Previous studies have found that integrating non-dispensing pharmacists in general practice may improve patient safety, improve patient outcomes, deliver health system efficiencies and generate savings. However, the employment of pharmacists in general practice is not common in Australia. A naturalistic study was conducted in the Australian Capital Territory with three general practices, each employing a part-time pharmacist for 12 months. This study reports on stakeholder perspectives of the benefits, barriers and enablers for integrating pharmacists into general practice. Patients, practice staff and community pharmacists that had interacted with a practice pharmacist were asked to complete a self-administered questionnaire. Patient questionnaire respondents (n=44) reported that a practice pharmacist was beneficial and wanted to see this continue. Practice pharmacists were also perceived beneficial by primary healthcare employees surveyed (n=42). Opinions were further explored by individual semi-structured interviews (n=20). The qualitative data explored five themes: perception of the practice pharmacist, collaboration with doctors, pharmacist roles, sustainability and community pharmacy aspects. Patients welcomed improved understanding about their medication, whereas general practice staff appreciated pharmaceutical advice about patients with chronic conditions. Participants discussed options to fund practice pharmacists longer term, which was identified as the main barrier to widespread roll out.

SummaryWhat is known and objective: Proton pump inhibitor (PPI) prescribing may often be inappropriate and expose patients to a risk of adverse effects, while incurring unnecessary healthcare expenditure. Our objective was to determine PPI usage in Australia since 2002 and review international studies investigating inappropriate PPI prescribing, including those that discussed interventions to address this issue. Methods: Australian Pharmaceutical Benefits Scheme (PBS) and RepatriationPharmaceutical Benefits Scheme (RPBS) data were analysed. A narrative literature review relevant to the objective was conducted. Time series analysis was also used to examine the trend of reported PPI appropriate use across the international studies included in this review. Results and discussion K E Y W O R D Sdeprescribing, gastro-oesophageal reflux, PPI, prescribing patterns, proton pump inhibitor

Background: Asthma is principally managed in general practice. Appropriate prescribing and medication use are essential, so general practice pharmacists appear suitable to conduct asthma management consultations. This pilot study aimed to evaluate the asthma management role of a pharmacist in general practice. Methods: Analysis of an activity diary and stakeholder interviews were conducted to identify interventions in asthma management; determine whether asthma control changed following pharmacist input; and determine acceptability of asthma management review by a pharmacist in one general practice in Canberra, Australia. Results: Over 13 months, the pharmacist saw 136 individual patients. The most common activities were asthma control assessment; recommendations to adjust medication or device; counselling on correct device use; asthma action plan development and trigger avoidance. For patients with multiple consultations, the mean Asthma Control Test score improved from the initial to last visit (14.4 ± 5.2 vs. 19.3 ± 4.7, n = 23, p < 0.0001). Eight of the 19 (42%) patients moved from having poor to well-controlled asthma. Case studies and qualitative data indicated probable hospital admission avoidance and stakeholder acceptability of asthma management by a practice pharmacist. Conclusions: This pilot study demonstrated it is feasible, acceptable and potentially beneficial to have a general practice pharmacist involved in asthma management. Fuller evaluation is warranted.

In Australia and elsewhere, chlamydia screening rates for those aged between 16 and 30 years continue to be low. Innovative, age-appropriate approaches are necessary to increase chlamydia screening among this target group to prevent short- and long-term consequences of the infection such as pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy and infertility. Studies have demonstrated that offering chlamydia screening in community pharmacies may be a useful adjunct to current screening services. Approximately 90% of Australians visit a pharmacy at least once a year. Chlamydia screening and education in community pharmacies with remuneration may provide another option for opportunistic testing as part of a national chlamydia screening scheme. Compensation is an accepted practice in the field of research and has been demonstrated to improve adherence to health promotion activities. In 2011, a cross-sectional study of community pharmacy-based chlamydia screening offered in conjunction with an A$10 cash incentive to participate was conducted in the Australian Capital Territory. As part of this study young people were asked about their experience of, and views about, pharmacy-based chlamydia screening. The views of consented participants were collected using the one-page questionnaire consisting of 10 closed questions and one open-ended question. Participants completed the questionnaire when they returned their urine sample and before being given the cash incentive. Overall participants were highly satisfied with the pharmacy-based chlamydia screening service. Over 60% of questionnaire respondents felt that the payment did affect their decision to have the chlamydia test, and 23% stated that it made no difference. Young people reported that pharmacy-based screening is acceptable and convenient. Accessibility and the small cash incentive played significant roles in increasing participation.

No abstract

Providing a cash reward to encourage chlamydia screening in community pharmacies resulted in greater participation rates than previously reported pharmacy-based studies, particularly among men. Easily implemented mechanisms to reduce inappropriate repeat screening, incorrect contact details and effects on pharmacy work flow may enhance the efficiency of this approach.

INTERNATIONALLY, pharmacists have become increasingly integrated into general practice clinics. 1,2 It has been reported that general practice pharmacists perform a range of clinical and administrative duties related to their expertise in medication use and safety; the clinical activities typically include providing drug information to practice staff, educating patients, reviewing medication, undertaking health promotion, and conducting disease management clinics. 1-4 The primary purpose of a general practice pharmacist is to support general practitioners (GPs) to minimise the risks associated with medicines and optimise patient outcomes through the quality use of medicines. 2 The co-location of pharmacists with GPs can enhance interprofessional communication and the development of collaborative working relationships. It can also reduce fragmentation of care and facilitate the delivery of patient-centred interdisciplinary chronic disease and medication management services. A general practice pharmacist can also improve communication between GPs and pharmacists working in community pharmacies and provide a link to existing community pharmacy services. 2 Evidence suggests that general practice-based medication reviews by a pharmacist can be more facilitating than a community pharmacybased service, 5 with key facilitators being: • an established pharmacist-GP relationship • pharmacists having access to medical records to improve the quality and appropriateness of their recommendations • a face-to-face meeting (case conference) between pharmacist and GP to discuss the pharmacist's recommendations. A systematic review by Tan et al found that pharmacists co-located in general practice clinics delivered a range of activities with favourable results in chronic disease management and the quality use of medicines, yet none of the included studies were from Australia. 1 Drawing on the skills of other health professionals is also one approach to tackling the workload pressures in general practice, although previous studies suggest that the main impact of practice-based pharmacists is on quality and safety rather than on GPs' workload. 6 While there has been a strong move to incorporate allied health professionals and nurses within GP-led multidisciplinary teams in Australia, this, to a large extent, has not included pharmacists. 7 Instead, the integration of pharmacists into general practice in Australia has been developing slowly, 2,3 particularly in comparison to the UK, where NHS England has committed to fund an extra 1500 pharmacists to work in general practice by 2020-21 (bringing the coverage to >40% of all practices). 8 In 2015, the Australian Medical Association (AMA) proposed a model whereby general practice

No abstract