What can pharmacists do in general practice? A pilot trial

Abstract

INTERNATIONALLY, pharmacists have become increasingly integrated into general practice clinics. 1,2 It has been reported that general practice pharmacists perform a range of clinical and administrative duties related to their expertise in medication use and safety; the clinical activities typically include providing drug information to practice staff, educating patients, reviewing medication, undertaking health promotion, and conducting disease management clinics. 1-4 The primary purpose of a general practice pharmacist is to support general practitioners (GPs) to minimise the risks associated with medicines and optimise patient outcomes through the quality use of medicines. 2 The co-location of pharmacists with GPs can enhance interprofessional communication and the development of collaborative working relationships. It can also reduce fragmentation of care and facilitate the delivery of patient-centred interdisciplinary chronic disease and medication management services. A general practice pharmacist can also improve communication between GPs and pharmacists working in community pharmacies and provide a link to existing community pharmacy services. 2 Evidence suggests that general practice-based medication reviews by a pharmacist can be more facilitating than a community pharmacybased service, 5 with key facilitators being: • an established pharmacist-GP relationship • pharmacists having access to medical records to improve the quality and appropriateness of their recommendations • a face-to-face meeting (case conference) between pharmacist and GP to discuss the pharmacist's recommendations. A systematic review by Tan et al found that pharmacists co-located in general practice clinics delivered a range of activities with favourable results in chronic disease management and the quality use of medicines, yet none of the included studies were from Australia. 1 Drawing on the skills of other health professionals is also one approach to tackling the workload pressures in general practice, although previous studies suggest that the main impact of practice-based pharmacists is on quality and safety rather than on GPs' workload. 6 While there has been a strong move to incorporate allied health professionals and nurses within GP-led multidisciplinary teams in Australia, this, to a large extent, has not included pharmacists. 7 Instead, the integration of pharmacists into general practice in Australia has been developing slowly, 2,3 particularly in comparison to the UK, where NHS England has committed to fund an extra 1500 pharmacists to work in general practice by 2020-21 (bringing the coverage to >40% of all practices). 8 In 2015, the Australian Medical Association (AMA) proposed a model whereby general practice

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