Abstract
BackgroundPrescribing for patients taking multiple medicines (i.e. polypharmacy) is challenging for general practitioners (GPs). Limited evidence suggests that the integration of pharmacists into the general practice team could improve the management of these patients. The aim of this study is to develop and test an intervention involving pharmacists, working within GP practices, to optimise prescribing in Ireland, which has a mixed public and private primary healthcare system.MethodsThis non-randomised pilot study will use a mixed-methods approach. Four general practices will be purposively sampled and recruited. A pharmacist will join the practice team for 6 months. They will participate in the management of repeat prescribing and undertake medication reviews (which will address high-risk prescribing and potentially inappropriate prescribing, deprescribing and cost-effective and generic prescribing) with adult patients. Pharmacists will also provide prescribing advice regarding the use of preferred drugs, undertake clinical audits, join practice team meetings and facilitate practice-based education. Throughout the 6-month intervention period, anonymised practice-level medication (e.g. medication changes) and cost data will be collected. A nested Patient Reported Outcome Measure (PROM) study will be undertaken during months 4 and 5 of the 6-month intervention period to explore the impact of the intervention in older adults (aged ≥ 65 years). For this, a sub-set of 50 patients aged ≥ 65 years with significant polypharmacy (≥ 10 repeat medicines) will be recruited from each practice and invited to a medication review with the pharmacist. PROMs and healthcare utilisation data will be collected using patient questionnaires, and a 6-week follow-up review conducted. Acceptability of the intervention will be explored using pre- and post-intervention semi-structured interviews with key stakeholders. Quantitative and qualitative data analysis will be undertaken and an economic evaluation conducted.DiscussionThis non-randomised pilot study will provide evidence regarding the feasibility and potential effectiveness of general practice-based pharmacists in Ireland and provide data on whether a randomised controlled trial of this intervention is indicated. It will also provide a deeper understanding as to how a pharmacist working as part of the general practice team will affect organisational processes and professional relationships in a mixed public and private primary healthcare system.
Highlights
Prescribing for patients taking multiple medicines is challenging for general practitioners (GPs)
This study aims to test an intervention (GPP intervention) involving pharmacists, working within GP practices, to optimise prescribing in a mixed public and private primary healthcare system in Ireland
The intervention will focus on patients aged ≥ 65 years with significant polypharmacy (≥ 10 repeat medicines) and will utilise a number of methodologies including the review of community-based and nursing home patients for instances of prescribing practices considered to be high risk or potentially inappropriate, use of preferred drugs and generic prescribing and assessment of the need for commonly prescribed preventive medicines
Summary
Prescribing for patients taking multiple medicines (i.e. polypharmacy) is challenging for general practitioners (GPs). Limited evidence suggests that the integration of pharmacists into the general practice team could improve the management of these patients. Prescribing in the context of polypharmacy (i.e. multiple medicines) is complicated, as the potential for drug-drug interactions, adverse drug reactions (ADRs) and potentially inappropriate prescribing (PIP) is increased [1]. The management of patients with multimorbidity who are taking multiple medicines is challenging, for GPs in primary care, as there is often fragmentation, or poor communication, between primary and secondary care settings [7]. One approach has been the integration of pharmacists into the general practice team. This co-location of pharmacists in general practices has positively affected various areas of chronic disease management and the quality use of medicines [9]
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