Clinical pharmacists working within family practice: What is the evidence?

There is increasing interest in the role of clinical pharmacists in primary care and family practice. They differ from community pharmacists in that they work directly with physicians, other health care professionals and patients with the aim of optimizing patients’ medication regimens, health outcomes and coordination of care. These pharmacists also play a key role in the education of patients with chronic disease. This is occurring in the context of a rising prevalence of long-term conditions (multimorbidity), multiple medicines (polypharmacy) and increased health care service utilization. Prescribing in the context of multimorbidity and polypharmacy is complicated, due to an increased potential for drug–drug interactions, adverse drug reactions and potentially inappropriate prescribing, a term used to describe suboptimal prescribing practices such as over-prescribing of certain medications such as opiates, misprescribing and under-prescribing. Moreover, disease-specific national prescribing guidelines are based on evidence derived from populations which do not necessarily reflect patients with more complex multimorbidity. Consequently, the management of these patients is difficult, particularly for family practitioners as there is often fragmentation and poor communication between primary and secondary care settings. The recognition of the need to support family practitioners in the management of these patients has led to the integration of non-dispensing, clinical pharmacists into the family practice team.