Abstract
BackgroundChanging demographics across the UK has led to general practitioners (GPs) managing increasing numbers of older patients with multi-morbidity and resultant polypharmacy. Through government led initiatives within the National Health Service, an increasing number of GP practices employ pharmacist support. The purpose of this study is to evaluate the impact of a medicines optimisation intervention, delivered by GP practice-based pharmacists, to patients at risk of medication-related problems (MRPs), on patient outcomes and healthcare costs.MethodsA multi-centre, randomised (normal care or pharmacist supplemented care) study in four regions of the UK, involving patients (n = 356) from eight GP practices, with a 6-month follow-up period. Participants were adult patients who were at risk of MRPs.ResultsMedian number of MRPs per intervention patient were reduced at the third assessment, i.e. 3 to 0.5 (p < 0.001) in patients who received the full intervention schedule. Medication Appropriateness Index (MAI) scores were reduced (medications more appropriate) for the intervention group, but not for control group patients (8 [4–13] to 5 [0–11] vs 8 [3–13] to 7 [3–12], respectively; p = 0.001). Using the intention-to-treat (ITT) approach, the number of telephone consultations in intervention group patients was reduced and different from the control group (1 [0–3] to 1 [0–2] vs 1 [0–2] to 1 [0–3], p = 0.020). No significant differences between groups were, however, found in unplanned hospital admissions, length of hospital stay, number of A&E attendances or outpatient visits. The mean overall healthcare cost per intervention patient fell from £1041.7 ± 1446.7 to £859.1 ± 1235.2 (p = 0.032). Cost utility analysis showed an incremental cost per patient of − £229.0 (95% CI − 594.6, 128.2) and a mean QALY gained of 0.024 (95% CI − 0.021 to 0.065), i.e. indicative of a health status gain at a reduced cost (2016/2017).ConclusionThe pharmacist service was effective in reducing MRPs, inappropriateness of medications and telephone consultations in general practice in a cost-effective manner.Trial registration: ClinicalTrials.Gov, NCT03241498. Registered 7 August 2017—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03241498
Highlights
Changing demographics across the United Kingdom (UK) has led to general practitioners (GPs) managing increasing numbers of older patients with multi-morbidity and resultant polypharmacy
The aim of the present research was to assess the impact of a medicines optimisation intervention, delivered in GP practices by practice-based pharmacists to patients at risk of medication-related problems (MRPs), on patient outcomes and healthcare resource utilisation, i.e. the number of unplanned hospital admissions, A&E attendances, general practice consultations, outpatient visits and overall costs associated with health care delivery
Additional objectives were to assess the impact of the intervention on medicines optimisation measures (MRPs and medication appropriateness), self-reported medication adherence and humanistic outcomes
Summary
Changing demographics across the UK has led to general practitioners (GPs) managing increasing numbers of older patients with multi-morbidity and resultant polypharmacy. The purpose of this study is to evaluate the impact of a medicines optimisation intervention, delivered by GP practice-based pharmacists, to patients at risk of medication-related problems (MRPs), on patient outcomes and healthcare costs. A medication-related problem (MRP) is defined as “an event or circumstance involving medication therapy that or potentially interferes with an optimum outcome for a specific patient” [4]. These problems have been found to lead to an increased incidence of hospital admissions, primary care physician and emergency department visits, and increase the cost of healthcare provision [5,6,7]. Optimisation of drug therapy and prevention of MRPs has the potential to reduce health care expenditure, increase patient quality of life and save lives [12,13,14,15]
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