The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: A systematic review

Hazen, Ankie; Bont, Antoinette de; Boelman, Lia; Zwart, Dorien; Gier, Johan J. de; Wit, Niek J. de; Bouvy, Marcel L.

doi:10.1016/j.sapharm.2017.04.014

Cited by 102 publications

(123 citation statements)

References 90 publications

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“…Full integration of NDPs in general practice seems key to enlarge effect on pharmaceutical care outcomes. 35 Also, taking integral responsibility for the patient's pharmacotherapy and providing follow-up consultations to monitor the patient is recognised to be essential. 42,43 Furthermore, education is needed to equip the NDPs with the necessary clinical knowledge, consultation skills and experience to work as part of the multidisciplinary general practice team.…”

Section: (3)mentioning

confidence: 99%

Effects of non‐dispensing pharmacists integrated in general practice on medication‐related hospitalisations

Sloeserwij

Hazen

Zwart

et al. 2019

Brit J Clinical Pharma

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To evaluate the effect of non-dispensing pharmacists (NDPs) integrated in general practice on medication-related hospitalisations, drug burden index and costs in patients at high risk of medication problems (being 65 years or older and using 5 or more chronic medications). Methods: This was a multicentre, nonrandomised, controlled intervention study with pre-post comparison (2013 vs June 2014 to May 2015) in 25 general practices in the Netherlands, comparing NDP-led care (intervention) with 2 current pharmaceutical care models (usual care and usual care plus). In the intervention group, 10 specially trained NDPs were employed in general practices to take integral responsibility for the pharmaceutical care. They provided a broad range of medication therapy management services both on patient level (e.g. clinical medication review) and practice level (e.g. quality improvement projects). In the control groups, pharmaceutical care was provided as usual by general practitioners and community pharmacists, or as usual plus, when pharmacists were additionally trained in performing medication reviews. Results: Overall, 822 medication-related hospitalisations were identified among 11 281 high-risk patients during the intervention period. After adjustment for clustering and potential confounders, the rate ratio of medication-related hospitalisations in the intervention group compared to usual care was 0.68 (95% confidence interval: 0.57-0.82) and 1.05 (95% confidence interval: 0.73-1.52) compared to usual care plus. No differences in drug burden index or costs were found. Conclusions: In general practices with an integrated NDP, the rate of medicationrelated hospitalisations is lower compared to usual care. No differences with usual care plus were found.

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Section: (3)mentioning

confidence: 99%

Effects of non‐dispensing pharmacists integrated in general practice on medication‐related hospitalisations

Sloeserwij

Hazen

Zwart

et al. 2019

Brit J Clinical Pharma

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“…The customised core value reliable and caring reflects that pharmacists not only felt a responsibility for the quality of pharmaceutical products, but also a responsibility to foster their professional relationships both with patients and other health professionals. It has previously been identified that the health professional‐patient fiduciary therapeutic relationship as well as effective collaboration with other health professionals are essential to (pharmaceutical) health care and can improve its services. However, aiming to care simultaneously for both these relationships often leads to moral dilemmas …”

Section: Discussionmentioning

confidence: 99%

Moral dilemmas reflect professional core values of pharmacists in community pharmacy

Kruijtbosch

Göttgens-Jansen

Floor-Schreudering

et al. 2018

International Journal of Pharmacy Practice

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Objectives The aim was to recognise the professional core values in the moral dilemmas of pharmacists in community pharmacy and to customise the descriptions of these values for community pharmacy practice. Methods The narratives of 128 moral dilemmas, collected from Dutch PharmD students and early career pharmacists who experienced these dilemmas in practice, were qualitatively analysed. An expert panel deductively coded relevant portions of these narratives with the core values as formulated by the Royal Dutch Pharmacists Association. Other values that emerged were inductively coded and if possible used to further customise the respective core values. Key findings The expert panel identified all four professional core values, that is, commitment to the patient's well‐being (117, 91.4%), reliable and caring (116, 90.6%), pharmaceutical expertise (72, 56.2%) and responsibility to society (30, 23.4%) in the 128 moral dilemma narratives. Thirteen other values that emerged in the analysis could all be used for the customisation of the professional core values in descriptions that better reflect community pharmacy practice. Conclusions Professional core values were identified in moral dilemma narratives of pharmacists in community pharmacy and customised for their practice. These customised core values can enable pharmacists to better recognise moral dilemmas in practice. This can add to the advancement of the profession as a pharmaceutical care practice.

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“…Author response: 1. Thank you, we have replaced the term significant polypharmacy with major polypharmacy as described in the literature (3). This review does note excessive and hyper polypharmacy, however major polypharmacy is cited as the most prevalent term.…”

Section: Is the Study Design Appropriate For The Research Question? Yesmentioning

confidence: 99%

The effectiveness of integrating clinical pharmacists within general practice to optimise prescribing and health outcomes in primary care patients with polypharmacy: A protocol for a systematic review

et al. 2020

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Introduction: Coordinating prescribing for patients with polypharmacy is a challenge for general practitioners. Pharmacists may improve management and outcomes for patients with polypharmacy. This systematic review aims to examine the clinical and cost-effectiveness of pharmacist interventions to optimise prescribing and improve health outcomes in patients with polypharmacy in primary care settings. Methods: The review will be reported using the PRISMA guidelines. A comprehensive search of 10 databases from inception to present, with no language restrictions will be conducted. Studies will be included where they evaluate the clinical or cost-effectiveness of a clinical pharmacist in primary care on potentially inappropriate prescriptions using validated indicators and number of medicines. Secondary outcomes will include health related quality of life measures, health service utilisation, clinical outcomes and data relating to cost effectiveness. Randomised controlled trials, non-randomised controlled trials, controlled before-after, interrupted-time-series and health economic studies will be eligible for inclusion. Titles, abstracts and full texts will be screened for inclusion by two reviewers. Data will be extracted using a standard form. Risk of bias in all included studies will be assessed using the Effective Practice and Organisation of Care (EPOC) criteria. Economic studies will be assessed using the Consensus Health Economic Criteria (CHEC) list as per the Cochrane Handbook for critical appraisal of methodological quality. A narrative synthesis will be performed, and the certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Where data support quantitative synthesis, a meta-analysis will be performed. Discussion: This systematic review will give an overview of the effectiveness of pharmacist interventions to improve prescribing and health outcomes in a vulnerable patient group. This will provide evidence to policy makers on strategies involving clinical pharmacists integrated within general practice, to address issues which arise in polypharmacy and multimorbidity. PROSPERO Registration: CRD42019139679 (28/08/19)

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The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: A systematic review

Cited by 102 publications

References 90 publications

Effects of non‐dispensing pharmacists integrated in general practice on medication‐related hospitalisations

Effects of non‐dispensing pharmacists integrated in general practice on medication‐related hospitalisations

Moral dilemmas reflect professional core values of pharmacists in community pharmacy

The effectiveness of integrating clinical pharmacists within general practice to optimise prescribing and health outcomes in primary care patients with polypharmacy: A protocol for a systematic review

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