Medication reviews provided by general medical practitioners (GPs) and nurses: an evaluation of their quality

Abstract

Objective To train general medical practitioners (GPs) and nurses in providing medication review services in the primary care setting and to evaluate the reviews provided. Setting One medical practice in Scotland with five whole‐time equivalent (WTE) GP partners, two practice nurses and six community‐based nurses. Method Training for GPs was provided as a group session plus individual supported clinic sessions. Nurse training consisted of a group session only. Patients aged over 75 were invited to attend the medical practice to receive a medication review. Output measures were: number of patients with pharmaceutical care issues (PCIs) documented, changes made to repeat medicines and computer records, monitoring undertaken, number of PCIs, PCIs identifiable from notes and records but not documented (‘missed’ PCIs). A sample of GP reviews provided before training and all GP and nurse reviews during training were evaluated. Key findings In 45 case note reviews provided prior to training, GPs documented PCIs in 20% of patients; average 0.3 per patient, but missed 1.75 per patient. In 56 reviews provided during training, they documented PCIs in 98% of patients; average 3.0 per patient, missing 0.8 per patient. The proportion of patients with changes to drug therapy or monitoring carried out during training increased significantly compared to pre‐training reviews. Nurses documented PCIs in 97% of 33 patients reviewed, average 1.5 PCIs per patient, but missed 0.8. The mean number of repeat drugs prescribed reduced from 4.73 to 4.42 per patient after nurse review, but increased after GP review from 4.07 to 4.18. Conclusion After training, both GPs and nurses identified PCIs appropriate to their expertise. The sustainability of this effect in the longer term is not known. Since all patients should have repeat medication reviewed regularly, involving these professionals in providing routine reviews would allow pharmacist medication review clinics to be optimised.

Pharmacist-supported medication review training for general practitioners: feasibility and acceptability

“…22 Furthermore, we have been unable to monitor the impact of the training on routine practice. However, we have shown that GPs are willing to accept training from practicebased pharmacists and that most viewed this as making a positive contribution to their confidence in reviewing medication.…”

“…27 During our training programme, changes were made in the medication of 80% of patients, although this may not be translated into routine practice following training. 22 Studies showing improved outcomes of pharmacist reviews compared with routine care suggest that both the frequency and quality of GP reviews could be improved. Little has been published on how to achieve this.…”

“…Recently, a tool for provision of reviews was proposed, 19 although providing documentation based around question prompts did not in itself appear to be sufficient to enable high quality reviews by GPs in our pilot study. 22 Indeed, several GPs commented negatively on documentation in the questionnaire and many failed to complete it fully.…”

“…1) was developed and piloted by JK, an experienced clinical pharmacist with training and medication review experience, with a group of 6 GPs in 1 practice. 22 The training material was also given to a single-handed GP, who provided comments on its relevance to other practices, and the material was then adapted for general use by the other practice pharmacists within the LHCC. Author DG sent letters to all 67 GPs in the 15 remaining practices in the LHCC, offering the training as a package with 1 session of funded locum cover for each GP and 1 further session per practice.…”

“…All 7 practice pharmacists employed by the LHCC received instruction from JK in using the package to provide training for GPs within the practices where they were routinely employed. Pharmacists were provided with the evidence base for medication reviews and data from an evaluation of the pilot training, 22 instruction in using the systematic approach, documentation modified from that developed by local pharmacists 23 for recording reviews and example case studies with postgraduate teaching and learning Overview What is already known on this subject…”