Integrating a pharmacist into the general practice environment: opinions of pharmacist’s, general practitioner’s, health care consumer’s, and practice manager’s

Abstract

Background: Pharmacists are viewed as highly trained yet underutilised and there is growing support to extend the role of the pharmacist within the primary health care sector. The integration of a pharmacist into a general practice medical centre is not a new concept however is a novel approach in Australia and evidence supporting this role is currently limited. This study aimed to describe the opinions of local stakeholders in South-East Queensland on the integration of a pharmacist into the Australian general practice environment. Methods: A sample of general practitioners, health care consumers, pharmacists and practice managers in SouthEast Queensland were invited to participate in focus groups or semi-structured interviews. Seeding questions common to all sessions were used to facilitate discussion. Sessions were audio recorded and transcribed verbatim. Leximancer software was used to qualitatively analyse responses. Results: A total of 58 participants took part in five focus groups and eighteen semi-structured interviews. Concepts relating to six themes based on the seeding questions were identified. These included positively viewed roles such as medication reviews and prescribing, negatively viewed roles such as dispensing and diagnosing, barriers to pharmacist integration such as medical culture and remuneration, facilitators to pharmacist integration such as remuneration and training, benefits of integration such as access to the patient's medical file, and potential funding models. Conclusions: These findings and future research may aid the development of a new model of integrated primary health care services involving pharmacist practitioners.

Educational and Career Goals of Pharmacy Students Upon Graduation

“…Pharmacists are assuming nontraditional clinical roles as well as prescribing responsibilities. [5][6][7][8][9][10] This change in the scope of pharmacy practice has been fueled, in part, by healthcare reform (eg, the implementation of the "medical home"). [11][12][13][14][15] Given the present workforce environment, full-time pharmacist employment postgraduation will continue to be more competitive.…”

Advocating for Patients and the Pharmacist's Role in Primary Care

“…MedsChecks, Diabetes MedsChecks and Clinical Interventions by pharmacists), none of which is supported by any evidence in the context of the Australian healthcare setting. Conversely, there is evidence on the value of HMRs to consumers, 2,5,6 a demonstration of cost savings of up to $550 per HMR to the health system, 7-10 and a demonstrable track record that clearly illustrates the delivery of a truly collaborative service between GPs, patients, independent accredited pharmacists and other community or hospitalbased pharmacists [11][12][13][14][15][16][17][18] (Fig. 1).…”

“…Australian studies have demonstrated that HMRs can resolve, manage or reduce medicine-related problems for a wide range of patients. [11][12][13][14][15][16][17][18][19][20][21] In addition, HMRs improve health outcomes; for example, in patients receiving betablockers for heart failure, an HMR resulted in a 45% reduction in likelihood of hospitalisation for heart failure at any time. 18 Another study found that an HMR in patients taking warfarin resulted in a 79% reduced likelihood of bleeding-associated hospitalisation 2-6 months after…”

“…12,13 Recent Australian research by innovators Dr Christopher Freeman and Edwin Tan has reported similar results. [14][15][16][17] Specifically, Freeman has shown that a practice pharmacist increases the timeliness and completion rate of HMRs. 18 Further, this work shows that access to the patient's medical file facilitates a more targeted and less theoretical medication review.…”

Implementation of pharmacist-led medication reviews in general practice

“…Nevertheless, the continued high rates of preventable ADEs, particularly among older people, suggest that initiatives like this fulfil an important need [11]. Previous research has shown support for this model among GPs and pharmacists in Australia and Canada [12][13][14]. Freeman et al provide an example of how it is possible for pharmacists to work within the framework of a national program to innovate at a local level.…”