Clinical intervention rates in community pharmacy: a randomised trial of the effect of education and a professional allowance

Abstract

Objectives To quantify the rate of clinical interventions by community pharmacists, and to determine the effect of providing targeted education and/or fee‐for‐service professional remuneration on the rate of clinical interventions. Methods A randomised trial involving four groups of 10 community pharmacies: group A served as a control and received neither education nor remuneration; group B received education and professional remuneration; group C received “advanced” education and professional remuneration; and group D received professional remuneration with no education. Pharmacists in all groups documented interventions for three one‐week periods. Types of intervention were pre‐specified by the researchers and logged as such by the pharmacists. Interventions were categorised as “reactive” or “proactive” by a panel comprising a community pharmacist and a hospital pharmacist. Logistic regression analysis was used to compare differences in intervention rates between the groups at baseline, between groups over time (six weeks), and within groups over time. Results 87,130 prescription items were dispensed in the study period, and there were 762 clinical interventions, an intervention rate of 0.87%. Of the total, 375 (0.43%) were proactive and 387 (0.44%) were reactive. Groups B and C showed increases in clinical intervention rates immediately after the educational intervention, but these rates then decreased between week 1 and 2. Over the study period, group D had statistically significant reductions in intervention rates from baseline (total, reactive and proactive), and group A showed statistically significant reductions in reactive intervention rates. Conclusions The results from this study show that providing remuneration alone or maintaining the status quo (ie, neither remuneration nor education) did not lead to an increase in clinical interventions in community pharmacies. Increases in rates within the groups receiving education and remuneration were short lived. Developing and implementing educational programmes in addition to fee‐for‐service remuneration packages may have a positive impact on clinical intervention rates. Longitudinal work is required to investigate the sustainable effects of longer‐term education strategies on clinical interventions in community pharmacy.

Classification of drug-related problems with new prescriptions using a modified PCNE classification system

“…Thus, a documentation and classification system is urgently needed. Intensive training can increase the number of interventions without increasing the time spent on documentation [28,29]. As Lampert [9] reported, the PCNE system with its classification of each DRP on four different levels gives enough detail to allow qualitative and even economic analyses.…”

Practical evaluation of the drug-related problem management process in Swiss community pharmacies

“…One incentive may be a training program, since the level of training of the pharmacist and staff tends to increase the intervention rate [22]. Intensive training can increase the number of interventions without increasing the time spent on documentation [6,24]. Specific continuing education programs could maximize the uniformity in codification among pharmacists.…”

“…Although prescription control by pharmacists improves clinical effects [2][3][4], cost savings [5,6], and collaborative care [7], the absence of nationwide data based on a well-defined system in Switzerland leads to doubts regarding the reality and effectiveness of prescription control in Swiss pharmacies. In Switzerland, pharmacist remuneration systems integrate professional fees for basic cognitive services, including the control of medical prescriptions, related patient counselling, and management of medication records [8].…”

A Computer Simulation of Community Pharmacy Practice for Educational Use

“…1 One of their most valuable services is performing clinical interventions, where they identify an actual or potential drug-related problem (DRP) and take actions to resolve it. 2,3 In order to detect and resolve DRPs, the pharmacist must not only have extensive clinical knowledge of the multitude of problems that can occur, but must also be sufficiently trained to detect the problems, which may require targeted communication with the patient, prescriber, and/or referral to patient records. At the same time the community pharmacist is under significant time pressure, with typically heavy workloads and waiting patients, so it is important that the pharmacist's investigation be efficient.…”