Non-dispensing pharmacists led to less hospitalisations than usual care in study, but the same outcome was found in trained, collaborative community pharmacists
A study has found fully integrated non-dispensing pharmacists in general practices led to a lower rate of medication-related hospitalisations among high-risk patients compared to usual care.
However the same lower rate was also found among community pharmacists trained to perform medication reviews.
Researchers from the Netherlands randomised general practices into three arms of the study:
- Nine intervention practices—with an embedded non-dispensing pharmacist on a full-time basis, who concurrently participated in a training program.
- 10 practices with usual care—pharmaceutical care provided in collaboration with community pharmacists.
- Six practices with usual care plus—care provided in collaboration with community pharmacists who had completed an accredited training program in performing medication reviews.
Between 1 June 2014 to 31 May 2015, there were 822 medication-related hospitalisations among 11,281 high-risk patients across the three study groups.
Most frequent hospitalisations were those related to infections, falls and bleeding.
The adjusted mean rate of medication-related hospitalisations in the intervention group was 4.4 per 100 high-risk patients per year, compared to 6.4 in the usual care group.
This rate was even lower at 4.2 in the usual care plus group.
The adjusted rate ratio for medication-related hospitalisations in the intervention group compared to usual care was 0.68 (95% confidence interval 0.57-0.82, and compared to usual care plus was 1.05 (95% CI 0.73-1.52).
Integration seems key to improve the quality of pharmaceutical care.
“Interestingly, medication-related hospitalisation outcomes in intervention and usual care plus practices did not differ,” found the researchers in the British Journal of Clinical Pharmacology.
“The additional training in performing clinical medication review (the inclusion criterion for usual care plus) appeared to be no standalone feature but rather an expression of an already highly integrated pharmaceutical-care model.
“In the usual care plus practices, there was a strong pre-existing collaboration between GPs and community pharmacists, with joint information systems, regular (in)formal face-to-face meetings between GPs and pharmacists and a common focus upon medication therapy management.
“The main difference with the non-dispensing pharmacist intervention practices was that in these practices non-dispensing pharmacists were formally co-located in general practices and extensively trained in clinical knowledge, skills and communication.
“Integration seems key to improve the quality of pharmaceutical care,” they continued.
“This may either be done by introduction of the non-dispensing pharmacist, or by developing more usual care plus practices. The latter would involve investment in existing infrastructure and collaboration.
“Cost effectiveness of both models should be investigated,” the researchers concluded.
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