Abstract
BackgroundIn the Netherlands, 5.6 % of acute hospital admissions are medication-related. Almost half of these admissions are potentially preventable. Reviewing medication in patients at risk in primary care might prevent these hospital admissions. At present, implementation of medication reviews in primary care is suboptimal: pharmacists lack access to patient information, pharmacists are short of clinical knowledge and skills, and working processes of pharmacists (focus on dispensing) and general practitioners (focus on clinical practice) match poorly. Integration of the pharmacist in the primary health care team might improve pharmaceutical care outcomes.The aim of this study is to evaluate the effect of integration of a non-dispensing pharmacist in general practice on the safety of pharmacotherapy in the Netherlands.MethodsThe POINT study is a non-randomised controlled intervention study with pre-post comparison in an integrated primary care setting. We compare three different models of pharmaceutical care provision in primary care: 1) a non-dispensing pharmacist as an integral member of a primary care team, 2) a pharmacist in a community pharmacy with a predefined training in performing medication reviews and 3) a pharmacist in a community pharmacy (care as usual). In all models, GPs remain accountable for individual medication prescription. In the first model, ten non-dispensing clinical pharmacists are posted in ten primary care practices (including 5 – 10 000 patients each) for a period of 15 months. These non-dispensing pharmacists perform patient consultations, including medication reviews, and share responsibility for the pharmaceutical care provided in the practice. The two other groups consist of ten primary care practices with collaborating pharmacists. The main outcome measurement is the number of medication-related hospital admissions during follow-up. Secondary outcome measurements are potential medication errors, drug burden index and costs. Parallel to this study, a qualitative study is conducted to evaluate the feasibility of introducing a NDP in general practice.DiscussionAs the POINT study is a large-scale intervention study, it should provide evidence as to whether integration of a non-dispensing clinical pharmacist in primary care will result in safer pharmacotherapy. The qualitative study also generates knowledge on the optimal implementation of this model in primary care. Results are expected in 2016.Trial registration numberNTR4389, The Netherlands National Trial Register, 07-01-2014.
Highlights
In the Netherlands, 5.6 % of acute hospital admissions are medication-related
As most of the pharmacotherapy is initiated in general practice, its quality may be primarily improved by structural reviewing patients’ medication in primary care
Group A: a General Practitioner (GP) practice with a non-dispensing pharmacist based in the practice as an integral member of the primary healthcare team;
Summary
In the Netherlands, 5.6 % of acute hospital admissions are medication-related. Almost half of these admissions are potentially preventable. Reviewing medication in patients at risk in primary care might prevent these hospital admissions. Adverse drug events account for 5,6 % of acute hospital admissions in the Netherlands. Almost half of these admissions are potentially preventable [1]. New strategies are needed to improve the effectiveness and safety of pharmacotherapy in clinical practice and to prevent these hospital admissions. As most of the pharmacotherapy is initiated in general practice, its quality may be primarily improved by structural reviewing patients’ medication in primary care. The results of studies on the effectiveness of medication reviews have been inconclusive: several studies reported a positive effect on the number of drug therapy problems [2,3,4,5,6,7], but no effect on morbidity, mortality or quality of life was found
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.