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

Abstract

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.

Non-dispensing pharmacist integrated in the primary care team: effect on the quality of physician’s prescribing, a non-randomised comparative study

“…Hence, its evaluation should be multidimensional, including a theoretical framework underlying the expected intervention effect, and assessment of feasibility, effectiveness and related process changes. The theoretical framework as well as results on feasibility and effectiveness have been described elsewhere [ 14 – 16 ]; in the present study we focus on the process changes as measured with indicators that can be derived from computerised healthcare records.…”

“…Data were considered a secondary outcome measurement of the POINT-study, for which a sample size calculation on the primary outcome (medication-related hospitalisations) was performed [ 7 ]. Outcomes on the primary outcome have been described elsewhere [ 16 ].…”

“…Data were considered a secondary outcome measurement of the POINT-study, for which a sample size calculation on the primary outcome (medication-related hospitalisations) was Box 1 Criteria that quality indicators were assessed on [11] Criteria Description Feasibility Whether the data needed to calculate the indicator were available in our database Validity Whether the content of the indicator was clinically relevant, based upon current guidelines and scientific publications Acceptability Whether assessment of the indicator was acceptable for both the patient and the healthcare provider Reliability Whether other factors than the prescribing behaviour of the GP could influence the outcome of the indicator, and whether these factors would differ between the study groups Sensitivity to change Whether the indicator would detect changes and differences in quality of care performed [7]. Outcomes on the primary outcome have been described elsewhere [16].…”

“…Taking results from the other sub studies of the POINT project into account [16,29,33], the latter option may be plausible as our intervention should be considered as complex [13,34].…”

Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study

“…Evidence from published evaluations suggests pharmacists in general practice can have a positive impact on clinical outcomes, such as blood pressure and glycosylated haemoglobin, 11 and may reduce medicationrelated hospitalisations. 12 They may also release GP capacity by reducing prescribing activities. 13 The model of practice-based pharmacists may provide advantages over a community pharmacy service, including (co-)location, access to medical records to inform the quality and appropriateness of recommendations, the potential for formal and informal communication and discussion of the pharmacist's recommendations, and reduced fragmentation of care.…”