Capturing pharmacists’ impact in general practice: an e-Delphi study to attempt to reach consensus amongst experts about what activities to record

Abstract

Background In the UK, there is ongoing integration of pharmacists into general practice as a new healthcare service in primary care. Evaluation of the service involves national measures that require pharmacists to record their work, on the general practice clinical computer systems, using electronic activity codes. No national agreement, however, has been established on what activities to record. The purpose of this study was to attempt to reach consensus on what activities general practice-based pharmacists should record. Methods The e-Delphi method was chosen as it is an excellent technique for achieving consensus. The study began with an initial stage in which screening of a general practice clinical computer system and discussion groups with pharmacists from two ‘pharmacists in general practice’ sites identified 81 codes potentially relevant to general practice-based pharmacists’ work. Twenty-nine experts (pharmacists and pharmacy technicians from the two sites along with experts recruited through national committees) were then invited by e-mail to participate as a panel in three e-Delphi questionnaire rounds. In each round, panellists were asked to grade or rank codes and justify their choices. In every round, panellists were provided with anonymised feedback from the previous round which included their individual choices along with their co-panellists’ views. Final consensus (in Round 3) was defined as at least 80% agreement. Commentaries on the codes from all e-Delphi rounds were pooled together and analysed thematically. Results Twenty-one individual panellists took part in the study (there were 12 responses in Round 1, 18 in Round 2 and 16 in Round 3). Commentaries on the codes included three themes: challenges and facilitators; level of detail; and activities related to funding. Consensus was achieved for ten codes, eight of which related to activities (general and disease specific medication reviews, monitoring of high-risk drugs and medicines reconciliation) and two to patient outcomes (presence of side effects and satisfactory understanding of medication). Conclusions A formal consensus method revealed general practice-based pharmacists’ preferences for activity coding. Findings will inform policy so that any future shaping of activity coding for general practice-based pharmacists takes account of pharmacists’ actual needs and preferences.

Implementation of pharmacist-led services in primary care: A mixed-methods exploration of pharmacists’ perceptions of a national educational resource package

“…This reluctance to provide support has been seen in previous research. 25 , 44 A possible explanation for this is that GPCPs were recommended to GPs to save time in practice; however, research indicates that pharmacists commencing employment within General Practice require time and support from GPs to help with their initial development. 2 , 15 Research suggests that pharmacists who are supported and integrated sufficiently are most effective, resulting in GPs acknowledging their usefulness.…”

“…Furthermore, internationally there has been an increase in primary care pharmacists, with some adopting competency-based education. 17,[24][25][26][27] It may be that all countries introducing pharmacists into General Practice should utilise competency-based education to help integrate them fully into practice and increase their confidence. However, the benefit of the resource may not be fully realised until its completion is recognised with a qualification indicating an enhanced skill set.…”

“…Countries including Australia, Canada, the Netherlands and the UK have developed competency-based educational resources which outline the tasks that clinical pharmacists should complete in primary care. 17,[24][25][26][27] While these resources have shown to be effective in improving confidence, patient communication, and teamwork, there is little research showing the suitability of competencybased training programs in supporting pharmacists working in the primary care setting.…”

Practice Transformation Driven through Academic Partnerships

“…To make the goal of tracking pharmacist interventions attainable, the process of recording data needs to be practical [ 34 ]. Pharmacists should ask, is there a workflow-based, efficient recording strategy I can utilize?…”

The Role of the Pharmacist in Patient Care (Book Review)

“…Pharmacists also get benefit because there is an increased recognition and respect for the value of the advice and service that they provide [8]. There is a need to increase access to primary care services, control costs, and improve outcomes in health care for patients especially in the management of chronic conditions which puts a strain on health care systems worldwide [9]. Pharmacists' better access to the patients and their acceptability improve patient care by enabling pharmacists to play an even greater role in the provision of safe and effective unscheduled care, treating common clinical conditions and responding to emergency requests for medicines [10].…”