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

Abstract

Background Especially in elderly with polypharmacy, medication can do harm. Clinical pharmacists integrated in primary care teams might improve quality of pharmaceutical care. Objective To assess the effect of non-dispensing clinical pharmacists integrated in primary care teams on general practitioners’ prescribing quality. Setting This study was conducted in 25 primary care practices in the Netherlands. Methods Non-randomised, controlled, multi-centre, complex intervention study with pre-post comparison. First, we identified potential prescribing quality indicators from the literature and assessed their feasibility, validity, acceptability, reliability and sensitivity to change. Also, an expert panel assessed the indicators’ health impact. Next, using the final set of indicators, we measured the quality of prescribing in practices where non-dispensing pharmacists were integrated in the team (intervention group) compared to usual care (two control groups). Data were extracted anonymously from the healthcare records. Comparisons were made using mixed models correcting for potential confounders. Main outcome measure Quality of prescribing, measured with prescribing quality indicators. Results Of 388 eligible indicators reported in the literature we selected 8. In addition, two more indicators relevant for Dutch general practice were formulated by an expert panel. Scores on all 10 indicators improved in the intervention group after introduction of the non-dispensing pharmacist. However, when compared to control groups, prescribing quality improved solely on the indicator measuring monitoring of the renal function in patients using antihypertensive medication: relative risk of a monitored renal function in the intervention group compared to usual care: 1.03 (95% CI 1.01–1.05, p-value 0.010) and compared to usual care plus: 1.04 (1.01–1.06, p-value 0.004). Conclusion This study did not demonstrate a consistent effect of the introduction of non-dispensing clinical pharmacists in the primary care team on the quality of physician’s prescribing. This study is part of the POINT-study, which was registered at The Netherlands National Trial Register with trial registration number NTR‐4389.

The impact of including a medication review in an integrated care pathway: A pilot study

“…11,46,47 However, the T A B L E 1 Characteristics (matching criteria and mean number of PIMs per hospital stay) in the exposed and unexposed cohorts data from nonrandomized studies of the effects of medication reviews are discordant. [48][49][50] In the study of primary care by Sloeserwij et al, a medication review by a nondispensing pharmacist did not improve most of the prescription quality indicators. The researchers suggested that "prescribing indicators might not capture the full effect of nondispensing pharmacists integrated in primary care teams, when interventions are not specifically targeted upon these indicators".…”

“…Many studies (including a number of RCTs) have shown that medication reviews can reduce the number of PIMs 11,46,47 . However, the data from nonrandomized studies of the effects of medication reviews are discordant 48–50 . In the study of primary care by Sloeserwij et al, a medication review by a nondispensing pharmacist did not improve most of the prescription quality indicators.…”

“…In the study of primary care by Sloeserwij et al, a medication review by a nondispensing pharmacist did not improve most of the prescription quality indicators. The researchers suggested that “prescribing indicators might not capture the full effect of non‐dispensing pharmacists integrated in primary care teams, when interventions are not specifically targeted upon these indicators” 50 …”

Clinical pharmacists in Dutch general practice: an integrated care model to provide optimal pharmaceutical care

“…We also looked at drug burden index, direct healthcare costs and the quality of prescribing (measured via prescribing quality indicators) but here no differences were found with usual care [ 12 , 13 ].…”

Lithium surveillance by community pharmacists and physicians in ambulatory patients: a retrospective cohort study

“…Next to i.e. confidence in the collaborations’ benefits and good communication, they found that close proximity between professions positively affects collaboration, medication management [ 17 , 37 , 38 ], and monitoring [ 39 ].On the other hand, factors impeding collaboration are i.e. lack of clarity regarding each other’s roles and responsibilities, lack of trust, respect, and time [ 36 ].…”