Pharmacists In General Practice Research Articles

‘We do not seem to engage with dentists’: a qualitative study of primary healthcare staff and patients in the North East of England on the role of pharmacists in oral healthcare

ObjectiveTo explore the attitudes towards, and perceptions of, primary care healthcare staff and patients, regarding the role of clinical pharmacists in the provision of oral health advice and collaboration with...

Exploring learning needs for general practice based pharmacist: Are behavioural and influencing skills needed?

Background:Embedding pharmacists in general practice has been shown to create cost efficiencies, improve patient care and free general practitioner capacity. Consequently, there is a drive to recruit additional pharmacists to work within general practices. However, equipping pharmacists with behaviour and influencing skills may further optimise their impact. Key elements which may enhance behaviour and influencing skills include self-efficacy and resilience.Objective:This study aimed to: 1) Assess general practice pharmacists’ self-efficacy and resilience. 2) Explore differences primarily between pharmacists reporting lower and higher self-efficacy, secondarily for those reporting lower and higher scores for resilience.Methods:All 159 NHS Greater Glasgow and Clyde general practice pharmacists were invited to complete an online survey in May 2019. The survey captured anonymised data covering: demographics; professional experience; qualifications, prescribing status and preferred learning styles. Unconscious learning needs for behavioural and influencing skills were assessed using validated tools: the new general self-efficacy scale (GSES) and short general resilience scale (GRIT). Participants’ responses were differentiated by the lowest quartile and higher quartiles of GSES and GRIT scores, and analysed to identify differences.Results:The survey was completed by 57% (91/159) of eligible pharmacists; mean age 38 (range 24-60) years; 91% were of white ethnicity and 89% female. The median time qualified was 14 (1-38) years and 3 (1-22) years working in general practices. Overall pharmacists scored well on the GSES, mean 25 (SD 3; 95%CI 24.4-25.6), and GRIT, mean 30 (SD 4; 95%CI 29.6-30.4), out of a maximum 32 and 40 respectively. A significant positive correlation between GSES and GRIT scores was found (Pearson’s r=0.284, p=0.006). However, no significant differences were identified between pharmacists scoring in the lower and upper quartiles by GSES or GRIT. Overall respondents reported their preferred learning styles were activists (46%) or pragmatists (29%). The majority (91%) preferred blended learning methods as opposed to 38% or less for a range of online methods.Conclusions:General practice pharmacists on average scored highly for self-efficacy and resilience. Higher scores did not appear to be associated with demographic, years of practice, professional or educational experience. Prospective interventions to support those with lower scores may enhance and optimise pharmacists’ effectiveness in general practice.

Establishing consensus for general practice pharmacist education: A Delphi study

IntroductionAn evolving area of pharmacist professional practice is performing as team members in general practice teams. To date, there is a paucity of literature to guide schools and colleges of pharmacy regarding the educational needs of pharmacists training for this area of practice. MethodsThis study employed a three-round e-Delphi method with the aim of establishing a consensus position on educational needs of pharmacists intending to work in the general practice setting. Educators from all Australian universities with a pharmacy school were invited to participate as part of the expert panel. Delphi panellists completed two e-survey rounds. A panel videoconference was then completed with results of the discussion confirmed in a final third e-survey. This study defined a proportion of experts rating agree or strongly agree at ≥75% to determine consensus and disagree or strongly disagree at ≥75% to determine non-consensus. ResultsTen of the 18 invited panellists agreed to participate in the study and completed both survey rounds; nine panellists completed the third-round survey. Twenty-six general practice pharmacist activities were identified as educational needs. Seventeen general practice pharmacist activities required no additional training. Five general practice pharmacist activities did not reach consensus. ConclusionsThis study is one of the first investigations of educational needs of pharmacists wishing to practice in the general practice setting. The panel differentiated between activities that could be performed by less experienced pharmacists operating at a general level and those that would require further training.

Pharmacist-led adherence support in general practice: a qualitative interview study of adults with asthma

ObjectivesThe National Health Service (NHS) in England recently introduced general practice pharmacists (GPPs) to provide medication-focused support to both patients and the general practice team. This healthcare model may benefit...

