Impact of integrating pharmacists into primary care teams on health systems indicators: a systematic review

Abstract

BackgroundEvidence suggests that pharmacists integrated into primary care can improve patient outcomes and satisfaction, but their impact on healthcare systems is unclear.AimTo identify the key impacts of pharmacists’ integration into primary care on health system indicators, such as healthcare utilisation and costs.Design and settingA systematic review of literature.MethodEmbase, MEDLINE, Scopus, the Health Management Information Consortium, CINAHL, and the Cochrane Central Register of Controlled Trials databases were examined, along with reference lists of relevant studies. Randomised controlled trials (RCTs) and observational studies published up until June 2018, which considered health system outcomes of the integration of pharmacists into primary care, were included. The Cochrane risk of bias quality assessment tool was used to assess risk of bias for RCTs; the National Institute of Health National Heart, Lung, and Blood Institute quality assessment tool was used for observational studies. Data were extracted from published reports and findings synthesised.ResultsSearches identified 3058 studies, of which 28 met the inclusion criteria. Most included studies were of fair quality. Pharmacists in primary care resulted in reduced use of GP appointments and reduced emergency department (ED) attendance, but increased overall primary care use. There was no impact on hospitalisations, but some evidence of savings in overall health system and medication costs.ConclusionIntegrating pharmacists into primary care may reduce GP workload and ED attendance. However, further higher quality studies are needed, including research to clarify the cost-effectiveness of the intervention and the long-term impact on health system outcomes.

The Evolving Role and Impact of Integrating Pharmacists into Primary Care Teams: Experience from Ontario, Canada

“…Similarly, in a survey of fifty-six physicians in the state of North Carolina, 87.5% felt that identifying enhanced clinical outcomes was the top benefit of embedding a clinical pharmacist into their practice [ 50 ]. In addition to optimizing outcomes for patients, a systematic review found that pharmacists in PCTs reduced physician workload substantially [ 51 ]. Primary care physicians further described that the inclusion of a clinical pharmacist can improve the perceived quality of their patients’ healthcare, the quality of the medication decisions made, and the management of medications [ 29 ].…”

“…A systematic review found that emergency room visits decreased and savings in medication and health system costs were realized when pharmacists are integrated into PCTs, even with increased primary care usage [ 51 ]. Improvements in health outcomes at the individual and population level was also demonstrated when pharmacists work as a member of an inter-professional team, as well as decreased fragmentation within the healthcare system [ 51 ].…”

“…A systematic review found that emergency room visits decreased and savings in medication and health system costs were realized when pharmacists are integrated into PCTs, even with increased primary care usage [ 51 ]. Improvements in health outcomes at the individual and population level was also demonstrated when pharmacists work as a member of an inter-professional team, as well as decreased fragmentation within the healthcare system [ 51 ]. Although there are no published economics analyses based on the Ontario data, one study estimates that PCT pharmacists can offset costs to the healthcare system by $1079 per patient and can generate revenues for the PCT that are 38% in excess of the cost of the pharmacist’s time [ 29 ].…”

Professional roles of general practitioners, community pharmacists and specialist providers in collaborative medication deprescribing - a qualitative study

“…Hitherto, physicians participating in several of these approaches adopted a substantial degree of pharmacists’ recommendations for medication change or deprescribing [ 13 , 17 , 18 ]. Though impact on clinical outcomes is difficult to detect from existing studies [ 19 ], collaborative care approaches revealed positive effects for patient-related, procedural and health-economic outcomes [ 13 , 20 – 23 ]. In a well-observed prospective cohort study in the UK, delegation to clinical pharmacists reduced GP-time spent on key prescribing activities by 51%, equating to 4.9 h of work per week being released [ 13 ].…”

Looking Back at US Pharmacy’s Past to Help Discern Its Future

“…13,14 A recent systematic review of pharmacist integration into primary care practice showed that pharmacists can reduce primary care practitioners’ (PCPs’) workload and patients’ ER visits enabling the PCPs to see more patients and grow practices while reducing costs under accountable care organization payment arrangements. 15 On the other hand, a systematic review of 60 studies evaluating incorporation of pharmacists in primary care offices found no effect on clinical health outcomes, with some effect on patient-related outcomes and quality-of-care performance indicators. 16 Because accountable care organizations are rewarded financially for improvement of processes-of-care indicators, pharmacists’ incorporation could be beneficial.…”