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Abstract
Objectives This study aimed to develop and assess the feasibility and cost impact of an intervention involving a practice pharmacist embedded in general practice to improve prescribing safety, deprescribe where appropriate and reduce costs.
Setting Four-doctor suburban general practice.
Participants Inclusion criteria: patients receiving 10+ repeat drugs per month. Exclusion criteria: deceased, <18 years of age, nursing home resident, no longer attending, late-stage life-limiting condition, unsuitable on clinical/capacity grounds. 137 patients were eligible. 78 were recruited as participants, all of whom completed the study.
Intervention Pharmacist conducting holistic medication reviews in the study group over a 6-month period.
Primary outcome measures Anonymised medication changes, cost, biochemical monitoring and clinical measurements data were collected. Cost analysis of having a pharmacist as part of the general practice team was calculated.
Results In total, 198 potentially inappropriate prescriptions (PIPs), and 163 opportunities for deprescribing were identified; 127 PIPs (64.1%) were actioned; 104 deprescribing opportunities were actioned (63.8%). The pharmacist identified 101 instances in which further investigations were warranted prior to prescription issue, of which 80 were actioned (79.2%). It was calculated that monthly savings of €1252 were made as a result of deprescribing.
Conclusions This study has shown that the integration of pharmacists within general practice in Ireland is feasible and is an effective means of improving prescribing safety and implementing deprescribing through medication reviews. The combination of safety and cost concerns support taking a holistic approach to deprescribing with the patient. This study highlights the ease with which a pharmacist could integrate into the general practice setting in Ireland and points to how this could be sustainably funded.
- PRIMARY CARE
- Health informatics
- HEALTH ECONOMICS
- Quality in health care
Data availability statement
Data are available in a public, open access repository. This does not include patient identifiable data. The full anonymised dataset is available from the Zenovo repository, DOI: 10.5281/zenodo.4475526.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available in a public, open access repository. This does not include patient identifiable data. The full anonymised dataset is available from the Zenovo repository, DOI: 10.5281/zenodo.4475526.
Footnotes
Contributors DÓC, A-MB and MÓC were involved in developing the study design. A-MB was responsible for conducting medication reviews. DC and MÓC were responsible for managing the data collection and analysis with additional input from DÓC and A-MB. A-MB prepared the initial manuscript with additional input by DÓC, DC and CD. DÓC and CD critically reviewed the manuscript and suggested revisions. All authors read and approved the final manuscript. DÓC is the guarantor with overall responsibility for the work, conduct of the study, data management, and control of the decision to publish.
Funding This work was supported by the Health Service Executive and Trinity College Dublin grant number 55838838. This study formed part of a larger pilot study examining the integration of a pharmacist into a general practice. The Tomorrow’s Care project is a collaboration between the Health Service Executive (CHO 7 Division), Trinity College Dublin and a large teaching and academic practice (GPs at Tallaght Cross). This project funded a data analyst and pharmacist for this study. Tomorrow’s Care is funded by the CHO7 Division of the Health Service Executive.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.