Supporting prescribing in Irish primary care: a non-randomised pilot study of a General Practice Pharmacist (GPP) intervention to optimise prescribing in primary care

Problem

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. The aim of this study is to develop and pilot test an intervention involving pharmacists, working within GP practices, to optimise prescribing in Ireland, which has a mixed public and private primary healthcare system.

Approach

This non-randomised pilot study uses a mixed-methods approach and builds upon previous research in the Health Research Board Centre for Primary Care Research. The Medical Research Council Framework for the design and evaluation of complex interventions to improve health has informed the study. Four general practices were sampled purposively (based on size, location, level of deprivation) and one clinical pharmacist has joined the general practice team for six months. The pharmacist is participating in the management of repeat prescribing, undertaking medication reviews (addressing high risk prescribing, potentially inappropriate prescribing [PIP], deprescribing and generic prescribing) with community-based and nursing home patients, joining practice team meetings and facilitating practice-based training for the rest of the general practice team. During the six-month intervention period, a nested Patient Reported Outcome Measures (PROM) study will be undertaken. For this, a sub-set of 50 patients aged ≥65 with significant polypharmacy (≥10 repeat medicines) will be recruited from each practice (total 200 PROM study patients). These patients will be invited to a medication review with the pharmacist and complete a questionnaire relating to their perceived level of health. Throughout the intervention period, aggregate practice-level medication data (e.g. changes in number of medications, instances of PIP identified) and PROM data (e.g. validated measures of health-related quality of life, attitudes towards deprescribing) will be collected. Acceptability of the intervention will be explored using semi-structured interviews with GPs, pharmacists and patients. Quantitative and qualitative data analysis will be undertaken and an economic evaluation conducted.

Findings

At the time of submission of this abstract, pre-intervention interviews have been undertaken with participating GPs and pharmacists. The six-month intervention period has started in each of the four practices. Practice-level data collection is on-going and PROM patient identification and recruitment has commenced. Thereafter, PROM data collection will be undertaken. The six-month intervention period will be completed end of March 2018 and preliminary data will be available for presentation.

Consequences

This pilot study will provide evidence regarding the feasibility and potential effectiveness of general practice-based pharmacists, 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.