Pharmacists In General Practice Research Articles

Perspectives of patients in relation to the role of the general practice pharmacist: a systematic review and meta-synthesis of qualitative studies

Abstract Introduction The integration of general practice pharmacists (GPPs) into general practice across the United Kingdom (UK) and internationally has been tested and supported through different initiatives.[1] The intention of this integration was to address issues relating to primary care workforce and workload.[1] However, there is limited evidence available on the views of patients about the GPP role.[1] Aim To synthesise qualitative research evidence on patients’ views of the GPP role in general practice. Methods A systematic, qualitative meta-synthesis was undertaken. A search of six electronic databases (Medline, Embase, Scopus, Web of Science, IPA and CINAHL) was conducted from the date of inception to May 2023; reference lists of included studies were also reviewed. Inclusion criteria were peer-reviewed studies which addressed the views of patients about the GPP role in general practice, in the English language, had used qualitative methods for data collection and analysis; no date restrictions were applied. Findings and verbatim quotes relevant to patients’ views were extracted. This was followed by applying the thematic synthesis approach of Thomas and Harden to the extracted data.[2] The Critical Appraisal Skills Programme (CASP) checklist was used to assess quality of the included studies.[2] The review protocol was registered with PROSPERO (CRD42023423623). Results Eight qualitative studies were included, of which five were conducted in the UK and three in Australia. Most studies used interviews to collect data (n=6). The total number of participants was 139 and sample sizes across studies ranged from 7 to 34. Two main analytical themes were generated. The first theme related to perceptions of the GPP role such as benefits (patients believed the GPP increased their knowledge and adherence to medications, rationalised drug therapy, and improved health outcomes) and challenges (patients felt that because GPPs were only available for specific hours every week and on certain days, this was a disadvantage) for patients. The second theme related to attitudes towards the GPP role such as acceptance (acceptability levels of the GPP and their role in general practice among patients were high and no objections were reported when patients were asked to meet with the GPP) and disappointment (some patients were not happy about the way in which medication review was conducted or its outcome). Overall, included studies demonstrated high methodological quality, meeting all or at least seven of the 10 criteria of the CASP checklist.[2] Conclusion The findings have shown that there were benefits and challenges associated with the GPP role, along with acceptance and disappointment. The method adopted (i.e. qualitative meta-synthesis) is considered an essential technique for informing practice, policy, and research in healthcare and pharmacy, and has highlighted patients’ views in this study. However, our searches only retrieved studies published in English. Thus, it is possible that there are relevant studies in other languages which have not been identified. Further work is needed to assess patients’ views on the role of the GPP and how this relationship can be developed.

Development of a Complex Medication Review Intervention Based on Secondment of a Clinical Pharmacist in General Practice

Development of a Complex Medication Review Intervention Based on Secondment of a Clinical Pharmacist in General Practice

Pharmacist-led interventions in optimising the use of oral anticoagulants in patients with atrial fibrillation in general practice in England: a retrospective observational study.

Oral anticoagulation (OAC) is the mainstay of treatment for the prevention of strokes in patients with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) account for increasing OAC in patients with AF. However, prescribing DOACs for patients with established AF poses various challenges and general practice pharmacists may have an important role in supporting their management. To investigate the effectiveness of pharmacist-led interventions in general practice in optimising the use of OAC therapies in AF. A retrospective observational study in general practices in Bradford. The data were collected retrospectively from 1 November 2018-31 December 2019 using electronic health record data. The data were analysed: 1) to identify patients with AF not on OAC; 2) to describe inappropriate DOAC prescriptions; and 3) to calculate HAS-BLED scores. Overall, 76.3% (n = 470) of patients with AF received OAC therapy, and of these, 63.4% received DOACs. Pharmacist-led interventions increased DOAC prescribing by 6.0% (P = 0.03). Inappropriate DOAC use was identified in 24.5% of patients with AF, with underdosed and overdosed identified in 9.7% and 14.8%, respectively. Post-intervention, inappropriate prescribing was reduced to 1.7%. The mean HAS-BLED score decreased from 3.00 to 2.22 (P<0.01). Successful transition from vitamin K antagonist (VKA) therapy to DOACs was achieved in 25.7% of patients. Pharmacist-led interventions have successfully improved the use of OAC therapies in patients with AF, and effectively managed the bleeding risks and transition from VKA to DOAC therapy, in line with guidelines.

