Guidelines for pharmacists integrating into primary care teams

Abstract

PRACTICE GUIDELINESPeer-reviewed Guidelines for pharmacists integrating into primary care teams Derek Jorgenson, BSP, PharmD, FCSHP; Dan Dalton, BSc; Barbara Farrell, BScPhm, PharmD, FCSHP; Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP, FACC; Lisa Dolovich, BScPhm, PharmD, MSc IntroductionHealth systems are moving toward a more interprofessional approach to primary care. This team-based paradigm has had a significant impact on the role of pharmacists within primary health care systems. Within the past decade, nondispensing clinical pharmacists have been integrated into many Primary Care Trusts in the United Kingdom, 1,2 primary care teams in North America 3-5 and similar practice settings around the world. 6,7 Pharmacists bring value to these teams by improving medication use through individual patient assessments and population-based interventions, providing education and drug information to other team members and implementing system-level practice enhancements. Pharmacists commonly encounter barriers to integrating into these primary care teams. For example, many experience a lack of role clarity, and other team members' expectations regarding the pharmacists' responsibilities are frequently unclear. 4,[8][9][10][11] In addition, patients often do not understand the role of the pharmacist in this setting. 9,10,12 Pharmacists are also typically unfamiliar with the roles of other team members, 13 creating difficulties in collaborating successfully.14-16 During the early stages, pharmacists often depend on other team members to assist in their integration, creating additional work for nurses and physicians.17 Other frequently reported barriers include physician resistance, lack of pharmacist assertiveness, inadequate pharmacist support, lack of space and inadequate pharmacist training. [9][10][11]13,14,[17][18][19][20][21] Many of these barriers to pharmacist integration can be minimized or avoided if pharmacists are prepared. Unfortunately, recent evidence suggests that pharmacists often continue to make the same mistakes and struggle to integrate into these teams, despite the fact that these barriers are well documented in the literature. 22 The purpose of these guidelines is to provide recommendations that will assist pharmacists to successfully integrate into existing primary care teams. MethodsA literature search was performed in OVID Books, MEDLINE, Embase and International Pharmaceutical Abstracts to identify publications related to the experiences of pharmacists in primary care teams. Additional studies were identified from bibliographical reviews of pertinent articles. Relevant articles from the search were selected for detailed review if they contained qualitative or quantitative data related to pharmacists' experiences integrating into primary care teams. Articles were excluded if they were not available in the English language. Two authors (DJ, DD) independently reviewed the relevant articles from the search and made lists of authors' conclusions about how pharmacists could have integrated bet...

Impact of Pharmacists in a Community-Based Home Care Service: A Pilot Program

“…When starting new practices, primary care pharmacists often use case-finding strategies to identify patients for pharmacist involvement 22,24 ; however, given the design of the Home Care Program's electronic medical records system, this approach was not feasible. Reliance on referrals, instead of seeking out at-risk patients, may have hampered the full implementation of pharmacist services: early in the pilot period, the team was less aware of the full scope of pharmacist care, indicated by the fact that 23.4% of the initial referrals were requests to print out the patient's medication history.…”

“…Pilot implementation followed the guidelines for integration into primary care teams described by Jorgenson and others. 22 This pilot program was approved by the University of Manitoba Health Research Ethics Board and was conducted in accordance with the Helsinki Declaration.…”

Learning and Networking: Utilization of a Primary Care Listserv by Pharmacists

“…Evolving professional roles and responsibilities in primary care present challenges and opportunities for pharmacists and necessitate collaboration with other health care professionals, as well as with colleagues within the profession. 3 Strategies for collaborative learning, networking, and sharing information among pharmacists have included communication by e-mail listservs for at least 2 decades. [4][5][6] Although listservs are increasingly used to share knowledge in many professional networks, little has been published about how pharmacists use them.…”

“…[14][15][16][17][18] Multiple challenges to team integration have also been identified in the literature. 3 However, few studies have examined the experiences or learning needs of pharmacists who are actively attempting to evolve their primary care practices in the real world.…”

Development of a Pharmacist REferral Program in a primary cARE clinic (PREPARE): A prospective cross-sectional study

“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17] Recently, the Canadian Pharmacists Journal published guidelines for integrating pharmacists into primary care teams and how to apply these guidelines in practice. 18,19 Because pharmacists in primary care clinics do not have a consistent source of patients for whom to provide care (such as patients attending a community pharmacy or patients admitted to a hospital unit), they primarily rely on referrals from other providers to identify patients who may benefit from pharmacy services. However, there are a variety of ways by which a primary care pharmacist may generate referrals, including direct referrals from other clinicians (e.g., physicians, nurses, other pharmacists), questionnaires (e.g., Medication Risk Assessment Questionnaire [MRAQ]), chart reviews or patient self-referrals.…”