ARTICLEFull text free online at nps.org.au/australianprescriberThe practice pharmacist: a natural fit in the general practice team SUMMARYThere is evidence that pharmacist integration into the general practice team may improve clinical and non-clinical outcomes.The roles of the practice pharmacist can be considered under three categories -patient-directed roles, clinician-directed roles and system-or practice-directed roles.The integration of pharmacists into the general practice team would reduce fragmentation of patient care and medication misadventure.If practice pharmacist services are to be flexible to suit the heterogeneity of general practices, a flexible funding model is needed. The evidenceThe majority of the current evidence examining an integrated model of pharmacist and GP care is positive. A recent systematic review and metaanalysis of pharmacist-delivered services in general practice included 38 studies. Of these, 25 reported positive effects on at least one primary outcome measure and 13 demonstrated no effect. 10Interventions usually involved medication review, with or without other activities delivered with the GP such as education, medication monitoring and adjusting therapy. Four clinical markers were used to assess the effect of interventions -blood pressure, glycosylated haemoglobin, cholesterol, and the Framingham Risk Score. Results of the metaanalysis favoured the pharmacist intervention with significant improvements observed in all clinical markers compared to the control groups. Positive effects were more likely to be seen with pharmacistdelivered multifaceted interventions in conjunction with follow-up of patients compared to interventions that delivered a service in isolation. There was limited or no effect on outcomes related to quality of life, patient satisfaction, symptoms, and use of health service.Individual studies have shown improvements in other outcomes including:• identification and reduction of medicine-related problems • patient adherence to medicines • process measures such as timeliness • appropriateness of prescribing • reduction in total number of medications. 11-16

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