National survey of UK general practice pharmacy services

Abstract Background The Clinical Pharmacists in General Practice (CPGP) initiative aims to recruit over 2000 clinical pharmacists in general practice (GP) surgeries in England by 2020. This study aimed to explore the services delivered by all GP pharmacy professionals (GPPPs; pharmacists/pharmacy technicians) across the UK. Methods 30-item e-questionnaire was developed using SurveyMonkey platform and piloted during one-to-one cognitive interviews with GPPPs. The survey was distributed via the Primary Care Pharmacy Association, social media sites, collaborating GP organisations and via emails to participants of CPGP pilot. Three reminders were sent out 1 week apart. University ethics approval was obtained. Results Ninety-one responses were received between November 2018 and March 2019 (89% pharmacists, 52% from CPGP pilot). Participants provided an average of 9 services (95% CI 8.3-9.9). Over 90% of pharmacists delivered medication reviews and over 80% managed patients with polypharmacy. More pharmacists within than outside of the CPGP pilot managed repeat prescribing requests (70% vs. 47%, p = 0.035). Technicians took responsibility for primarily non-clinical services such as service commissioning (90%), management of safety alerts/drug recalls (80%), standard operating procedures (80%) and education & training (80%). Over 40% of GPPPs not providing care home services wished to do so by 2024. Four technicians wanted to be more involved in medication reviews. The main perceived benefits of GP pharmacy services included identifying medicines-related issues (93%), utilisation of pharmacy professionals’ skills (93%) and a reduction in medication waste (92%). Conclusions GPPPs provide a range of clinical and non-clinical services which may benefit public health at an individual and healthcare system levels. Pharmacists within the pilot are more likely to deliver repeat prescribing services. Future GP pharmacy landscape will likely include additional services to care homes. Key messages GPPPs including pharmacy technicians provide clinical and non-clinical services, appropriate to their scope of practice, to benefit patients, healthcare systems and themselves. Developing future GP pharmacy services to care homes offers further opportunities to benefit a vulnerable group of patients with long-term illnesses.

Adaptation of potentially preventable medication-related hospitalisation indicators for Indigenous populations in Australia using a modified Delphi technique

ObjectivesOne of the outcomes of a medication review service is to identify and manage medication-related problems (MRPs). The most serious MRPs may result in hospitalisation, which could be preventable if...

Capturing pharmacists\u2019 impact in general practice: an e-Delphi study to attempt to reach consensus amongst experts about what activities to record

BackgroundIn the UK, there is ongoing integration of pharmacists into general practice as a new healthcare service in primary care. Evaluation of the service involves national measures that require pharmacists to record their work, on the general practice clinical computer systems, using electronic activity codes. No national agreement, however, has been established on what activities to record. The purpose of this study was to attempt to reach consensus on what activities general practice-based pharmacists should record.MethodsThe e-Delphi method was chosen as it is an excellent technique for achieving consensus. The study began with an initial stage in which screening of a general practice clinical computer system and discussion groups with pharmacists from two ‘pharmacists in general practice’ sites identified 81 codes potentially relevant to general practice-based pharmacists’ work. Twenty-nine experts (pharmacists and pharmacy technicians from the two sites along with experts recruited through national committees) were then invited by e-mail to participate as a panel in three e-Delphi questionnaire rounds. In each round, panellists were asked to grade or rank codes and justify their choices. In every round, panellists were provided with anonymised feedback from the previous round which included their individual choices along with their co-panellists’ views. Final consensus (in Round 3) was defined as at least 80% agreement. Commentaries on the codes from all e-Delphi rounds were pooled together and analysed thematically.ResultsTwenty-one individual panellists took part in the study (there were 12 responses in Round 1, 18 in Round 2 and 16 in Round 3). Commentaries on the codes included three themes: challenges and facilitators; level of detail; and activities related to funding. Consensus was achieved for ten codes, eight of which related to activities (general and disease specific medication reviews, monitoring of high-risk drugs and medicines reconciliation) and two to patient outcomes (presence of side effects and satisfactory understanding of medication).ConclusionsA formal consensus method revealed general practice-based pharmacists’ preferences for activity coding. Findings will inform policy so that any future shaping of activity coding for general practice-based pharmacists takes account of pharmacists’ actual needs and preferences.

