Easing the load

doctor consultation GP appointment

A study of more than 131,000 patients has found pharmacists were able to alleviate GP workload by following up new hypertensive prescriptions

In the UK, the New Medicine Service (NMS) is a nationally commissioned NHS contractual service aimed at providing support for patients within the first month of starting a new medication.

It has been delivered in >90% of community pharmacies in England since being introduced in 2011.

Covering four areas – hypertension, type 2 diabetes, asthma and chronic obstructive pulmonary disease (COPD), and anticoagulation and antiplatelet therapy – the service aims to improve patient adherence to long-term medications by encouraging engagement with their new medication.

A cross-sectional study and multivariate logistic regression analysis of 131,419 patients was conducted by a group of pharmacists, GPs and researchers from the University of Oxford, UK.

The researchers looked at factors associated with patient referral from community pharmacies to general practice within the first two weeks of starting a new antihypertensive medication.

They found a total of 5895 patients (4.5%) had been referred by a pharmacist back to a GP within the first two weeks, according to results published this month in the British Journal of General Practice.

Patients reporting side effects from their new medication (19%) were most likely to be referred to their GP (adjusted OR 11.60, 95% CI = 10.85 to 12.41).

Meanwhile patients who were provided with more information about their new medication from the pharmacist, and those using their medications as prescribed (82.2%), were less likely to be referred to their GP.

Alpha-blockers were associated with referral, whereas patients prescribed an ARB were significantly less likely to be referred.

In total, within the first two weeks of starting a new antihypertensive medication, the majority of patients with hypertension (95.5%) were supported by a pharmacist without further recourse to their GP.

“Hypertension-related appointments make up almost one in 10 of all GP consultations each year,” say the authors.

“With the workload of GPs thought to be nearing saturation point, alternative models of hypertension management such as pharmacist-led care have the potential to alleviate this increasing burden on primary healthcare systems.”

In the case of patients reporting side effects, the likely responses from clinicians would be dose reductions or switching to alternative medications.

This is within pharmacists’ professional capacity, considering they are highly trained in the use and management of medications, say the authors.

“An extended prescribing role for community pharmacists could reduce referral of routine cases to an already overstretched general practice, but would require many to undertake further training.”

With the incidence of new hypertension cases at eight people per 1000 in the UK, a 4% referral rate would mean that of the 52 new hypertension cases per practice per year, only two would need to be seen again by the GP within two weeks of medication initiation.

See the full study here

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