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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 25.08.2021, 08:58 by Karen Cardwell, Susan SmithSusan Smith, Barbara ClyneBarbara Clyne, Laura McCullagh, Emma WallaceEmma Wallace, Ciara Kirke, Tom FaheyTom Fahey, Frank MoriartyFrank Moriarty
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 six 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 (e.g. 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 six weeks after medication review by the pharmacist.
Results: Across four practices, 787 patients were identified as having 1,521 prescribing issues by the pharmacists. Issues relating to potentially inappropriate or high-risk prescribing were addressed most often by the prescriber (51.8%), compared to cost-related issues (7.5%). 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.
Article summary: Strengths and limitations of this study
This is the first study examining the role of general practice-based pharmacists in Ireland and the feasibility of evaluating this role. Integration of pharmacists was limited to four general practices, although these were diverse in terms of practice characteristics. A range of medication and patient-reported outcome measures data were collected, although because this was a pilot study there was no control group to compare these to.

Funding

Health Research Board Research Collaborative for Quality and Patient Safety Award.

History

Associated research data files

Data and analytical code relating to prescribing issues is available from www.doi .org/10.5281/zenodo.3492198

Comments

The original article is available at https://www.medrxiv.org Published version is available in BMJ Open http://dx.doi.org/10.1136/bmjopen-2019-035087 & RCSI repository https://hdl.handle.net/10779/rcsi.12925190.v1

Published Citation

Cardwell K, et al. Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study. medRxiv 19009910

Publication Date

25 Oct 2019

Department/Unit

  • General Practice
  • HRB Centre for Primary Care Research
  • CICER

Research Area

  • Population Health and Health Services

Publisher

Cold Spring Harbor Laboratory

Version

  • Submitted Version (Preprint)