Abstract
Background Medication-related harm is a major problem in healthcare. New models of integrated care are required to guarantee safe and efficient use of medication. Aim To prevent medication-related harm by integrating a clinical pharmacist in the general practice team. This best practice paper provides an overview of 1. the development of this function and the integration process and 2. its impact, measured with quantitative and qualitative analyses. Setting Ten general practices in the Netherlands. Development and implementation of the (pragmatic) experiment We designed a 15-month workplace-based post-graduate learning program to train pharmacists to become clinical pharmacists integrated in general practice teams. In close collaboration with general practitioners, clinical pharmacists conduct clinical medication reviews (CMRs), hold patient consultations for medication-related problems, carry out quality improvement projects and educate the practice staff. As part of the Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in a primary care Team (POINT) intervention study, ten pharmacists worked full-time in general practices for 15 months and concurrently participated in the training program. Evaluation of this integrated care model included both quantitative and qualitative analyses of the training program, professional identity formation and effectiveness on medication safety. Evaluation The integrated care model improved medication safety: less medication-related hospitalisations occurred compared to usual care (rate ratio 0.68 (95% CI: 0.57–0.82)). Essential hereto were the workplace-based training program and full integration in the GP practices: this supported the development of a new professional identity as clinical pharmacist. This new caregiver proved to align well with the general practitioner. Conclusion A clinical pharmacist in general practice proves a feasible integrated care model to improve the quality of drug therapy.
Highlights
Medication-related harm is a major problem in healthcare
In 2014, a multidisciplinary team of clinical, social and educational researchers, General practitioners (GPs) and clinical pharmacists designed an integrated care model in which pharmacists are a member of the multidisciplinary general practice team
Our study showed that the transformation of pharmacists in general practice expanded the traditional ‘being a medication expert’ with being a clinician, being a professional who takes responsibility for the patient’s pharmacotherapy based on the patient’s needs, being an anticipator by proactively detecting medication safety issues and being a collaborator by bridging care between community pharmacy and general practice
Summary
Medication-related harm is a major problem in healthcare. New models of integrated care are required to guarantee safe and efficient use of medication. As part of the Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in a primary care Team (POINT) intervention study, ten pharmacists worked full-time in general practices for 15 months and concurrently participated in the training program. Evaluation of this integrated care model included both quantitative and qualitative analyses of the training program, professional identity formation and effectiveness on medication safety. Essential hereto were the workplace-based training program and full integration in the GP practices: this supported the development of a new professional identity as clinical pharmacist This new caregiver proved to align well with the general practitioner. Pharmacists’ primary responsibility is dispensing which leads to underutilisation of their knowledge and skills [1]
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