GPs’ perceptions of pharmacists working in general practices: A mixed methods survey study

BackgroundPharmacists are increasingly incorporated into general practice teams globally and have been shown to positively impact patient outcomes. However, little research to date has focused on determining general practitioners’ (GPs’) perceptions of practice-based pharmacist roles in countries yet to establish such roles.ObjectivesTo explore GPs’ perceptions towards integrating pharmacists into practices and determine if any significant associations were present between GPs’ perceptions and their demographic characteristics.MethodsIn June 2022, a survey was disseminated to GPs in Ireland via post (n = 500 in Munster region), Twitter, WhatsApp, and an online GP support and education network. Quantitative data were captured through multiple option and Likert-scale questions and analysed using descriptive and inferential statistics. Qualitative data were captured via free-text boxes, with the open comments analysed using reflexive thematic analysis.ResultsA total of 152 valid responses were received (24.6% response to postal survey). Overall, GPs welcomed the role of practice-based pharmacists and perceived that they would increase patient safety. Most agreed with practice pharmacists providing medicine information (98%) vs. 23% agreeing with practice pharmacists prescribing independently. Most agreed they would partake in a practice pharmacist pilot (78.6%). The free-text comments described current pressures in general practice, existing relationships with pharmacists, funding and governance strategies, potential roles for pharmacists in general practice, and anticipated outcomes of such roles.ConclusionThis study provides a deeper understanding of GPs’ perceptions of integrating pharmacists into practices and the demographic characteristics associated with different perceptions, which may help better inform future initiatives to integrate pharmacists into practices.

‘It’s the stuff they can do better than us’: case studies of general practice surgeries’ experiences of optimising the skill-mix contribution of practice-based pharmacists in Wales

ObjectivePharmacists are increasingly joining the general practice skill-mix. Research is still in relative infancy, but barriers and facilitators to their integration are emerging, as well as indications that pharmacists’ skillset...

A pharmacist integrated into a general practice in Australia: an evolving model of care in medicines optimization.

The general practice pharmacist (GPP) role in Australia is evolving. A pilot GPP model of care developed to optimize medicines for patients at risk of medicine-related harm was evaluated. The aims of this study were 2-fold: to evaluate the GPP model of care on medicines optimization, with a focus on deprescribing, in a population at risk of harm due to their medicines, or clinical condition, and to explore the perspectives of study participants. This single practice study involved two phases. Phase 1 (September 2019-May 2020): at risk patients were referred to the GPP for medication reconciliation, recommendations for optimization, and when appropriate, deprescribing support, especially for opioids. Medication plans were developed with patients, GPs, and the GPP. Quantitative data collected from patient records included demographics, discrepancies, medicines reviewed, GPP recommendations and uptake, and medicines deprescribed. Opioid-related data included dose changes from baseline, at 6 and 9 months, standardized to oral morphine equivalents. Descriptive statistics were used for analysis. Phase 2 (7-21 September 2020): qualitative evaluation using semi-structured interviews was undertaken, to explore the perspectives of GP and patient participants of the GPP model of care. Interview data were thematically analysed. The study had ethical approval. Phase 1: 198 multimorbid patients with multiple medications [median = 13 (9-16)] had at least one GPP consultation (n = 243). Discrepancies were resolved through 88% of GPP consultations; deprescribing commenced or occurred in 54%. Acceptance of GPP recommendations was 86%. Opioids were the most common medicines deprescribed (42% ceased). The baseline median opioid dose [44.4 (30-90) mg] was significantly reduced at 6 months [13.5 (0-40) mg] and 9 months [7 (0-30) mg], P < .0001. Phase 2: Thematic analysis of 28 interviews (10 GPs, 3 practice personnel, 10 patients, 5 carers) identified four key themes: safer foundation for deprescribing, deprescribing opportunities recognition, benefits of embedded GPP, and a supported approach to shared decision-making. General practice provides opportunities for medicine optimization and deprescribing. This study has demonstrated a GPP model of care that achieved functional deprescribing to reduce potential harm in a population at risk and addressed recognized barriers.

