Abstract
Even though pharmaceutical care is not a new concept in pharmacy, its introduction and development has proved to be challenging. In Iceland, general practitioners are not familiar with pharmaceutical care and additionally no such service is offered in pharmacies or primary care settings. Introducing pharmaceutical care in primary care in Iceland is making great efforts to follow other countries, which are bringing the pharmacist more into patient care. General practitioners are key stakeholders in this endeavor. The aim of this study was to introduce pharmacist-led pharmaceutical care into primary care clinics in Iceland in collaboration with general practitioners by presenting different setting structures. Action research provided the framework for this research. Data was collected from pharmaceutical care interventions, whereby the pharmaceutical care practitioner ensures that each of a patient’s medications is assessed to determine if it is appropriate, effective, safe, and that the patient can take medicine as expected. Sources of data included pharmaceutical care notes on patients, researcher’s notes, meetings, and interviews with general practitioners over the period of the study. The study ran from September 2013 to October 2015. Three separate semi-structured in-depth interviews were conducted with five general practitioners from one primary health care clinic in Iceland at different time points throughout the study. Pharmaceutical care was provided to elderly patients (n = 125) before and between general practitioners’ interviews. The study setting was a primary care clinic in the Reykjavik area and the patients’ homes. Results showed that the GPs’ knowledge about pharmacist competencies as healthcare providers and their potential in patient care increased. GPs would now like to have access to a pharmacist on a daily basis. Direct contact between the pharmacist and GPs is better when working in the same physical space. Pharmacist’s access to medical records is necessary for optimal service. Pharmacist-led clinical service was deemed most needed in dose dispensing polypharmacy patients. This research indicated that it was essential to introduce Icelandic GPs to the potential contribution of pharmacists in patient care and that action research was a useful methodology to promote and develop a relationship between those two health care providers in primary care in Iceland.
Highlights
The pharmacy profession has increasingly been making individualized care plans for patients [1]since Hepler and Strand described the term pharmaceutical care practice in 1990 [2]
The pharmaceutical care practitioners are employed in the primary care clinics and practice full-time or part-time in the clinic providing this service [8]
This study aimed to introduce and subsequently study pharmacist-led pharmaceutical care in primary care in collaboration with general practitioners (GPs) using action research methodology
Summary
The pharmacy profession has increasingly been making individualized care plans for patients [1]since Hepler and Strand described the term pharmaceutical care practice in 1990 [2]. The service can be provided in different settings of care; pharmacies, primary, secondary, and tertiary care [6,7]. The pharmaceutical care practitioners are employed in the primary care clinics and practice full-time or part-time in the clinic providing this service [8]. Other pharmaceutical care practitioners are located outside of the primary care clinic in the community pharmacy [9], in the hospital setting [10], or as self-employed consultants [9]. Even though reliable data have pointed out that pharmaceutical care can lead to progress in health outcomes and cost-effective therapy [11], and positive impact on Health-Related Quality-of-Life Outcomes [12], the implementation has not been as fast as one might have expected [13,14]. It should be noted that barriers are not the same in all countries [15,16,17,18]
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