Top results for pharmacist-GP trial


Pharmacist intervention resulted in significantly lower ED and hospital re-admissions in this new Australian study

A randomised controlled trial has found positive results for pharmacists working in the general practice setting, according to a paper published on Monday in the Medical Journal of Australia.

The research team, led by University of Queensland Associate Professor Chris Freeman, recruited patients between May 2017 and March 2018.

Adults who had been discharged during the preceding seven days from one of seven public hospitals in Queensland were eligible if they:

  • had nominated a general practitioner in a participating general practice as their regular GP; and
  • had been prescribed five or more long-term regular medicines on discharge; or
  • had received a primary discharge diagnosis of congestive heart failure or exacerbation of chronic obstructive pulmonary disease—both conditions associated with high re-admission rates.

The intervention group received a face-to-face medicine management consultation with a pharmacist embedded in the general practice, followed by a consultation with their GP.

Pharmacist consultations involved a comprehensive medicine review to identify drug-related problems, review of discharge medicines lists and their reconciliation with practice records, and discussion of any changes to usual medicines during the hospital admission.

Meanwhile the control group received usual care at their general practice, with no practice pharmacist review or routinely scheduled GP appointment.

All participating intervention and control patients were followed up 30 days and three, six, and 12 months after discharge from their index hospitalisations.

Researchers included 177 control and 129 intervention patients in their analysis. Of these, 101 patients completed the full intervention.

Pharmacists identified an average of four drug-related problems during the initial consultation, most related to medicine choices (i.e. duplication) or adherence.

For 81 patients in the intervention group, GPs implemented at least one pharmacist recommendation.

At 12 months, incidence of emergency department presentation was 54% lower for intervention group than the control group, and combined incidence of hospital re-admission and ED presentation incidence was 31% lower.

Intervention patients were 64% less likely to be re-admitted or re-present to hospital at 30 days.

“As the proportions of patients who saw their GP within a week of discharge were similar for both groups (about 60%), lower hospital use was probably more attributable to the consultation with the pharmacist than early GP review,” said the researchers.

The intervention also proved to be of positive economic value of the health system. The authors of the paper estimated the health service cost saving achieved by the intervention at 12 months was $5072 per patient.

“A substantial net benefit to the health care system was associated with the intervention, with a return over 12 months of $31 per dollar invested,” they said.

There were some limitations to the study. The researchers were unable to pin down how many hospital re-admissions were directly linked to medicine-related adverse events. In addition, the target sample size of 2240 patients was not achieved for a few reasons.

However based on the promising results, larger scale studies of the pharmacist-GP model of care are warranted, the researchers conclude. More funding is required to support this collaborative model of care, A/Prof added on Twitter.

While a 2013 survey found only 26 pharmacists worked in the general practice setting, this number continues to grow as Primary Health Networks (PHNs) are employing more in these roles.

In 2020, 13% of GPs reported that they worked in practices employing pharmacists.

Read the full article in the MJA here

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1 Comment

  1. Dr Evan Ackermann
    22/02/2021

    First impressions – Chris has designed and implemented a large well-constructed trial, the findings are suggestive and I would support/justify the recommendation for the need for larger trials. It’s a shame about enrolment numbers not meeting targets.

    The major issue as I see is that we do not know if the patient groups are indeed comparable.

    Randomisation was done after an index unplanned admission – not complexity. It would have been beneficial if the data collected included admissions, ED presentations etc for the populations PRIOR 12 months as well. This would have given some insight as to case complexity and the propensity for admission/ ED presentation.

    Deaths were also not collated (I could not see any) – it may sound bizarre but deaths rates decrease hospital admission rates and ED presentations.

    All findings and conclusions rest on this – it would be valuable if Chris could comment if this was done – or why it wasn’t done.

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