Pharmacists in Australian general practice: Discussion of the findings of an evaluation from 2016 to 2021

AbstractPharmacists embedded in general practice can improve medicines optimisation and patient safety, but Australia has been slower to adopt and fund this model than other comparable countries. Over the last decade there have been various local programs integrating pharmacists in general practice across Australia. This article summarises the results of an evaluation in Canberra from 2016–2021. Pharmacists predominantly conducted clinical activities, including medication reviews and clinical audits. General practitioner (GP) acceptance and implementation of medication review recommendations was high (75%). General practice pharmacists were able to achieve positive clinical outcomes in asthma and smoking cessation. Surveys and interviews identified that the general practice pharmacist role was welcomed by patients, GPs, and other healthcare professionals. Patient satisfaction was very high, with patients supporting the expansion of this pharmacy service. Collaboration between the pharmacists and other healthcare professionals was high. Some pharmacists left employment in general practice after less than a year. Introducing a clear job description could be beneficial in retaining pharmacists, improving trust and working relationships, and enhancing collaboration. The majority of clinical activities conducted by the pharmacists had the potential to improve patient care and decrease healthcare costs. Apart from healthcare savings, benefit–cost ratios of income generated and costs reduced by pharmacists when compared to salaries suggested that pharmacists may be cost‐beneficial in some scenarios. Absence of funding for this model of care remains a barrier to wider adoption in Australia and needs addressing. This study was approved by the University of Canberra Human Research Ethics Committee (Project number: 15–235) and funded under the Primary Health Network Program (Grant number: 25097479).

Professional stakeholders’ expectations for the future of community pharmacy practice in England: a qualitative study

ObjectivesTo explore the views of professional stakeholders on the future of community pharmacy services in England. Specific objectives related to expectations of how community pharmacy services will be provided by...

Pharmacists in general practice: what do they do? A qualitative case study

BackgroundPharmacists working in general practice are a relatively new phenomenon in many European countries. Providing insight into what pharmacists do in general practice may support further implementation of general practice-based pharmacist roles and enhance their contribution to health care.AimTo explore the tasks performed by pharmacists in general practice in Sweden.MethodA case study was conducted in 7 general practices in Uppsala County, Sweden, where pharmacists were employed. Activities performed by pharmacists were self-reported during March 2021. Participant observations and semi-structured interviews with pharmacists were conducted between October and November 2021. Self-reported activities were categorised and analysed using descriptive statistics. Qualitative data were analysed using conventional content analysis.ResultsIn total, 174 activities were self-reported by 8 pharmacists. Two pharmacists were observed for 2 days each, and 6 pharmacists were interviewed. Their main task was conducting medication reviews in older patients with polypharmacy. In addition, they handled a broad variety of drug-related questions and treatment follow-up. Pharmacists described working in a more efficient and needs-based manner over time. They stressed that working at the practice increased their accessibility to and their collaborative work with other healthcare professionals, and enabled them to meet patients face-to-face. Future challenges include defining tasks more clearly, assuming greater responsibility for patient care, and meeting the growing demand for pharmacists in general practice.ConclusionPharmacists in general practice in Sweden perform a broad variety of tasks related to identifying, resolving and preventing drug-related problems, mainly in older patients with polypharmacy.

Integration and impact of pharmacists in general practice internationally: A rapid review.