Specialist pharmacist in general practice coordinating HIV patient care to manage a complicated drug–drug interaction: case report

Specialist pharmacist in general practice coordinating HIV patient care to manage a complicated drug–drug interaction: case report

Smoking cessation and the general practice pharmacist

AbstractIntroductionRoles for pharmacists in general practice are developing in Australia. It is known that pharmacists can provide effective smoking cessation services in other settings but evidence in general practice is lacking.AimTo determine whether a pharmacist can provide effective smoking cessation services within general practice.MethodData from smoking cessation consultations were obtained for 66 consecutive patients seen by one practice pharmacist. The pharmacist tailored interventions to the individual. Medication was offered in collaboration with community pharmacists and general practitioners. Quit coaching, based on motivational interviewing, was conducted. Smoking status was ascertained at least 6 months after the intended quit date and verified by a carbon monoxide breath test where possible.ResultsThe patients’ median age was 43 years (range 19–74 years); 42 were females (64%). At baseline, the median (i) number of pack years smoked was 20 (range: 1–75); (ii) Fagerstrom Test of dependence score was 6 (1–10); and (iii) number of previous quit attempts was 3 (0–10). Follow-up after at least 6 months determined a self-reported point prevalence abstinence rate of 30% (20/66). Of all patients who reported to be abstinent, 65% (13/20) were tested for carbon monoxide breath levels and were all below 7 ppm. The biochemically verified smoking abstinence rate was therefore 20% overall (13/66). Successful quit attempts were associated with varenicline recommendation (69% v 25%), increased median number of practice pharmacist consultations (4 v 2 per patient) and mental health diagnosis (85% v 51%).ConclusionOur observed abstinence rate was comparable or better than those obtained by practice nurses, community pharmacists and outpatient pharmacists, indicating the general practice pharmacist provided an effective smoking cessation intervention. A larger randomised trial is warranted.

The development of a role description and competency map for pharmacists in an interprofessional care setting.

Background Pharmacists are increasingly being included as members of general practice primary care teams. To date, there have been few published studies describing the competencies of general practice (GP) pharmacists and establishing their subsequent educational needs. Aim of the review The aim of this literature review is to establish the activities of pharmacists in general practice to inform the development of a comprehensive role description and competency map. Method A systematic literature search of EMBASE, MEDLINE, international pharmaceutical abstracts and the Cochrane database of systematic reviews was conducted from the start of the databases to August 2018. The search focused on studies investigating the roles performed by GP pharmacists. Full text peer-reviewed English language articles were included. A qualitative content analysis of included studies was performed. Two researchers reviewed studies to identify pharmacist roles. Subcategories of roles were then agreed by the research team and used to present the data. GP pharmacist's activities were mapped by two researchers to associated competencies. Any discrepancies between role descriptions and competency maps were resolved in consultation with a third member of the research team. Results The search conducted resulted in 5370 potential articles. Two hundred and twenty-seven full text articles were selected for review resulting in 34 articles that were included for analysis. Seven GP pharmacist role sub-categories and 48 GP pharmacist individual roles were identified. The seven GP pharmacist role sub-categories included medication management, patient examination and screening, chronic disease management, drug information and education, collaboration and liaison, audit and quality assurance and research. All FIP competency domains were included in the GP pharmacist competency map. Competencies related to compounding, dispensing and packaging of medications were not found relevant to the GP Pharmacist role. No roles were mapped to competencies relating to re-imbursement for medicines, procurement, or medication production. All areas of professional and personal competence were relevant to the GP pharmacist role. Conclusion A comprehensive role description and competency map for GP pharmacists is described and may be used to inform future research into the education of GP pharmacists.

The value of pharmacists in general practice: perspectives of general practitioners-an exploratory interview study.

Background NHS England has recently invested on a large scale in the development of the role of pharmacists in general practice. Despite this initial funding, the perpetuation of pharmacists' roles ultimately relies on the funding and co-operation of GPs. Objective This study aimed to explore the perspectives of GPs with experience of fully funding a pharmacist in general practice, focussing on the value that GPs place on the role of the pharmacist. Setting General practice in the Midlands and East area of England. Method In-depth, face to face, semi-structured qualitative interviews were carried out with seven purposively sampled GPs. Interviews were audio recorded, transcribed verbatim and thematically analysed. Main outcome measure Main outcomes were defined themes in the data. Results GPs valued the medication expertise of the pharmacist, which enabled the pharmacists to unburden the GPs of workload. GPs also valued the capability of pharmacists to adapt their role to meet the changing needs of their individual practice. GPs supported the role of pharmacists in general practice but identified funding as a possible barrier to wider uptake of the role. Conclusion This study provides an initial insight into what GPs value in the role of pharmacists in general practice. It highlights the value of the medication-related expertise which pharmacists bring to the team. Heterogeneity in the role is necessary to meet the needs of individual practices. Sustained funding was identified as a possible barrier to wider implementation of the role.

General practice pharmacists in England: Integration, mediation and professional dynamics.

