Integrating non-dispensing pharmacists into the general practice team

INTRODUCTION

Prescribing occurs at a rate of 85.5 prescriptions per 100 patient encounters in Australian general practices.  When used appropriately medicines maintain health, manage chronic conditions and cure disease. However, medicine-related problems can lead to harm, unnecessary general practice visits and potential hospitalisation.

Evidence demonstrates that integrating pharmacists into the general practice team can reduce medicine-related problems through better medication management and coordination of care. Yet as of May 2018, only 42 pharmacists were working in Australian general practices.

PRACTICE CHANGE IMPLEMENTED

In 2018, North Western Melbourne Primary Health Network (NWMPHN) commissioned the Pharmaceutical Society of Australia (PSA) to deliver the project. Over 14-months, practice pharmacists provided medication services in three general practices within NWMPHN’s region.

The pharmacist worked as part of the practice team for 14 hours per week providing patient medication reviews, staff education and quality improvement.

AIM AND THEORY OF CHANGE

•Improve quality use of medications by patients and general practitioners (GPs).

•Optimise prescribing in general practice.

•Improve patient medication literacy and adherence.

•Identify the roles of practice pharmacists that are accepted by GPs, patients and pharmacists.

TARGETED POPULATION AND STAKEHOLDERS

The targeted population for this project was people on multiple medicines. Targeted stakeholders were general practice staff, patients and pharmacists.

TIMELINE

The project ran from January 2018 to May 2019.

HIGHLIGHTS

•Improved quality use of medications by patients via 402 patient education sessions.

•Optimised prescribing in general practice via pharmacist participation in 62 case-conferences.

•Improved patient medication literacy and adherence via the identification of adherence issues on 70 occasions.

Impact was demonstrated via the patient survey results:

•97% of patients agreed that being able to access a practice pharmacist was a valuable service.

•87% of patients agreed that after talking with the practice pharmacist they could better manage their health.

•92% of patients agreed that after talking with the practice pharmacist they felt reassured that their medicines were appropriate.

COMMENTS ON SUSTAINABILITY

Sustainability relies on the remuneration of the practice pharmacist.

Currently, practice pharmacists are remunerated through completing home medicine reviews or via pilots like this one.

In January 2020, a new Workforce Incentive Program (WIP) enabling allied health professionals working in general practice, including pharmacists, to be remunerated will be implemented. However, the WIP includes remuneration of practice nurses and therefore the uptake of practice pharmacists is likely to be low.

COMMENTS ON TRANSFERABILITY

The general practices were selected to inform the transferability of the project. They were an inner urban community health centre, an outer urban community health centre and a privately-run suburban clinic.

CONCLUSIONS

Key findings suggest integrating pharmacists into general practices:

•Is acceptable to practice staff and patients. 

•Improves quality use of medications by patients and GPs.

DISCUSSION

The project demonstrated the value of practice pharmacists in multidisciplinary general practice teams and highlighted enablers to facilitate this process.

LESSIONS LEARNED

•Practices require a GP champion.

•At corporate practices, engagement is essential at all business levels.

•The pharmacist’s role varies depending on the needs of the practice, patient demographics, and GP special interests.