English general practices have been facing ongoing pressures, arising from complicated health care needs and the recent pandemic. To overcome these pressures and reduce the workload of general practitioners, there have been extensive attempts to integrate pharmacists into general practices. A number of literature reviews, often systematic, have partially explored the topic of general practice-based pharmacists (GPBPs) internationally. Our aim was to further explore the employment/integration models of GPBPs and their actual activities and impact, concepts that have not been thoroughly investigated by previous reviews. Two databases were searched from inception to June 2021 for studies published in the English language. Results were independently screened by two reviewers to establish eligibility for inclusion. Original research studies, or protocols where results had not been released at the time of search, that reported on services provided by pharmacists with some sort of integration into general practices were included. The studies were analysed using narrative synthesis. Searches identified 3206 studies in total, of which 75 met the inclusion criteria. The included studies were highly heterogeneous in terms of participants involved and methodologies employed. Integration of pharmacists into general practices has occurred in several countries, with funds originating from multiple sources. Several employment models for GPBPs were described - for example, part-time and full-time work and/or coverage of multiple or single practices. GPBP activities, with some exceptions, were comparable between different countries, with medication reviews being the most common task globally. GPBP impact was identified through both observational and/or interventional research methods, by pursuing a large variety of measures (e.g. activity volume, contact with patients, perceptions/experiences, and patient outcomes). Independent, quantifiable outcomes from GPBP activities were all positive but were of varying statistical significance. Our findings suggest that GPBP services can lead to positive, quantifiable outcomes, mainly in relation to medication use. This shows the usefulness of GPBP services. The findings of this review can help policy makers decide how best to implement and fund GPBP services, and how to identify and measure GPBP impact.

Factors contributing to pharmacists leaving employment in general practice in Australia: an exploratory study.

To identify perceived factors contributing to pharmacists leaving employment in general practice. Qualitative semi-structured interviews were conducted with pharmacists who had left employment in general practice within 12 months of commencing (5 pharmacists out of 14 recruited into these roles) in Canberra, Australia. Thematic analysis was undertaken. The main specific reasons cited for leaving were lack of utilisation and part-time hours, while the over-arching themes identified were: challenges of the new role, poor role definition, professional relationships and job satisfaction. In this cohort of newly appointed general practice pharmacists, employment turnover was relatively high. The interview findings indicated a need for strategies, including having clear role descriptions that are understood by all members of the practice team, so that pharmacists with appropriate skillsets can be supported and retained in the general practice setting.

481 An exploration of general practice pharmacists’ (GPPs) views on their role in general practice: a cross-sectional questionnaire study

Abstract Introduction The integration of pharmacists into general practice across the UK (also called general practice pharmacists; GPPs) has been tested through different pilot plans; the intention of this integration was to address issues of the primary care workforce and workload (1). Currently, there is a lack of research examining the views of GPPs on their role and their impact in general practice within the UK. Findings from published studies may not be generalisable to specific UK regions due to differences in the organisation and funding mechanisms of healthcare between these regions (2). Aim To explore GPPs’ views regarding their role within general practice in one region of the UK. Methods Using a cross-sectional study design, a paper-based self-administered questionnaire was mailed to all general practices in one UK region (n=319) in June and July 2022 and was completed by one GPP in every general practice. The questionnaire was developed following a review of published literature related to GPPs’ views of their role in general practice (1,2). A variety of open-ended and closed-ended questions were included in six sections: demographics, activities of GPPs, GPPs’ communication within primary care, GPPs’ attitudes towards collaboration, GPPs’ communication with patients and GPPs’ views on their impact in primary care. All returned questionnaires were coded, entered into Microsoft Excel 365, and then imported into the Statistical Package for the Social Sciences (SPSS) version 28 to conduct descriptive statistical analysis. Responses to five-point Likert scale statements were also analysed descriptively by calculating the percentage of agreement or disagreement to each statement. Results One hundred and fifty-five responses were received, equating to a response rate of 48.5%. The majority of respondents were female (72.3%; n=112) aged between 30-39 years. The services that were provided by GPPs were medication reconciliation (99.4%; n=154) and medication reviews (97.4%; n=151). The majority of GPPs indicated that the most common method of communication between them and GPs was face-to-face (89.0%, n=138). Just under 60% of respondents (58.7%; n=91) expressed positive attitudes towards collaboration (based on a validated scale) with GPs, and most of them agreed/strongly agreed (84.5%; n=131) that the roles of the GPP and GP in patient care were clear. When GPPs contacted patients, the most common method of communication was via the telephone (98.7%, n=153). Only a third of GPPs (32.9%; n=51) agreed that patients were aware of the role they provided. The majority of GPPs expressed positive views on the impact of the GPPs on primary care and strongly agreed that the GPP role had a positive impact on patient outcomes (80.6%; n=125), alleviated work pressure within primary care (89.7%; n=139) and helped to reduce prescribing errors (81.3%; n=126). Conclusion The findings from this study indicated that GPPs were largely positive about their contribution to primary care and their impact on patients. However, they recognised that patients were largely unaware of their role. The findings may provide useful data for practices and service commissioners but may not represent the views of GPPs in other parts of the UK.