A number of key publications in recent years have advocated a more integrated vision of UK primary care involving increased multi-professional communication and understanding. This has resulted in a marked change in the roles being undertaken by pharmacists. Community pharmacists have traditionally provided a medicine supply function and treated minor ailments in addition to delivering a suite of locally commissioned services; however these functions have not necessarily been part of a programme of care involving the other clinicians associated with the patient. An integrated model of care would see much closer working between pharmacy and general practice but also with pharmacists not only working with, but in the practice, in an enhanced patient-facing role, trained as independent prescribers. This has implications for the dynamics amongst professionals in this environment. This exploratory multiple case study attempts to explore these changing dynamics across ten GP surgeries throughout the South-East of England. Semi-structured, in-depth interviews were conducted with one nurse, one pharmacist and one physician from each clinic, and survey data was collected from 38 patients who had appointments with a pharmacist. The data suggested that the pharmacists who had enhanced roles perceived some uncertainty about their professional role and identity, which resulted in instability and insecurity and that this uncertainty led to both professional and interprofessional tension with their primary care colleagues. The survey data revealed that n = 35 (92%) patients stated they were 'very satisfied' or 'satisfied' with their appointment. And n = 37 (97%) were 'very comfortable' or 'comfortable' discussing their medications with the pharmacist. In addition, 36 patients (95%) reported that they strongly agreed or agreed with the clinical recommendations made by the pharmacist. These findings are discussed in relation to role expansion and professional/interprofessional relations before key practical suggestions are offered.

How Clinical Integration of Pharmacists in General Practice has Impact on Medication Therapy Management: A Theory-oriented Evaluation.

Background:Data on medication-related hospital admissions suggest that there is an opportunity for improved pharmaceutical care. Hence, concerns about medication-related hospital admissions is a driver to extend and integrate the role of community pharmacists in general practice.Aim:The aim of this paper is to give a systematic description of 1) what integrating a non-dispensing pharmacist (NDP) in general practice entails and 2) how this integrated care model is expected to contribute to patients’ medication therapy management.Methods:Based on ethnographic data collected by NDPs in general practices in the Netherlands, we conducted a theory evaluation.Results:The impact of NDPs providing integrated care can be explained by 1) the specific expertise NDPs bring into general practice and the tailored solutions they offer for individual patients, including deviation from medical protocols when necessary, 2) the reconciliation of interprofessional tensions caused by overlapping tasks with practice nurses, which results in a distinct patient population, 3) the conduct of clinical medication reviews aligned to the work processes of the GP practice and 4) the integration of quality management work into clinical work.Conclusion:The success of integrated pharmaceutical care is dependent on how NDPs collaborate with GPs and practice nurses. NDPs need to mobilize clinical pharmaceutical expertise into general practice. Yet, integrating quality management into clinical work is key to integrate pharmaceutical care. Paradoxically, full integration requires from NDPs to develop a distinct role in general practice.

Barriers to developing the clinical pharmacist in general practice

Barriers to developing the clinical pharmacist in general practice

Barriers to developing the clinical pharmacist in general practice

Barriers to developing the clinical pharmacist in general practice

Pharmacist integration into general practice in New Zealand.

Introduction Pharmacist integration into general practice is gaining momentum internationally, with benefits noted in reducing medication errors, improving chronic disease management and alleviating general practitioner workforce shortages. Little is known about how general practice pharmacists are working in New Zealand. Aim This study characterised the current landscape of pharmacist integration into general practice in New Zealand. Methods An online questionnaire was developed, piloted and distributed to all pharmacists in New Zealand. Results Thirty-six responses were analysed. Respondents were more likely to be female, have been pharmacists for at least 10 years and all but one held formal postgraduate clinical pharmacy qualifications. Seven pharmacists were working as pharmacist prescribers. Primary health organisations (PHOs) were the most common employer, with funding primarily derived from either PHOs or District Health Boards. Pharmacist integration into general practice appears to have progressed further in particular regions of New Zealand, with most respondents located in the North Island. Tasks performed by respondents included medication reviews, managing long-term conditions and medicines reconciliation. Increased job satisfaction compared with previous roles was reported by most respondents. Funding and a general lack of awareness about pharmacists' professional scope were seen as barriers to further expansion of the role. Discussion This study describes the characteristics of pharmacists currently working in general practices in New Zealand and provides insights into key requirements for the role. Understanding the way practice pharmacists are currently employed and funded can inform general practices considering employing pharmacists.

