What value do pharmacist-general practitioner (GP) inter-professional collaborative discussions have in patient medication reviews? A qualitative process evaluation (IMPPP Trial).

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

7D.4

Presenter:

Dr Debbie McCahon

Co-authors:

Dr Roxanne M. Parslow, Dr Lorna Duncan, Professor Carolyn A. Chew-Graham, Professor Bruce Guthrie, Professor Rupert A. Payne, Professor Katrina Turner

Author institutions:

University of Bristol, Keele University, University of Edinburgh, University of Exeter

Problem

Polypharmacy is increasingly common with risks to patient safety. The Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) trial aimed to evaluate the effectiveness of a complex intervention to optimise medication use for patients with polypharmacy in general practice. The intervention comprised a structured medication review, which included structured case-finding, pharmacist-general practitioner (GP) inter-professional collaborative discussions and a person-centred approach. Additional training, financial incentives and feedback was used to enhance professional engagement.

Approach

The trial received NHS Research Ethics Committee approval (ref 19/WA/0090).

A nested mixed-methods process evaluation explored: adoption, delivery/fidelity, clinician and patient’s views and perceptions, maintenance, and context to give insight into how the intervention was implemented in primary care. A subset of intervention practices were purposively sampled. GP and pharmacist inter-professional collaborative discussions, and patient-facing reviews were recorded. Semi-structured interviews were undertaken with GPs, pharmacists and patients to understand their experiences of the medication review, usual clinical care and practice systems. Interviews followed a checklist of topics. All interviews were audio-recorded and both recordings and interviews were transcribed verbatim, uploaded to NVivo V.11 and analysed using thematic analysis to facilitate both deductive and inductive coding, allowing the identification of overarching themes.

Findings

Data collection and analysis are ongoing. To date we have: 14 recordings of GP-Pharmacist inter-professional collaborative discussions; 21 recordings of patient medication reviews, 15 interviews with GPs/pharmacists and 22 interviews with patients. The inter-professional collaborative discussion (IPCD) between GPs and pharmacists emerged as one of the most valued aspects of the intervention. Prior to the trial, pharmacists described uncertainty about which GP to approach about queries and described ad hoc communication about medication queries. The IPCD as part of the trial provided a dedicated GP with protected time, offering an opportunity to focus on the whole patient and pharmacy perspectives jointly. Both pharmacists and GPs felt that this strengthened their working relationship and they learnt from each other. Pharmacists often brought suggestions to the meeting that were confirmed by the GP, giving them confidence in making decisions about medication. Pharmacists described how they often reinforced their discussions with GPs to patients as part of the medication review which seemed to increase patient confidence in their interactions. Patients reported that they valued the knowledge that pharmacists were working with GPs to over-see their care.

Consequences

Primary care is becoming more multidisciplinary. Clearly defined roles for healthcare professionals, inter-professional liaison and collaboration, and structured interventions can support improved patient care.

Submitted by:

Roxanne Parslow

Funding acknowledgement:

This project is funded by the National Institute for Health Research (NIHR) under its Health and Social Care Delivery Research programme (Grant Reference Number 16/118/14). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.