Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis

Dear Sir or Madam,

There appears to be some confusion by Clark et al with regards to the
term 'nurse prescribing'. The objective of Clark et al's review is to
'review trials of nurse led interventions for hypertension in primary care
to clarify the evidence base, establish whether nurse prescribing is an
important intervention, and identify areas requiring further study.'

Clark et al claim that 9 of the studies reviewed include 'nurse
prescribing in their protocol'.

However, at no stage in each of the studies reviewed, do the authors
of the studies talk about nurse prescribing. Interventions provided by
nurses in each of these 9 studies comprised life style
advice/education/support and monitoring and titration of medicines
according to locally agreed guidelines/predefined treatment
algorithms/protocols. Throughout their review, Clark et al describe these
activities as prescribing. They are not. Furthermore, the 2 studies from
the United Kingdom, reviewed by Clark et al, were undertaken prior to the
legislation permitting nurses to prescribe.

As the studies are not about nurse prescribing, it is impossible to
see how Clark et al have met the stated objective of their study and so
reached the conclusions that they have (namely, 'there is some evidence of
improved outcomes with nurse prescribers, but there is no evidence of good
quality from United Kingdom studies of essential hypertension in primary
care').

The UK has the most extended prescribing rights for nurses worldwide,
and many countries are looking to follow our example. It is, therefore,
important that the term 'prescribing' is used appropriately and correctly.
The definition of prescribing by the Department of Health (DoH) is useful:

'prescribing by a practitioner (e.g. doctor, dentist, nurse,
pharmacist) responsible and accountable for the assessment of patients
with undiagnosed or diagnosed conditions and for decisions about the
clinical management required, including prescribing.'(1)

Reference
1) DoH. Improving Patients' Access to Medicines: A Guide to Implementing
Nurse and Pharmacist Independent Prescribing within the NHS in England.
London:DoH, 2006