Supporting prescribing in Irish primary care: protocol for a non-randomised pilot study of a general practice pharmacist (GPP) intervention to optimise prescribing in primary care
Abstract Background 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 stud...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-07-01
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| Series: | Pilot and Feasibility Studies |
| Online Access: | http://link.springer.com/article/10.1186/s40814-018-0311-7 |
| _version_ | 1818081917973561344 |
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| author | Karen Cardwell B. Clyne F. Moriarty E. Wallace T. Fahey F. Boland L. McCullagh S. Clarke K. Finnigan M. Daly M. Barry S. M. Smith on behalf of the General Practice Pharmacist (GPP) Study Group |
| author_facet | Karen Cardwell B. Clyne F. Moriarty E. Wallace T. Fahey F. Boland L. McCullagh S. Clarke K. Finnigan M. Daly M. Barry S. M. Smith on behalf of the General Practice Pharmacist (GPP) Study Group |
| author_sort | Karen Cardwell |
| collection | DOAJ |
| description | Abstract Background 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 test an intervention involving pharmacists, working within GP practices, to optimise prescribing in Ireland, which has a mixed public and private primary healthcare system. Methods This non-randomised pilot study will use a mixed-methods approach. Four general practices will be purposively sampled and recruited. A pharmacist will join the practice team for 6 months. They will participate in the management of repeat prescribing and undertake medication reviews (which will address high-risk prescribing and potentially inappropriate prescribing, deprescribing and cost-effective and generic prescribing) with adult patients. Pharmacists will also provide prescribing advice regarding the use of preferred drugs, undertake clinical audits, join practice team meetings and facilitate practice-based education. Throughout the 6-month intervention period, anonymised practice-level medication (e.g. medication changes) and cost data will be collected. A nested Patient Reported Outcome Measure (PROM) study will be undertaken during months 4 and 5 of the 6-month intervention period to explore the impact of the intervention in older adults (aged ≥ 65 years). For this, a sub-set of 50 patients aged ≥ 65 years with significant polypharmacy (≥ 10 repeat medicines) will be recruited from each practice and invited to a medication review with the pharmacist. PROMs and healthcare utilisation data will be collected using patient questionnaires, and a 6-week follow-up review conducted. Acceptability of the intervention will be explored using pre- and post-intervention semi-structured interviews with key stakeholders. Quantitative and qualitative data analysis will be undertaken and an economic evaluation conducted. Discussion This non-randomised pilot study will provide evidence regarding the feasibility and potential effectiveness of general practice-based pharmacists in Ireland 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. |
| first_indexed | 2024-12-10T19:13:50Z |
| format | Article |
| id | doaj.art-e82f86620ac94066a38b85339209b8f8 |
| institution | Directory Open Access Journal |
| issn | 2055-5784 |
| language | English |
| last_indexed | 2024-12-10T19:13:50Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Pilot and Feasibility Studies |
| spelling | doaj.art-e82f86620ac94066a38b85339209b8f82022-12-22T01:36:39ZengBMCPilot and Feasibility Studies2055-57842018-07-014111110.1186/s40814-018-0311-7Supporting prescribing in Irish primary care: protocol for a non-randomised pilot study of a general practice pharmacist (GPP) intervention to optimise prescribing in primary careKaren Cardwell0B. Clyne1F. Moriarty2E. Wallace3T. Fahey4F. Boland5L. McCullagh6S. Clarke7K. Finnigan8M. Daly9M. Barry10S. M. Smith11on behalf of the General Practice Pharmacist (GPP) Study GroupHealth Research Board Centre for Primary Care Research, Royal College of Surgeons in IrelandHealth Research Board Centre for Primary Care Research, Royal College of Surgeons in IrelandHealth Research Board Centre for Primary Care Research, Royal College of Surgeons in IrelandHealth Research Board Centre for Primary Care Research, Royal College of Surgeons in IrelandHealth Research Board Centre for Primary Care Research, Royal College of Surgeons in IrelandHealth Research Board Centre for Primary Care Research, Royal College of Surgeons in IrelandDepartment of Pharmacology and Therapeutics, Trinity College DublinHealth Service Executive Medicines Management ProgrammeHealth Service Executive Medicines Management ProgrammeHealth Service Executive Medicines Management ProgrammeDepartment of Pharmacology and Therapeutics, Trinity College DublinHealth Research Board Centre for Primary Care Research, Royal College of Surgeons in IrelandAbstract Background 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 test an intervention involving pharmacists, working within GP practices, to optimise prescribing in Ireland, which has a mixed public and private primary healthcare system. Methods This non-randomised pilot study will use a mixed-methods approach. Four general practices will be purposively sampled and recruited. A pharmacist will join the practice team for 6 months. They will participate in the management of repeat prescribing and undertake medication reviews (which will address high-risk prescribing and potentially inappropriate prescribing, deprescribing and cost-effective and generic prescribing) with adult patients. Pharmacists will also provide prescribing advice regarding the use of preferred drugs, undertake clinical audits, join practice team meetings and facilitate practice-based education. Throughout the 6-month intervention period, anonymised practice-level medication (e.g. medication changes) and cost data will be collected. A nested Patient Reported Outcome Measure (PROM) study will be undertaken during months 4 and 5 of the 6-month intervention period to explore the impact of the intervention in older adults (aged ≥ 65 years). For this, a sub-set of 50 patients aged ≥ 65 years with significant polypharmacy (≥ 10 repeat medicines) will be recruited from each practice and invited to a medication review with the pharmacist. PROMs and healthcare utilisation data will be collected using patient questionnaires, and a 6-week follow-up review conducted. Acceptability of the intervention will be explored using pre- and post-intervention semi-structured interviews with key stakeholders. Quantitative and qualitative data analysis will be undertaken and an economic evaluation conducted. Discussion This non-randomised pilot study will provide evidence regarding the feasibility and potential effectiveness of general practice-based pharmacists in Ireland 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.http://link.springer.com/article/10.1186/s40814-018-0311-7 |
| spellingShingle | Karen Cardwell B. Clyne F. Moriarty E. Wallace T. Fahey F. Boland L. McCullagh S. Clarke K. Finnigan M. Daly M. Barry S. M. Smith on behalf of the General Practice Pharmacist (GPP) Study Group Supporting prescribing in Irish primary care: protocol for a non-randomised pilot study of a general practice pharmacist (GPP) intervention to optimise prescribing in primary care Pilot and Feasibility Studies |
| title | Supporting prescribing in Irish primary care: protocol for a non-randomised pilot study of a general practice pharmacist (GPP) intervention to optimise prescribing in primary care |
| title_full | Supporting prescribing in Irish primary care: protocol for a non-randomised pilot study of a general practice pharmacist (GPP) intervention to optimise prescribing in primary care |
| title_fullStr | Supporting prescribing in Irish primary care: protocol for a non-randomised pilot study of a general practice pharmacist (GPP) intervention to optimise prescribing in primary care |
| title_full_unstemmed | Supporting prescribing in Irish primary care: protocol for a non-randomised pilot study of a general practice pharmacist (GPP) intervention to optimise prescribing in primary care |
| title_short | Supporting prescribing in Irish primary care: protocol for a non-randomised pilot study of a general practice pharmacist (GPP) intervention to optimise prescribing in primary care |
| title_sort | supporting prescribing in irish primary care protocol for a non randomised pilot study of a general practice pharmacist gpp intervention to optimise prescribing in primary care |
| url | http://link.springer.com/article/10.1186/s40814-018-0311-7 |
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