GP pharmacists: stakeholder perspectives


What do patients, general practice staff and community pharmacists think about general practice pharmacists?

A new qualitative pilot study published in the Australian Journal of Primary Health has reviewed stakeholder perception about the role of the pharmacist in general practice.

Researchers from the University of Canberra, Capital Health Network and the Queensland University of Technology used self-report questionnaires and qualitative semi-structured interviews to gather perspectives of patients, practice staff and community pharmacists that had interacted with a practice pharmacist.

The study was conducted across three general practices in the ACT, each of which employed a part-time (15.2-16 hours per week) non-dispensing pharmacist for 12 months as part of an initiative of the Capital Health Network – ACT’s Primary Health Network.

Activities that the three pharmacists performed in their role included conducting clinical audits, medication review, patient education, community pharmacy liaison about complex patients, and administration.

Response rates for the questionnaires were 48% for patients (n = 44) and 36% (n = 42) for staff. Opinions were further explored by individual semi-structured interviews (n = 20).

Patient respondents indicated that they mainly heard about the general practice pharmacist from doctors (66%), while about 80% of healthcare workers  said they had made referrals to the pharmacist.

The main reasons for these referrals included medication review, patient education, medication adherence and smoking cessation.

About 60% of patients had seen the general practice pharmacist at least once, while 32% had seen them twice, 7% three times and 2% four times. Average consultation time with the pharmacist was 40 minutes (range: 20-100 minutes).

Medicare funding of practice pharmacists was supported by 73% of patients.

Continued integration of pharmacists in general practice was supported by both patients and healthcare workers, with mean Likert scores of 4.4 and 4.4 out of 5 respectively.

Positive feedback came from all stakeholders including the patients, GPs, practice nurses and practice pharmacists themselves.

“We’ve been able to scale down the amount of medications and reduce the pill burden for these patients which obviously improves adherence,” said one GP.

“Complicated people, and sometimes when they come out of … hospital or if they’ve visited two or three specialists, then each one of them has made a small change, and getting [the practice pharmacist] to go over .. what they are actually, really taking now, as opposed to what my computer thinks they’re taking, has been incredibly helpful,” said another GP.

Within the context of being a member of the practice team, there was recognition of the importance of working within the scope of practice.

“I don’t want to be taking away work from the nurses,” said one general practice pharmacist.

Negative perceptions of practice pharmacists mainly came from community pharmacists, say the authors.

Their main concerns were about low effect on patient care and the lack communication with the community pharmacist.

“No feedback from the patients whatsoever, and certainly I haven’t seen any major changes,” said one community pharmacist.

Limitations for the study include low participant numbers, low response rate to the questionnaires and no knowledge of non-respondents. It was also conducted in one Australian urban city, and general practices in the study volunteered to be involved.

See the full study here

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4 Comments

  1. Deirdre Criddle
    22/06/2018

    Patients = Tick, Colleagues within the practice = Tick, Community Pharmacists = “TBA”. A culture of communication and handover will provide the proof that GP Pharmacists are the antithesis of a threat to improved pharmaceutical care – rather they have the opportunity to improve medication management. As someone working across care transitions – I am heartened to be able to hand over medication management care of important, sometimes complex instructions to another pharmacist. This ensures the message gets received and acted upon with the patient/carers. I am certain that once we embed these roles, the reality of how pharmacists can and will work together will be different to the “concerns” about what this model “may” look from Community colleagues. It should increase communication and co-operation with those Community pharmacies who provide real care and support between GP visits. Such an important aspect of patient care! .

    • Jarrod McMaugh
      22/06/2018

      Speaking from my personal opinion, and from what I have observed from others:

      Community Pharmacists = Tick

      There are definitely issues that need to be addressed to ensure that the roles provided by pharmacists in GP practice are utilised effectively. There will be duplication of roles (how can there not be…. much of what a community pharmacist does in their clinical role is the same things that make a pharmacist in GP clinics attractive) but this isn’t inherently an issue – if it improves communication and patient outcomes, then so be it.

      The main concern I have personally is that communication continues unchanged the way it is now. I have conversations with prescribers regularly about medication issues…. and often these issues are not heeded.There is a trend for some prescribers to justify errors rather than acknowledge them. This kind of communication issue probably won’t be fixed by pharmacists working in GP clinics, because these types of GPs won’t employ a pharmacist, or won’t utilise them for this purpose. “Often” may only be 1 or 2 calls per day, but when dealing with health issues, that’s too often.

      I think it’s also important that this doesn’t become a new layer of communication between a community pharmacist and the prescriber. I’ll value the ability to discuss prescribing issues, medication reconciliation, and even owing prescriptions with the resident pharmacist at a clinic, but when I have a specific issue, I’ll need to speak to the prescriber, not the pharmacist.

  2. Debbie Rigby
    25/06/2018

    WentWest PHN has released a really good document outlining the role of a general practice pharmacist.

    Please read with an open mind to see the role described and how it enhances the role of community pharmacists, and most importantly, improves team-based care to consumers.

    “A General Practice Pharmacist (GPP) is a non-dispensing pharmacist who delivers clinical and education services to patients within the general practice setting. The GPP is integrated as a member of the patient care team to foster true team-based care and support the Patient Centred Medical Home principles. Their role complements the dispensing role undertaken by Community Pharmacists but can bring core pharmacist skills into the general practice setting. The role of a GPP is diverse and can be tailored to meet the needs of the patient to ensure they experience effective team-based care in the primary care setting being at GP practices, the patient’s home or in the community.”

    See http://wentwest.com.au/documents/resources/reports/WSGPPP2018-_WEB.pdf

  3. Kevin Hayward
    27/06/2018

    From my own experience recently based in GP practice as part of a project, I was delighted by the enthusiasm and level of communication I enjoyed with the two local pharmacies. As with previous postings I sought to identify points of input for my community pharmacy colleagues in patient education and medication review, only covering myself those activities they were unable to undertake. In over 20 yrs of working in this role I cannot remember a point where my community pharmacy colleagues or my GPs indicated that we were duplicating our roles. As for outcomes that depends how it is set up. The evidence is there. In Australia we see NPS (mainly pharmacists) achieving clinical targets in GP practice, in my role in the UK we had to meet key prescribing indicators in both cost and rational prescribing.

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