Interprofessional collaboration within general practice teams following the inclusion of non-dispensing pharmacists

BackgroundPharmacists have been included in general practice teams to provide non-dispensing services in the Australian Capital Territory (ACT) since 2016. Interprofessional collaboration and team effectiveness are key considerations in providing high-quality patient care. These concepts have not been well studied following the inclusion of a pharmacist in general practice teams.MethodsA mixed methods study was conducted to explore collaboration between pharmacists and health professionals in eight general practices in the ACT, where pharmacists were included in their teams. A validated survey instrument was adapted and utilised to assess the changes in interprofessional collaboration over time following the addition of a pharmacist. Another validated survey was utilised to explore team effectiveness at the end of the study. Semi-structured interviews, with a thematic analysis, were conducted with a purposeful sample of general practice staff members to understand the factors influencing the development of interprofessional collaboration.ResultsIn total, 56 and 41 participants completed the baseline and follow-up survey, including 26 who completed both surveys to assess the change in collaboration over time. Interprofessional collaboration scores were high initially and did not change over time. Team effectiveness was also high at the end of the study. Twenty-one individuals participated in interviews, which generated four main interrelated themes related to interprofessional collaboration: professional working relationships, trust, commitment to collaboration, and barriers to collaboration. Trust was integral to professional working relationships and commitment to collaboration. The barriers to collaboration included not having a role description for pharmacists, inadequate interest to initiate working relationships, lack of dedicated time for interaction, lack of utilisation, and poor awareness of pharmacist-led activities in general practice.ConclusionInterprofessional collaboration was initially high and not influenced by the addition of a pharmacist, perhaps reflecting the inherent nature of the general practices willing to include a pharmacist within their team. Introducing a clear job description for pharmacists, and dedicating time to interact with pharmacists, could be beneficial in improving trust and professional working relationships and enhancing collaboration between the pharmacists and other general practice team members.

Identifying the important outcomes to measure for pharmacy-led, clinical services within primary care: A nominal group technique approach.

The introduction of clinical pharmacy services is part of a multi-disciplinary approach to reduce pressure on primary care. Ascertaining the impact of clinical pharmacists in general practice is vital to ensure intended benefits are achieved. However, this is complicated by poor quality evidence, multiple interventions, and a lack of agreement regarding outcome measures. To develop an outcomes framework for clinical pharmacy services delivered in Scottish general practice using a consensus methodology. A modified nominal group technique (NGT) was conducted using Microsoft Teams and Qualtrics. This involved a pre-NGT questionnaire, silent generation of ideas, round robin, discussions, ranking, and a final consensus exercise. A selective sampling strategy recruited experienced pharmacists from Scottish health regions. NGT ranking results were used to signify relative importance of the outcome areas. NGT discussions underwent inductive thematic analysis to explore key areas considered. Overall, 13 (median: 24 years of experience) pharmacists participated, representing 11 of 14 Scottish regions. In total, 21 outcome areas, derived from the literature and a pre-NGT questionnaire, were considered during the NGT ranking exercise. Consensus identified five important outcome areas: Patient Experience, Medication Related Adverse Events, Cost-Effectiveness, Medication Optimisation, and Health Related Quality of Life. Thematic analysis highlighted the importance of the outcome framework's target audience, factors influencing the interpretation of outcomes, and the feasibility of the associated outcome measures. The five key outcome areas will facilitate evidence-based decisions regarding service delivery. Future work should develop a measurement plan, involving routinely collected sources of outcomes data. The feasibility of collecting outcomes in the real-world context should be considered, identifying measures which are easy to collect within existing data infrastructures. This paper describes a replicable method to gain consensus for a national approach to data collection from a strong theoretical basis using an online methodology.

