Original Research
Pharmacist consultations in general practice clinics: The Pharmacists in Practice Study (PIPS)

https://doi.org/10.1016/j.sapharm.2013.08.005Get rights and content

Abstract

Background

Medication-related problems (MRPs) are a concern in primary care settings. Pharmacists based in the community or community pharmacies are able to identify, resolve and prevent MRPs; however, the lack of a formal partnership with physicians and poor access to patients' medical records are limitations. In Australia, delivery of pharmacist services within general practice clinics is rare.

Objectives

To evaluate the effectiveness of consultations by pharmacists based within primary care medical practices.

Methods

A prospective, before-after intervention study was conducted at two primary health care (general practice) clinics in Melbourne, Australia. Participants were clinic patients who had risk-factors for MRPs (e.g. polypharmacy). Patients received a consultation with the pharmacist in a private consulting room at the clinic or in their home. The pharmacist reviewed the patient's medication regimen and adherence, with full access to their medical record, provided patient education, and produced a report for the general practitioner. The primary outcome was the number of MRPs identified by the pharmacist, and the number that remained unresolved 6 months after the pharmacist consultation. Secondary outcomes included medication adherence, health service use, and patient satisfaction.

Results

Eighty-two patients were recruited and 62 (75.6%) completed the study. The median number of MRPs per patient identified by the practice pharmacist was 2 (interquartile range [IQR] 1, 4). Six months after review, this fell to 0 (IQR 0, 1), P < 0.001. The proportion of patients who were adherent to their medications improved significantly, according to both the Morisky (44.1% versus 62.7%, P = 0.023) and the Tool for Adherence Behaviour Screening (TABS) (35.6% versus 57.6%, P = 0.019) scales. There was no significant effect on health service use. Patients were highly satisfied with the pharmacist consultations.

Conclusions

Consultations undertaken by pharmacists located within primary health care clinics were effective in identifying and resolving MRPs. The consultations were well received by patients and were associated with improvements in medication adherence.

Section snippets

Background

A medication-related problem (MRP) can be defined as “an event or circumstance involving medication therapy that actually or potentially interferes with an optimum outcome for a specific patient.”1 Medication-related problems are a serious concern in primary care globally.2, 3, 4, 5 They result in adverse drug events in up to 18% of general practice patients each year,5 of which nearly a quarter are preventable.2 Poor communication between health professionals has been recognized as a

Study design

A prospective, before–after intervention study was conducted at two general practice clinics in Melbourne, Australia, between December 2011 and January 2013.22 Each practice consisted of four to five full time equivalent GPs who all participated in the study. A pharmacist was employed by the research team at each clinic for at least 8 h/week, on the same day(s) each week. The pharmacists were accredited to undertake Home Medicines Reviews (HMRs) (a government subsidized program where a

Patient characteristics

A total of 82 patients were recruited (Fig. 1). Follow-up data were available for 71 patients (86.6%) at 3 months and 62 (75.6%) at 6 months. Baseline characteristics are summarized in Table 1.

Medication-related problems

Outcomes of the pharmacist consultations are summarized in Table 2. A total of 251 MRPs were identified at baseline, of which 166 MRPs related to patients who completed the study. The median (interquartile range [IQR]) number of MRPs was 2 (IQR 1, 4) in patients who completed the study, and 3 (IQR 2, 7)

Discussion

This study trialled medication consultations by a pharmacist co-located with GPs in Australian general practice clinics. The intervention identified and resolved MRPs and improved patients' medication adherence. It also provided GPs with a more accurate medication list. Patients were highly satisfied with the pharmacist consultations.

The practice pharmacist identified a median of two MRPs per patient. This aligns with the findings of other studies assessing pharmacist medication reviews

Conclusion

Pharmacist consultations in primary health care clinics in Australia identified and resolved MRPs and were associated with improved medication adherence in patients at risk of medication misadventure. Interdisciplinary practice pharmacist services were well received by patients and staff. Future research should confirm these findings in larger, controlled trials.

Acknowledgment

Funding provided by Windermere Foundation.We would like to thank the study pharmacists, Robyn Saunders and Philip Grasso, and the staff and patients of West Brunswick Clinic and Doutta Galla Community Health Service for their participation.

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