours of Advanced Practice Nurses (APN) and pharmacist prescribers in Singapore, assess their confidence in key prescribing competencies, examine their use of information sources, and understand their views on the consequences of prescribing errors.

Design

Cross-sectional national survey.

Methods

A census survey of all registered APN and pharmacist prescribers in Singapore was conducted from February to May 2024 using a validated 96-item instrument. The survey assessed prescribing practices, confidence in prescribing competencies, use of information sources, and prescribing safety. Descriptive statistics were used for analysis.

Results

Ninety-one prescribers (54 APNs, 37 pharmacists) responded (32% response rate), most of whom worked in public medical/surgical settings. Prescribing comprised a median of 75% of their practice. Most time was spent prescribing continued medications, with less on initiating new medicines. Participants reported high confidence in communication, therapeutic partnerships, and working within professional standards. Greatest confidence was seen in educating patients, legal prescribing, and monitoring treatment response. Lower confidence was noted in complementary medicine-related tasks. Professional literature and colleagues were the most valued information sources. Most participants acknowledged the serious consequences of prescribing errors, though many believed such errors would likely be intercepted.

Conclusion

APNs and pharmacists demonstrate strong competencies in safe, holistic prescribing. However, cultural factors may limit patient engagement, highlighting the need to strengthen shared decision-making and collaborative practice.

Implications for the Profession

Refining governance structures, adopting tiered prescriber autonomy, and enhancing training in complex prescribing are essential. Standardising deprescribing, improving access to decision-support tools, and promoting interprofessional collaboration and patient involvement can strengthen care quality and team-based delivery.

Impact

This study offers the first national insight into Singapore's Collaborative Prescribing Framework and informs training, policy, and workforce development for non-physician prescribers locally and in similar international contexts.

Reporting Method

STROBE checklist.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.

Perceptions of Trans and Gender Non‐Conforming People on General Health Care in the Being LGBTQI+ in Ireland Study

ABSTRACT

Aim

To examine if trans and gender non-conforming participants perceive greater healthcare inequities in their interactions with healthcare practitioners than cisgender sexual minority participants, and analyse free text responses from transgender and gender non-conforming participants to gain possible insight into causes of inequities.

Design

A cross-sectional study.

Methods

An anonymous online survey of over 2800 self-selecting LGBTQI+ participants, 30% of whom identified as trans and gender non-conforming. The research team devised closed and open-ended questions about perceptions of healthcare provision and analysed quantitative responses using SPSS and open-ended data through thematic analysis.

Results

Over half of trans and gender non-conforming participants reported having had occasion to educate healthcare professionals about LGBTQI+ identities and a majority reported that healthcare professionals made incorrect assumptions about their LGBTQI+ identity. Invalidation and pathologisation of participants' trans and gender non-conforming identity and unhelpful therapeutic approaches were some of the negative health experiences cited.

Conclusion

Trans and gender non-conforming populations experience significant barriers to healthcare relative to their cisgender sexual minority peers. Cisnormative thinking in healthcare practice together with a lack of knowledge of trans and gender non-conforming people's experiences leads to substandard care and acts as a barrier to disclosure and help seeking.

Implications

Culturally responsive healthcare is critical to ending health inequities experienced by trans and gender non-conforming people.

Impact

Problem addressed: Healthcare inequities among trans and gender non-conforming participants.

Main findings: Trans and gender non-conforming participants reported more negative perceptions of their healthcare experiences compared to cisgender sexual minority participants.

Where and on whom will the research have an impact? Healthcare educators/practitioners.

Reporting Method

Strobe.

Public or Patient Contribution

Members of the LGBTQI+ community were part of the research advisory group and inputted into paper authorship.

Paper Contribution to the Wider Global Clinical Community

Highlights the need for training to increase cultural competency among healthcare providers.

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