General practitioners' perceptions of pharmacists working in general practice: a qualitative interview study.

Pharmacists in general practice have been shown to enhance patient care and are becoming increasingly prevalent worldwide. Yet, little is known about general practitioners' (GPs') perceptions of pharmacists prior to potentially working alongside them in this setting. Therefore, this study aimed to investigate these GP perceptions to inform future efforts to integrate pharmacists into general practice. Semi-structured interviews were conducted with GPs practising in the Republic of Ireland between October and December 2021. Content analysis was used to identify the most relevant Theoretical Domains Framework (TDF) domains that affected the theoretical integration of pharmacists into general practice. Fifteen GPs were interviewed. Five TDF domains were found to be most relevant in affecting pharmacist integration: (1) 'environmental context and resources' (space, government funding, information technology, current workplace pressures, increasing patient complexity, indemnity, moves towards group practices); (2) 'skills' (GP mentors, practical in-service training, consultation skills development); (3) 'social professional role and identity' (role definition, clinical governance, pharmacist prescribing, medication review and monitoring); (4) 'beliefs about consequences' (patient safety, cost savings, workload); and (5) 'knowledge' (pharmacists as medication experts, lack of knowledge of pharmacist undergraduate training). This is the first qualitative interview study to focus on exploring GPs' perceptions of pharmacists working in general practice outside of private practice settings. It has provided a deeper understanding of GPs' considerations regarding the integration of pharmacists into general practice. In addition to informing future research, these findings should help optimise future service design and aid pharmacist integration into general practice.

Potential of pharmacists in general practice to improve care is being squandered

Rarely a day goes by without a new headline about how much pressure GPs are under. The amount of bureaucracy and box ticking they face, an increasing number of patients to see, two years of pressures brought on by the COVID-19 pandemic — all to the detriment of their own health and mental wellbeing​[1–3]​. Pharmacists have […]

Acceptability of a cross-sectoral hospital pharmacist intervention for patients in transition between hospital and general practice: a mixed methods study.

Drug-related problems (DRPs) are often seen when a patient is transitioning from one healthcare sector to another, for example, when a patient moves from the hospital to a General Practice (GP) setting. This transition creates an opportunity for information on medication changes and follow-up plans to be lost. A cross-sectoral hospital pharmacist intervention was developed and pilot-tested in a large GP clinic. The intervention included medication history, medication reconciliation, medication review, follow-up telephone calls, identification of possible DRPs and communication with the GP. It is unknown whether the intervention is transferable to other GP clinics. The aim of the study was to explore similarities and differences between GP clinics in descriptive data and intervention acceptability. A convergent mixed methods study design was used. The intervention was tested in four GP clinics with differing characteristics. Quantitative data on the GP clinics, patients and pharmacist activities were collected. Qualitative data on the acceptability were collected through focus group interviews with general practitioners, nurses and pharmacists. The Theoretical Framework of Acceptability was used. Overall, the intervention was found acceptable and relevant by all. There were differences between the GP clinics in terms of size, daily physician work form and their use of pharmacists for ad hoc tasks. There were similarities in patient characteristics across GP clinics. Therefore, the intervention was found equally relevant for all of the clinics. Shared employment with unique access to health records in both sectors was important in the identification and resolution of DRPs. Economy was a barrier for further implementation. The intervention was found acceptable and relevant by all; therefore, it was considered transferable to other GP clinics. Hospital pharmacists were perceived to be relevant healthcare professionals to be utilized in GP, in hospitals and in the cross-sectoral transition of patients.

Interprofessional Collaboration and Team Effectiveness of Pharmacists in General Practice: A Cross-National Survey.

