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. 2018 Jul 5:4:122.
doi: 10.1186/s40814-018-0311-7. eCollection 2018.

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

Karen Cardwell  1 , B Clyne  1 , F Moriarty  1 , E Wallace  1 , T Fahey  1 , F Boland  1 , L McCullagh  2 , S Clarke  3 , K Finnigan  3 , M Daly  3 , M Barry  2   3 , S M Smith  1 ; General Practice Pharmacist (GPP) Study Group
Collaborators, Affiliations

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

Karen Cardwell et al. Pilot Feasibility Stud. .

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.

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Conflict of interest statement

Ethical approval was granted by the Irish College of General Practitioners, on 14 June 2017. Recruited practices received information about the study when first invited to participate. Information about the study will be given to eligible patient participants. It will be explained that participation is voluntary and can be terminated at any time. Written informed consent will be obtained prior to the interviews being recorded. Interview transcripts will be anonymised.Consent to publish data collected as part of this project will be attained prior to publication.The authors declare that they have no competing interests. .Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Figure showing the flow of patients through the study
Fig. 2
Fig. 2
Overview of the general practice pharmacist intervention and its components
See this image and copyright information in PMC

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