Clinical pharmacist facilitators in primary care: a descriptive study of their roles and services provided in general practices of southern New Zealand
Sivamanoj Yadav Boyina 1 5 , Tim Stokes 2 , Angela Renall 3 , Rhiannon Braund 1 41 Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
2 Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
3 Clinical Pharmacist Facilitator, WellSouth Primary Health Network, Dunedin, New Zealand
4 New Zealand Pharmacovigilance Centre, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
5 Corresponding author. Email: boysi071@student.otago.ac.nz
Journal of Primary Health Care 12(1) 88-95 https://doi.org/10.1071/HC19073
Published: 30 March 2020
Journal Compilation © Royal New Zealand College of General Practitioners 2020 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
INTRODUCTION: Internationally, the inclusion of pharmacists into general practice as clinical pharmacy facilitators has improved patient outcomes. However, clinical pharmacists are relatively new to southern New Zealand general practices and their range of services has not been studied.
AIMS: To describe the implementation of clinical pharmacist services in general practices in the Southern region; to examine the tasks conducted by clinical pharmacy facilitators; and to determine the characteristics of patients who access this service.
METHODS: The establishment and development of the clinical pharmacy facilitator role was determined by documentation held within the local Primary Health Organisation. The activities performed by clinical pharmacy facilitators were collected from patient medical records for the period 31 March 2015 to 31 March 2018. To describe the characteristics of patients receiving these services, a retrospective case note review of patients seen by the facilitators was conducted.
RESULTS: The clinical pharmacy facilitator role was initiated with three pharmacists in three geographical locations across the region. Within 18 months, the number of facilitators was increased to eight. As a result of collaboration with the general practice team, 42% of referrals came from general practitioners directly. Overall, 2621 medicine-related problems were identified in 2195 patients. Dosage adjustment was the most common recommendation made by pharmacy facilitators. They consulted mostly older patients and patients taking five or more medicines.
DISCUSSION: With effective collaboration, clinical pharmacy facilitators can play a key role in optimisation of medicines therapy.
KEYwords: Pharmacists; primary health care; general practice; medication therapy management; health services (MeSH terms).
References
[1] Hazen ACM, de Bont AA, Boelman L, et al. The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: a systematic review. Res Social Adm Pharm. 2018; 14 228–40.| The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: a systematic review.Crossref | GoogleScholarGoogle Scholar | 28506574PubMed |
[2] Tan ECK, Stewart K, Elliott RA, George J. Pharmacist services provided in general practice clinics: a systematic review and meta-analysis. Res Social Adm Pharm. 2014; 10 608–22.
| Pharmacist services provided in general practice clinics: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[3] Reeves S, Pelone F, Harrison R, et al. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2017;
| Interprofessional collaboration to improve professional practice and healthcare outcomes.Crossref | GoogleScholarGoogle Scholar | 28639262PubMed |
[4] Hatah E, Tordoff J, Duffull SB, Braund R. Pharmacists’ performance of clinical interventions during adherence support medication reviews. Res Social Adm Pharm. 2014; 10 185–94.
| Pharmacists’ performance of clinical interventions during adherence support medication reviews.Crossref | GoogleScholarGoogle Scholar | 23688540PubMed |
[5] Avery AJ, Rodgers S, Cantrill JA, et al. A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. Lancet. 2012; 379 1310–9.
| A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis.Crossref | GoogleScholarGoogle Scholar | 22357106PubMed |
[6] Simpson SH, Lier DA, Majumdar SR, et al. Cost-effectiveness analysis of adding pharmacists to primary care teams to reduce cardiovascular risk in patients with Type 2 diabetes: results from a randomized controlled trial. Diabet Med. 2015; 32 899–906.
| Cost-effectiveness analysis of adding pharmacists to primary care teams to reduce cardiovascular risk in patients with Type 2 diabetes: results from a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 25594919PubMed |
[7] Chisholm-Burns MA, Kim Lee J, Spivey CA, et al. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Med Care. 2010; 48 923–33.
