Integration of pharmacists into general practice clinics in Australia: the views of general practitioners and pharmacists

Tan, Edwin C.K.; Stewart, Kay; Elliott, Rohan A; George, Johnson

doi:10.1111/ijpp.12047

Cited by 72 publications

(147 citation statements)

References 17 publications

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“…Those studies suggested various potential benefits of colocation, such as patient privacy, improved access to patient information and increased interprofessional rapport and communication, and these perceived benefits were confirmed in our study 14 15. Additionally, some proposed desirable pharmacist attributes and logistical challenges raised in the previous studies aligned with our findings 14 15.…”

Section: Discussionsupporting

confidence: 88%

“…Previous Australian studies14 15 on this topic generally have not involved participants who have experienced a practice pharmacist. Those studies suggested various potential benefits of colocation, such as patient privacy, improved access to patient information and increased interprofessional rapport and communication, and these perceived benefits were confirmed in our study 14 15.…”

Section: Discussionmentioning

confidence: 99%

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Stakeholder experiences with general practice pharmacist services: a qualitative study

et al. 2013

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ObjectivesTo explore general practice staff, pharmacist and patient experiences with pharmacist services in Australian general practice clinics within the Pharmacists in Practice Study.DesignQualitative study.SettingTwo general practice clinics in Melbourne, Australia, in which pharmacists provided medication reviews, patient and staff education, medicines information and quality assurance services over a 6-month period.ParticipantsPatients, practice staff and pharmacists.MethodSemi-structured telephone interviews with patients, focus groups with practice staff and semi-structured interviews and periodic narrative reports with practice pharmacists. Data were analysed thematically and theoretical frameworks used to explain the findings.Results34 participants were recruited: 18 patients, 14 practice staff (9 general practitioners, 4 practice nurses, 1 practice manager) and 2 practice pharmacists. Five main themes emerged: environment; professional relationships and integration; pharmacist attributes; staff and patient benefits and logistical challenges. Participants reported that colocation and the interdisciplinary environment of general practice enabled better communication and collaboration compared to traditional community and consultant pharmacy services. Participants felt that pharmacists needed to possess certain attributes to ensure successful integration, including being personable and proactive. Attitudinal, professional and logistical barriers were identified but were able to be overcome. The findings were explained using D'Amour's structuration model of collaboration and Roger's diffusion of innovation theory.ConclusionsThis is the first qualitative study to explore the experiences of general practice staff, pharmacists and patients on their interactions within the Australian general practice environment. Participants were receptive of colocated pharmacist services, and various barriers and facilitators to integration were identified. Future research should investigate the feasibility and sustainability of general practice pharmacist roles.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Stakeholder experiences with general practice pharmacist services: a qualitative study

et al. 2013

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“…The studies were from 11 countries and most of the studies were conducted in Canada ( n = 17) [45, 51–53, 55, 57, 63, 65, 66, 71, 78–80, 82–84, 87], followed by the USA ( n = 12) [40, 43, 44, 47, 49, 56, 58, 72, 76, 77, 85, 86], the UK ( n = 7) [39, 48, 59, 64, 68, 70, 81], Australia ( n = 4) [42, 73–75], New Zealand ( n = 2) [41, 62], Sweden ( n = 2) [54, 67], France ( n = 1) [50], Spain ( n = 1) [46], Netherlands ( n = 1) [60], Brazil ( n = 1) [61] and Republic of South Africa ( n = 1) [69]. Thirty-two different primary care professionals participated in these studies, with most of the data relating to General Practitioners/Family Physicians (42 papers), nurses (35 papers), pharmacists (14 papers) and administrative staff (11 papers) (Table 3).…”

Section: Resultsmentioning

confidence: 99%

Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review

et al. 2017

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BackgroundInterdisciplinary team working is of paramount importance in the reform of primary care in order to provide cost-effective and comprehensive care. However, international research shows that it is not routine practice in many healthcare jurisdictions. It is imperative to understand levers and barriers to the implementation process. This review examines interdisciplinary team working in practice, in primary care, from the perspective of service providers and analyses 1 barriers and facilitators to implementation of interdisciplinary teams in primary care and 2 the main research gaps.Methods and findingsAn integrative review following the PRISMA guidelines was conducted. Following a search of 10 international databases, 8,827 titles were screened for relevance and 49 met the criteria. Quality of evidence was appraised using predetermined criteria. Data were analysed following the principles of framework analysis using Normalisation Process Theory (NPT), which has four constructs: sense making, enrolment, enactment, and appraisal. The literature is dominated by a focus on interdisciplinary working between physicians and nurses. There is a dearth of evidence about all NPT constructs apart from enactment. Physicians play a key role in encouraging the enrolment of others in primary care team working and in enabling effective divisions of labour in the team. The experience of interdisciplinary working emerged as a lever for its implementation, particularly where communication and respect were strong between professionals.ConclusionA key lever for interdisciplinary team working in primary care is to get professionals working together and to learn from each other in practice. However, the evidence base is limited as it does not reflect the experiences of all primary care professionals and it is primarily about the enactment of team working. We need to know much more about the experiences of the full network of primary care professionals regarding all aspects of implementation work.Systematic review registrationInternational Prospective Register of Systematic Reviews PROSPERO 2015: CRD42015019362.

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“…Studies which detail the role of the practice pharmacist in the intervention can also be considered. 10,11,14,19,23,24 These roles can be considered under three broad categories -patient-directed roles, clinician-directed roles, and system-or practice-directed roles (Box).…”

Section: The Role Of the Practice Pharmacistmentioning

confidence: 99%

The practice pharmacist: a natural fit in the general practice team

Freeman¹,

Rigby²,

Aloizos³

et al. 2016

Aust Prescr

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ARTICLEFull text free online at nps.org.au/australianprescriberThe practice pharmacist: a natural fit in the general practice team SUMMARYThere is evidence that pharmacist integration into the general practice team may improve clinical and non-clinical outcomes.The roles of the practice pharmacist can be considered under three categories -patient-directed roles, clinician-directed roles and system-or practice-directed roles.The integration of pharmacists into the general practice team would reduce fragmentation of patient care and medication misadventure.If practice pharmacist services are to be flexible to suit the heterogeneity of general practices, a flexible funding model is needed. The evidenceThe majority of the current evidence examining an integrated model of pharmacist and GP care is positive. A recent systematic review and metaanalysis of pharmacist-delivered services in general practice included 38 studies. Of these, 25 reported positive effects on at least one primary outcome measure and 13 demonstrated no effect. 10Interventions usually involved medication review, with or without other activities delivered with the GP such as education, medication monitoring and adjusting therapy. Four clinical markers were used to assess the effect of interventions -blood pressure, glycosylated haemoglobin, cholesterol, and the Framingham Risk Score. Results of the metaanalysis favoured the pharmacist intervention with significant improvements observed in all clinical markers compared to the control groups. Positive effects were more likely to be seen with pharmacistdelivered multifaceted interventions in conjunction with follow-up of patients compared to interventions that delivered a service in isolation. There was limited or no effect on outcomes related to quality of life, patient satisfaction, symptoms, and use of health service.Individual studies have shown improvements in other outcomes including:• identification and reduction of medicine-related problems • patient adherence to medicines • process measures such as timeliness • appropriateness of prescribing • reduction in total number of medications. 11-16

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Integration of pharmacists into general practice clinics in Australia: the views of general practitioners and pharmacists

Cited by 72 publications

References 17 publications

Stakeholder experiences with general practice pharmacist services: a qualitative study

Stakeholder experiences with general practice pharmacist services: a qualitative study

Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review

The practice pharmacist: a natural fit in the general practice team

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