As team-based care continues to evolve, pharmacists have been included in general practice teams in many countries, to varying extents, to improve medication use and patient safety. However, evidence on interprofessional collaboration and team effectiveness of pharmacists in general practice is sparse. This study aimed to compare the extent of interprofessional collaboration and team effectiveness of general practice pharmacists in Australia with international sites (Canada and the UK), and identify the factors associated with interprofessional collaboration and team effectiveness. General practice pharmacists from Australia, Canada, and the UK were identified through professional organisations and networks, and invited to participate in an online survey, adapted from existing validated tools. The survey explored interprofessional collaboration through four sub-domains (professional interactions, relationship initiation, trust and role clarity, and commitment to collaboration) and team effectiveness of general practice pharmacists. Of the 101 respondents (26 from Australia, 44 from Canada and 31 from the UK), 79% were female and 78% were aged below 50 years. Interprofessional collaboration and team effectiveness appeared to be high and similar between countries. Total scores for collaboration of pharmacists were 86.1 ± 7.4 in Australia, 88.5 ± 7.5 in the UK, and 89.1 ± 7.3 in Canada (mean ± SD, where higher scores represent more advanced collaboration), while the team effectiveness scores of the pharmacists were 88.6 ± 14.6 in Canada, 91.8 ± 14.6 in Australia and 97.5 ± 14.0 in the UK. Pharmacists who had worked in general practice for a longer time showed advanced interprofessional collaboration while those who worked exclusively in general practice had higher scores for team effectiveness. Overall, general practice pharmacists in the three countries were highly collaborative with general practitioners. Long-term employment and longer work hours could enhance interprofessional collaboration and team effectiveness in general practice pharmacists by improving trust and working relationships over time.

Clinical pharmacists in primary care general practices: evaluation of current workforce and their distribution.

General practices in primary careacross England are increasingly employing clinical pharmacists to help tackle the workforce crisis and alleviate pressure. Clinicalpharmacists can provide administrative and clinical duties, including non-medical prescribing, advice on polypharmacy and medicines optimisation. The aim of this study was to investigate the distribution of clinical pharmacists in general practice across England, and explore the relationship between the distribution and regional demography. This study used publicly available government database from various sources pertaining to primary care general practice workforce and population demographics of England. The number and distribution of pharmacists working within general practices in England were analysed and compared across practices considering general practitioner (GP), nurse and patient population in the practices, patientsage ≥ 65years and over and the Index of Multiple Deprivation (IMD) scores. Twenty two percentage (1469 of 6674)of practices in England were found to have access to a clinical pharmacist, equating to 1358 full-time equivalent (FTE) pharmacists and a mean pharmacist FTE of 10.07 (95% CI 8.40, 11.75, SD = 9.84) per Clinical Commissioning Group (CCG). A significant relationship between pharmacist FTE and the number of patients 65years and older [r (132) = 0.75, P < 0.001)] was observed; however, the distribution was not related to population deprivation scores. Approximately one in five general practices in England have access to a clinical pharmacist. Further research is needed to ensure wider and equitable distribution based on workforce needs and practice population demography.

Feasibility of a collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: a preliminary study.

Pharmacists working in general practices provide medication reviews with recommendations to general practitioners (GPs) to optimise medications. We describe a model where the pharmacist is empowered with increased responsibility to implement agreed recommendations through collaborative prescribing. To assess a collaborative pharmacist prescribing model incorporating increased pharmacist responsibility, for patients with chronic diseases in general practice. This was a pre-test-post-test quasi experimental pilot study using a pharmacist embedded in three Australian general practices. A pharmaceutical care plan was developed with patients and their GP to identify drug related problems (DRPs). The pharmacist discussed recommendations to manage DRPs with the GP and implemented recommendations agreed by the GP and patient over the six-month study period. Outcome measures included acceptance and implementation rate of recommendations made by the pharmacist. The pharmacist made 135 recommendations to optimise medicine use of which 126 (93.3%) were accepted by the GP. There were 105 (83.3%) implemented by the end of the study of which the pharmacist implemented 62 (49.3%). Compared to other Australian studies using a general practice pharmacist model, this study suggested increased pharmacist responsibility through collaborative prescribing led to high acceptance and implementation rates of recommendations to manage DRPs.