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

Abstract

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

Beyond the four walls: an exploratory survey of location, employment and roles of pharmacists in primary health care

“…[28][29][30]40 internationally, momentum is building for pharmacists to be integrated within individual general practices. 11,12,20,24 in this study, a small number of respondents reported spending time physically located in a general practice. Colocation of pharmacists and general practitioners enabling regular face-to-face communication is an important factor in successful interprofessional working for medicines optimisation.…”

“…9 The UK National Health Service vision is for pharmacists in general practice to support patients to self-manage their wellbeing and long-term conditions through optimising medicines, and to facilitate improved medicine-related communication at interfaces of care. 12 Similar integrated care models have been described in Canada 10,22,24 and australia, 11,20,23 where the concept is supported by the australian medical association. 25 in NZ, available cognitive pharmacy services include the adherence support service, 'medicines Use review' and the medication review service, 'medicines Therapy assessment'.…”

“…as cognitive pharmacy services mature, comprehensive medication management roles with or without prescribing rights are also developing. 11,12 medication adherence support services aim to improve patients' understanding of and adherence to prescribed medicines, while medication reviews involve a clinical review and the provision of recommendations on therapy adjustments, as necessary, with the goal of optimising patient outcomes.…”

“…7 Pharmacists have been employed in population-level primary care management organisations 8 similar to New Zealand (NZ) Primary Health Organisations (PHOs) and, more recently, the concept is emerging of pharmacists being fully integrated within general practice teams. [10][11][12][20][21][22][23] in the UK, a successful £30 million pilot project has facilitated nearly 500 clinical pharmacists to be employed directly by general practices.…”

Embedding the clinician-researcher pharmacist in healthcare

“…9,16,17 Progressive pharmacists continue to try to leave behind roles related to supply of pharmaceutical products and shift towards that of a provider of services and information, and ultimately, a provider of patient care. 9,[18][19][20][21][22][23][24] Moving away from dispensing and a supply service is essential for the evolution of pharmacists. Dispensing activities have already begun to be done by trained technicians and appropriate technology.…”