| US pharmacists’ effect as team members on patient care: systematic review and meta-analyses.Crossref | GoogleScholarGoogle Scholar | 20720510PubMed |
[8] Nkansah N, Mostovetsky O, Yu C, et al. Effect of outpatient pharmacists’ non-dispensing roles on patient outcomes and prescribing patterns. Cochrane Database Syst Rev. 2010;
| Effect of outpatient pharmacists’ non-dispensing roles on patient outcomes and prescribing patterns.Crossref | GoogleScholarGoogle Scholar | 20614422PubMed |
[9] Dolovich L, Pottie K, Kaczorowski J, et al. Integrating family medicine and pharmacy to advance primary care therapeutics. Clin Pharmacol Ther. 2008; 83 913–7.
| Integrating family medicine and pharmacy to advance primary care therapeutics.Crossref | GoogleScholarGoogle Scholar | 18388882PubMed |
[10] Kolodziejak L, Rémillard A, Neubauer S. Integration of a primary healthcare pharmacist. J Interprof Care. 2010; 24 274–84.
| Integration of a primary healthcare pharmacist.Crossref | GoogleScholarGoogle Scholar | 20388026PubMed |
[11] Lui E, Ha R, Truong C. Applying the pharmaceutical care model to assess pharmacist services in a primary care setting. Can Pharm J. 2017; 150 90–3.
| Applying the pharmaceutical care model to assess pharmacist services in a primary care setting.Crossref | GoogleScholarGoogle Scholar |
[12] Dolovich L. Ontario pharmacists practicing in family health teams and the patient-centered medical home. Ann Pharmacother. 2012; 46 S33–S39.
| Ontario pharmacists practicing in family health teams and the patient-centered medical home.Crossref | GoogleScholarGoogle Scholar | 22499739PubMed |
[13] Freeman C, Cottrell N, Kyle G, et al. Chronicles of a primary care practice pharmacist. Integr Pharm Res Pract. 2012; 13–18.
| Chronicles of a primary care practice pharmacist.Crossref | GoogleScholarGoogle Scholar |
[14] Angley MT, Kellie A, Barrow G. Integration of a consultant pharmacist into a general practice: development of a collaborative care model. J Pharm Pract Res. 2015; 45 81–5.
| Integration of a consultant pharmacist into a general practice: development of a collaborative care model.Crossref | GoogleScholarGoogle Scholar |
[15] Benson H, Sabater-Hernández D, Benrimoj SI, Williams KA. Piloting the integration of non-dispensing pharmacists in the Australian general practice setting: a process evaluation. Int J Integr Care. 2018; 18 4
| Piloting the integration of non-dispensing pharmacists in the Australian general practice setting: a process evaluation.Crossref | GoogleScholarGoogle Scholar | 30127688PubMed |
[16] Tan ECK, Stewart K, Elliott RA, George J. Pharmacist consultations in general practice clinics: The Pharmacists in Practice Study (PIPS). Res Social Adm Pharm. 2014; 10 623–32.
| Pharmacist consultations in general practice clinics: The Pharmacists in Practice Study (PIPS).Crossref | GoogleScholarGoogle Scholar |
[17] Patterson BJ, Solimeo SL, Stewart KR, et al. Perceptions of pharmacists’ integration into patient-centered medical home teams. Res Social Adm Pharm. 2015; 11 85–95.
| Perceptions of pharmacists’ integration into patient-centered medical home teams.Crossref | GoogleScholarGoogle Scholar | 24954185PubMed |
[18] Komwong D, Greenfield G, Zaman H, et al. Clinical pharmacists in primary care: a safe solution to the workforce crisis? J R Soc Med. 2018; 111 120–4.
| Clinical pharmacists in primary care: a safe solution to the workforce crisis?Crossref | GoogleScholarGoogle Scholar | 29480743PubMed |
[19] NHS England. Clinical pharmacists in general practice. Leeds: NHS England; 2018 [Cited 2018 October 8]. Available from: https://www.england.nhs.uk/gp/gpfv/workforce/building-the-general-practice-workforce/cp-gp/
[20] Bryant LJ, Coster G, Gamble GD, McCormick RN. The General Practitioner-Pharmacist Collaboration (GPPC) study: a randomised controlled trial of clinical medication reviews in community pharmacy. Int J Pharm Pract. 2011; 19 94–105.
