Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care - a non-randomised pilot study.pdf (332.88 kB)
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Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study

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posted on 07.09.2020 by K Cardwell, Susan Smith, Barbara Clyne, L McCullagh, Emma Wallace, C Kirke, Tom Fahey, Frank Moriarty
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

OBJECTIVE: Limited evidence suggests integration of pharmacists into the general practice team could improve medicines management for patients, particularly those with multimorbidity and polypharmacy. This study aimed to develop and assess the feasibility of an intervention involving pharmacists, working within general practices, to optimise prescribing in Ireland.

DESIGN: Non-randomised pilot study.

SETTING: Primary care in Ireland.

PARTICIPANTS: Four general practices, purposively sampled and recruited to reflect a range of practice sizes and demographic profiles.

INTERVENTION: A pharmacist joined the practice team for 6 months (10 hours/week) and undertook medication reviews (face to face or chart based) for adult patients, provided prescribing advice, supported clinical audits and facilitated practice-based education.

OUTCOME MEASURES: Anonymised practice-level medication (eg, medication changes) and cost data were collected. Patient-reported outcome measure (PROM) data were collected on a subset of older adults (aged ≥65 years) with polypharmacy using patient questionnaires, before and 6 weeks after medication review by the pharmacist. RESULTS: Across four practices, 786 patients were identified as having 1521 prescribing issues by the pharmacists. Issues relating to deprescribing medications were addressed most often by the prescriber (59.8%), compared with cost-related issues (5.8%). Medication changes made during the study equated to approximately €57 000 in cost savings assuming they persisted for 12 months. Ninety-six patients aged ≥65 years with polypharmacy were recruited from the four practices for PROM data collection and 64 (66.7%) were followed up. There were no changes in patients' treatment burden or attitudes to deprescribing following medication review, and there were conflicting changes in patients' self-reported quality of life.

CONCLUSIONS: This non-randomised pilot study demonstrated that an intervention involving pharmacists, working within general practices is feasible to implement and has potential to improve prescribing quality. This study provides rationale to conduct a randomised controlled trial to evaluate the clinical and cost-effectiveness of this intervention.

Funding

This research was supported by the Health Research Board Research Collaborative for Quality and Patient Safety Award.

History

Associated research data files

Data and code: Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non‐randomised pilot study https://doi.org/10.5281/zenodo.3492198

Comments

The original article is available at https://bmjopen.bmj.com/

Published Citation

Cardwell K, Smith SM, Clyne B, McCullagh L, Wallace E, Kirke C, Fahey T, Moriarty F. Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study. BMJ Open. 2020;10:e035087.

Publication Date

28 Jun 2020

PubMed ID

30002869

Research Area

  • Population Health and Health Services

Publisher

BMJ

Version

  • Published Version (Version of Record)

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