Integration and impact of pharmacists in general practice internationally: A rapid review

Abstract

Objective English general practices have been facing ongoing pressures, arising from complicated health care needs and the recent pandemic. To overcome these pressures and reduce the workload of general practitioners, there have been extensive attempts to integrate pharmacists into general practices. A number of literature reviews, often systematic, have partially explored the topic of general practice-based pharmacists (GPBPs) internationally. Our aim was to further explore the employment/integration models of GPBPs and their actual activities and impact, concepts that have not been thoroughly investigated by previous reviews. Methods Two databases were searched from inception to June 2021 for studies published in the English language. Results were independently screened by two reviewers to establish eligibility for inclusion. Original research studies, or protocols where results had not been released at the time of search, that reported on services provided by pharmacists with some sort of integration into general practices were included. The studies were analysed using narrative synthesis. Results Searches identified 3206 studies in total, of which 75 met the inclusion criteria. The included studies were highly heterogeneous in terms of participants involved and methodologies employed. Integration of pharmacists into general practices has occurred in several countries, with funds originating from multiple sources. Several employment models for GPBPs were described – for example, part-time and full-time work and/or coverage of multiple or single practices. GPBP activities, with some exceptions, were comparable between different countries, with medication reviews being the most common task globally. GPBP impact was identified through both observational and/or interventional research methods, by pursuing a large variety of measures (e.g. activity volume, contact with patients, perceptions/experiences, and patient outcomes). Independent, quantifiable outcomes from GPBP activities were all positive but were of varying statistical significance. Conclusions Our findings suggest that GPBP services can lead to positive, quantifiable outcomes, mainly in relation to medication use. This shows the usefulness of GPBP services. The findings of this review can help policy makers decide how best to implement and fund GPBP services, and how to identify and measure GPBP impact.

Pharmacists in general practice: what do they do? A qualitative case study

“…Similar to the findings from two literature reviews with mainly studies from the UK, USA, Australia and Canada [ 11 , 12 ], and a recent study in Australia [ 20 ], pharmacists in Region Uppsala mostly performed tasks related to medication management (e.g., medication reviews, DRPs and repeat prescriptions), hence were involved in detecting, resolving and preventing DRPs. In countries where pharmacists can prescribe medications, medication management also included prescribing activities [ 11 , 12 ], which was an option carefully considered for the future by some pharmacists in the current study. Other activities were related to collaboration with various HCPs, serving as a liaison between general practice and community pharmacy, and counselling and educating patients and other HCPs [ 11 , 12 ].…”

“…Pharmacists in Region Uppsala performed fewer tasks related to patient examination and screening (e.g., ordering and reviewing laboratory tests and physical examination), chronic disease management (e.g., formulating and following-up on care plans for patients) compared to reports in other studies [ 11 , 12 , 20 ]. These activities require a higher degree of autonomy and responsibility for patient care.…”

“…In countries where pharmacists can prescribe medications, medication management also included prescribing activities [ 11 , 12 ], which was an option carefully considered for the future by some pharmacists in the current study. Other activities were related to collaboration with various HCPs, serving as a liaison between general practice and community pharmacy, and counselling and educating patients and other HCPs [ 11 , 12 ].…”

“…Pharmacists, who are qualified medication experts with a range of knowledge and skills, have been introduced in general practice to cope with this challenge [ 7 , 8 ]. Evidence suggests that pharmacists can provide valuable services to ease the burden on general practice in addition to improving patient safety and health outcomes [ 9 – 11 ]. Some countries including Australia, Canada, the United Kingdom (UK) and the United States of America (USA), have well-established general practice-based pharmacists compared to other parts of the world.…”

“…Some countries including Australia, Canada, the United Kingdom (UK) and the United States of America (USA), have well-established general practice-based pharmacists compared to other parts of the world. The pharmacists in these countries undertake a range of activities such as medication reviews and management of chronic conditions [ 11 , 12 ]. In many European countries like Sweden, the concept of pharmacists in general practice is relatively new, and literature on their work is scarce.…”