| The General Practitioner-Pharmacist Collaboration (GPPC) study: a randomised controlled trial of clinical medication reviews in community pharmacy.Crossref | GoogleScholarGoogle Scholar | 21385240PubMed |
[21] Hatah E, Tordoff J, Duffull SB, et al. Retrospective examination of selected outcomes of Medicines Use Review (MUR) services in New Zealand. Int J Clin Pharm. 2014; 36 503–12.
| Retrospective examination of selected outcomes of Medicines Use Review (MUR) services in New Zealand.Crossref | GoogleScholarGoogle Scholar | 24626968PubMed |
[22] Hatah E, Tordoff J, Duffull SB, Braund R. Pharmacists’ performance of clinical interventions during adherence support medication reviews. Res Social Adm Pharm. 2014; 10 185–94.
| Pharmacists’ performance of clinical interventions during adherence support medication reviews.Crossref | GoogleScholarGoogle Scholar | 23688540PubMed |
[23] Bidwell S, Thompson L. GPs, community pharmacists and shifting professional boundaries. N Z Med J. 2015; 128 19–26.
| 26117387PubMed |
[24] Pharmaceutical Society of New Zealand Project Team. National Pharmacist Services Framework 2014. Wellington: Pharmaceutical Society of New Zealand; 2014 [Cited 2018 October 8] Available from: https://www.psnz.org.nz/Folder?Action=View%20File&Folder_id=86&File=PSNZPharmacistServicesFramework2014FINAL.pdf
[25] Campbell C, Braund R, Morris C. Beyond the four walls: an exploratory survey of location, employment and roles of pharmacists in primary health care. J Prim Health Care. 2017; 9 297–310.
| Beyond the four walls: an exploratory survey of location, employment and roles of pharmacists in primary health care.Crossref | GoogleScholarGoogle Scholar | 29530142PubMed |
[26] Haua R, Harrison J, Aspden T. Pharmacist integration into general practice in New Zealand. J Prim Health Care. 2019; 11 159–69.
| Pharmacist integration into general practice in New Zealand.Crossref | GoogleScholarGoogle Scholar | 32171359PubMed |
[27] Ministry of Health. Population of Southern DHB. Wellington: Ministry of Health; 2018 [Cited 2018 October 8]. Available from: https://www.health.govt.nz/new-zealand-health-system/my-dhb/southern-dhb/population-southern-dhb
[28] Health Safety and Quality Commission of New Zealand. Polypharmacy in older people. Wellington: Health Safety and Quality Commission of New Zealand; 2018 [Cited 2018 December 12]. Available from: https://public.tableau.com/profile/hqi2803#!/vizhome/Polypharmacysinglemap/AtlasofhealthcarevariationPolypharmacy?publish=yes
[29] Freeman CR, Cottrell WN, Kyle G, et al. An evaluation of medication review reports across different settings. Int J Clin Pharm. 2013; 35 5–13.
| An evaluation of medication review reports across different settings.Crossref | GoogleScholarGoogle Scholar | 23011269PubMed |
[30] Farrell B, Ward N, Dore N, et al. Working in interprofessional primary health care teams: what do pharmacists do? Res Social Adm Pharm. 2013; 9 288–301.
| Working in interprofessional primary health care teams: what do pharmacists do?Crossref | GoogleScholarGoogle Scholar | 22835709PubMed |
[31] Jorgenson D, Dalton D, Farrell B, et al. Guidelines for pharmacists integrating into primary care teams. Can Pharm J. 2013; 146 342–52.
| Guidelines for pharmacists integrating into primary care teams.Crossref | GoogleScholarGoogle Scholar |
[32] Tan ECK, Stewart K, Elliott RA, George J. Stakeholder experiences with general practice pharmacist services: a qualitative study. BMJ Open. 2013; 3 e003214
| Stakeholder experiences with general practice pharmacist services: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[33] Deeks LS, Naunton M, Tay GH, et al. What can pharmacists do in general practice? A pilot trial. Aust J Gen Pract. 2018; 47 545–49.
| What can pharmacists do in general practice? A pilot trial.Crossref | GoogleScholarGoogle Scholar | 30114892PubMed |