Patients ‘really valued’ the service

Image: Katja Boom (right), Pharmacist at YourGP@Crace in the ACT, educates a patient about asthma management. Courtesy Roz Lemon

A pilot study has found beneficial results for patients through a GP pharmacist focused on asthma management

Researchers from the University of Canberra have reviewed the work of one pharmacist embedded in a general practice in Canberra over 13 months.

Specifically, they looked at interventions in asthma management conducted by the GP pharmacist, and whether these led to any positive changes in asthma control.

Activity diary data of the pharmacist was collected from May 2016 until November 2016, and May 2017 until December 2017.

Patients with asthma had either been identified and invited to attend for review by the practice pharmacist, or referred to the pharmacist by GPs and other members of practice staff.

Patient ages ranged from 17 months to 84 years.

Overall 87.5% (119/136) patients who consulted with the practice pharmacist had their asthma control recorded on their first visit.

Asthma plans were provided and discussed with all patients, with prescribing recommendations, asthma control test results and asthma plans discussed with each patient’s GP during or as soon as possible after the consultation.

Follow up consultations were arranged with the GP, pharmacist or nurse to monitor progress with alterations to management where necessary.

A subset of 26 patients (19.1% of the total sample) were seen more than once by the pharmacist over the study period.

Following the pharmacist’s interventions, asthma control test scores improved for 19 patients, worsened for three patients, were unchanged for one patient, and data was incomplete for three patients.

Prior to pharmacist review, 17% (4/23) patients in this subset had good asthma control, increasing to 52% (12/23) afterwards (p = 0.03).

In total, 42% (8/19) patients with poor control in this subset moved to well-controlled asthma following review by the practice pharmacist.

At least one avoided hospital admission was attributed to the practice pharmacist’s interventions.

GPs also reported that the pharmacist had educated them about asthma.

Here are some things GPs had to say about the practice pharmacist:

“I think some of the patients have really valued that and got better asthma control so that has been really good.” (GP2, 2018)

“Patients who have poor adherence that I wasn’t aware of and their asthma is so much better now because they’re actually taking their preventers, which is a revelation to them. I think patients have found the interactions with [the pharmacist] very helpful around asthma.” (GP1, 2016)

“There is one asthma patient that I have who was really difficult and basically tolerated really poorly controlled asthma. She would only come in when she was very bad. Again, [the pharmacist] got her in and emphasised the preventative part of it, and I think that’s prevented even hospital admissions as well as improved the lady’s quality of life.” (GP1, 2018)

This pilot study demonstrated that it is “feasible, acceptable and beneficial” to have a pharmacist in general practice focusing on asthma management, the researchers found.

The results were published in the journal Pharmacy.

While the idea of pharmacists in general practice is ramping up, with some financial support to be provided through the Workforce Incentive Program announced this year, not everyone agrees with the idea.

In a recent article for AJP, pharmacy owner Catherine Bronger argued that integrating pharmacists into GP surgeries will duplicate roles.

She says the idea fails to acknowledge the myriad health services already being provided by community pharmacies.

And in August 2018, the Small Pharmacies Group penned an open letter arguing that a focus on GP pharmacists may lead to systematic cuts to community pharmacy funding.

“There is no evidence to show that co-location of a pharmacist in a GP practice is essential to achieve the health outcomes and certainly no studies to show that delivery of such services in a GP setting provides better health outcomes and is more cost effective than delivery in a community pharmacy as no comparative studies have been undertaken,” said the group.

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  1. Debbie Rigby

    More evidence to support the role of practice pharmacists and demonstrates the value and patient outcomes. Imagine the impact on asthma control, morbidity and mortality if pharmacists were providing this care in general practice around Australia.

  2. Debbie Rigby

    Just read another publication – a systematic review and meta-analyses of pharmacist intervention for asthma adherence.

    Conclusions are “In clinical practice, pharmacists can act as “medication experts” providing updated information and ongoing support for people with long-term conditions. Community pharmacy interventions such as the New Medicine Service can significantly increase adherence. These interventions offer convenient access points to the healthcare system and ensure consistent contact with people through the provision of ongoing pharmaceutical care.
    Our findings suggest that pharmacist-led interventions may be more effective if they are integrated into government policy and existing healthcare services. Notably, NHS England recently extended the Clinical Pharmacists in General Practice pilot. These embedded pharmacists are working to improve patient safety and quality of care, whilst reducing the pressure on general practitioners.”

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