First evaluation of its kind shows involving pharmacists in general practice optimises patient outcomes

Research undertaken by the RCSI University of Medicine and Health Sciences suggests that integrating pharmacists into general practice (GP) teams facilitates collaboration to optimise treatment plans for patients with long-term medical needs and alleviates pressures on GP practices.  

The study, conducted by researchers in the RCSI’s Department of General Practice and School of Pharmacy and Biomolecular Sciences, is was published recently in BMJ Open

GPs frequently manage medications for patients with multiple complex health conditions, further complicated by long-standing prescriptions from previous doctors and the evolving nature of treatment. Pharmacists are well placed to assist with this, working collaboratively with GPs to decide on the most appropriate treatment options, stated the authors. 

Although not yet introduced in Ireland, general practice pharmacists are common in other countries and have been shown to provide essential support to GP teams, with the potential to optimise treatment and lower costs. The pilot study led by the RCSI is the first evaluation of pharmacists in this role in Ireland.

Support

Researchers selected four GP practices with approximately 35,000 patients to participate in the study over a six-month period. During this time, pharmacists were integrated into and worked in these practices, reviewing prescriptions to support existing GP teams. They flagged 786 patients who had 1,521 potential issues relating to medication effectiveness or concerns over possible side-effects. The most common medications involved were proton pump inhibitors used to suppress stomach acid, benzodiazepines used to treat anxiety or insomnia, and anti-inflammatory drugs.

Over 50 per cent of these issues resulted in a change being made by the patient’s GP, such as reducing the dose or ending a prescription where the risks outweighed the benefits or the medication was no longer necessary. Overall, the changes to prescriptions in the four GP practices amounted to potential cost savings of approximately €57,000 each year. 

“Our findings clearly demonstrate the possible benefit of introducing general practice pharmacists to the Irish healthcare system. While further study is needed to establish the cost-effectiveness of such an initiative nationwide, implementing it would work towards alleviating the pressure our GPs are under and improving the quality of care for Irish patients,” said senior author Dr Frank Moriarty, pharmacist and lecturer at the School of Pharmacy and Biomolecular Sciences.

Complex needs

Leading the study alongside Dr Moriarty were GP and Professor of Primary Care Medicine, Prof Susan Smith, and research lecturer Dr Barbara Clyne, both from the RCSI Department of General Practice. 

“As demands on primary care increase, integrating pharmacists into GP practices has the potential to bring a more closely integrated model of care to patients with multiple complex needs. The best patient care in general practice includes multidisciplinary collaboration across healthcare professionals and I look forward to further studies in this area to explore the feasibility of introducing this practice in Ireland,” said Professor Smith. 

The authors wrote: “This study found that the integration of pharmacists, working with GPs, to optimise prescribing in Irish primary care is largely feasible and has potential clinical and cost benefits. A qualitative evaluation of this feasibility study is ongoing to explore this role further and inform future research. In line with the MRC guidelines on developing and evaluating complex interventions, this will now proceed to a randomised pilot study, with changes to the intervention and study design informed by the results of the present study (in particular, relating to patient recruitment) and qualitative evaluation.

“Patient recruitment ahead of integration of pharmacists will allow for earlier engagement between pharmacists and patients and the potential for enhanced follow-up after medication review. This will provide further evidence on the role of [the] pharmacist in GP practices in the Irish context and the potential of this intervention to help achieve the ambitious target of the WHO’s Medication Without Harm challenge to reduce serious, avoidable medication-related harm by 50 per cent in five years.”

The research was supported by the Health Research Board, the Health Service Executive’s National Quality Improvement Team, and the Royal College of Physicians of Ireland Research Collaboration in Quality and Patient Safety fund.