Clinical skills training for pharmacists in general practice

Clinical skills are becoming increasingly important for pharmacists as they take on more patient‐facing roles in primary care. In this article, the authors discuss the clinical skills currently taught to pharmacists during undergraduate and postgraduate training, and how this training could be expanded.

The Role of Pharmacists in General Practice in Asthma Management: A Pilot Study.

Background: Asthma is principally managed in general practice. Appropriate prescribing and medication use are essential, so general practice pharmacists appear suitable to conduct asthma management consultations. This pilot study aimed to evaluate the asthma management role of a pharmacist in general practice. Methods: Analysis of an activity diary and stakeholder interviews were conducted to identify interventions in asthma management; determine whether asthma control changed following pharmacist input; and determine acceptability of asthma management review by a pharmacist in one general practice in Canberra, Australia. Results: Over 13 months, the pharmacist saw 136 individual patients. The most common activities were asthma control assessment; recommendations to adjust medication or device; counselling on correct device use; asthma action plan development and trigger avoidance. For patients with multiple consultations, the mean Asthma Control Test score improved from the initial to last visit (14.4 ± 5.2 vs. 19.3 ± 4.7, n = 23, p < 0.0001). Eight of the 19 (42%) patients moved from having poor to well-controlled asthma. Case studies and qualitative data indicated probable hospital admission avoidance and stakeholder acceptability of asthma management by a practice pharmacist. Conclusions: This pilot study demonstrated it is feasible, acceptable and potentially beneficial to have a general practice pharmacist involved in asthma management. Fuller evaluation is warranted.

Learning Through Boundary Crossing: Professional Identity Formation of Pharmacists Transitioning to General Practice in the Netherlands

To unravel boundary crossing as it relates to professional identity formation in pharmacists transitioning from a community pharmacy to working as nondispensing clinical pharmacists in general practice, with the aim of optimizing their education. This was a multiple-case study, including two-stage interviews, peer feedback, and individual reflection, that collected data in 2014-2016 from eight clinical pharmacists working in general practice in the Netherlands. These pharmacists acted-without a workplace role model-as pharmaceutical care providers in general practices during a 15-month training program. In within-case and cross-case analysis, data were collected regarding pharmacists' role development in practice and perceptions of learning processes, and examined through the lens of professional identity formation and boundary crossing. Analysis of data collected during and after the training program demonstrated that the clinical pharmacists who applied the learning mechanisms of reflection and transformation developed a patient-care-oriented professional identity. Some clinical pharmacists, who learned mainly through the mechanism of identification, did not integrate the new patient-care-oriented role into their professional identity. They felt that their workplace provided limited opportunities for reflection and transformation. Learning with peers on formal training days was seen as highly valuable for professional identity formation; it counterbalanced the lack of a role model in the workplace. Professional identity formation in the transition from community pharmacist to clinical pharmacist in general practice benefited from reflective, on-the-job training. This permitted transformative, boundary-crossing learning with peers and supported professional identity formation oriented to providing practice-based pharmaceutical care.

Evolution of the general practice pharmacist’s role in England: a longitudinal study

BackgroundTo address the growing GP workforce crisis, NHS England (NHSE) launched the Clinical Pharmacists in General Practice scheme in 2015. The NHSE scheme promotes a newer, patient-facing role for pharmacists and, currently, there is little insight into the role and activities undertaken. All scheme pharmacists are enrolled on the general practice pharmacist training pathway (GPPTP).AimTo investigate the role evolution and integration of clinical pharmacists in general practice in England.Design and settingLongitudinal survey of all phase 1 GPPTP registrants working in general practice at start of (T1) and 6 months into (T2) training.MethodAn online longitudinal survey was administered to all phase 1 GPPTP registrants (n = 457) at T1 and T2, measuring their perceived knowledge, skill, and confidence, activities performed, and perceptions of practice integration, environment, and support. Descriptive statistics and non-parametric tests were conducted.ResultsResponse rates were 46% (T1) and 52% (T2); 158 participants completed both questionnaires. Perceived knowledge, skill, and confidence levels increased significantly from T1 to T2 for all areas, except for managing acute or common illness. Scope of practice increased significantly, particularly in patient-facing activities. Sharing office space with administrative staff was common and 13% of participants reported having no designated work area. Perceived integration at T2 was fairly high (median = 5 on a scale of 1–7) but GP clinical support was ‘too little’ according to one-third of participants.ConclusionFindings show not only patient-facing role expansion, but also practice environment and support issues. Pharmacists may appreciate more GP time invested in their development. Practices need to be realistic about this support and not expect an immediate reduction in workload.