Why do GPs ignore pharmacist advice?


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Over half of pharmacist recommendations were not actioned by GPs in this randomised trial

Researchers from the universities of Bristol, Bath, Reading, Sydney and Laval have examined the impact of a pharmacist intervention in general practice patients.

They examined data from a cluster-randomised trial in general practices in England and Scotland, which allocated practices to either usual care (17 practices) or to provide six-monthly comprehensive ‘3D’ reviews (16 practices).

The ‘3D’ approach, comprising dimensions of health, depression, and drugs, included reviews by pharmacists, nurses and doctors.

Results were published in The Lancet.

The pharmacist used patient electronic medical records to review medication and make recommendations about simplifying and optimising treatment.

This including considering whether any medications could be stopped or started, or whether any medication regimens needed to be changed.

Doctors were to then discuss medication adherence and review pharmacist recommendations.

A sub-study, the results of which were presented at the Society for Academic Primary Care annual scientific meeting in the UK this month, found that among the 797 patients in the intervention group, 607 (76%) had a review of their medication by the pharmacist.

For 115 patients (19%) no pharmacist recommendation was made.

Of 1100 total recommendations made, 218 (20%) were either vague, indirect or a question, said the researchers.

The most common interventions were to stop/reduce a medication (26%), switch a medication within the same class (18%) or ‘review’ a medication (16%).

Of the recommendations advising changes to prescriptions, over half were not actioned by GPs.

“A high proportion of pharmacist recommendations were vague or indirect, and over half of the recommendations that advised a change in prescribing were not actioned by the GPs,” the researchers found.

“This explains why the 3D intervention had no effect on the number of medications prescribed.

“It is possible that the 3D Study intervention improved the medication complexity, e.g. the number of doses per day,” they said.

GPs who took part in the latest study told lead researcher Dr Polly Duncan that they tended to ignore pharmacist recommendations because they thought they were “more technical and unlikely to lead to patient benefit, such as switching the patient’s statin, ” according to Pulse Today.

“GPs most valued recommendations that improved prescribing safety and two of the GPs talked about medication errors that had been picked up by the pharmacist,” Dr Duncan said.

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8 Comments

  1. Kevin Hayward
    16/07/2019

    I get different outcomes between a written report, with ad lib verbal exchanges, from that I achieve with a written report and a full case conference. In the latter scenario I get a much better understanding of why a recommendation may not adopted, and the opportunity to ask questions. As a famous explorer once told me, for your practice to succeed you need three things, … communication, communication and communication

    • PharmOwner
      17/07/2019

      Ah but communication has to be a two-way street. I contacted a prescriber today with legitimate concerns about whether the scripts presented by a patient may have been stolen. The medico in question, a psychiatrist, was quite aggressive and berated me for “wasting his time” In fact, he was so upset that I’d contacted him, he wasted about 4 minutes of his precious time telling me about how I’d wasted his time! A simple, quick, “Yes, I wrote those scripts for patient X and Y” would have sufficed.

      • Kevin Hayward
        18/07/2019

        I have to admit it has taken me around 15yrs of close working with the same primary care teams to get to where I am now, I am certain I could get the same response as you from outside these teams.

    • Geoff Murrell
      18/07/2019

      Different FROM, Similar TO, would certainly improve communication!

  2. Debbie Rigby
    17/07/2019

    A “remote” medication review just looking at the electronic medical records is only a medication chart review not a comprehensive medication review involving the patient ie HMR. I’m not surprised at the outcomes and GP comments that the recommendations were “technical” and therefore not that useful. Medication chart reviews can be useful to identify potential drug-related problems, but then should be followed by a patient-centred, comprehensive med review.

    • Jarrod McMaugh
      17/07/2019

      Agreed.

      If anything, this study highlights the importance of clinical information being available across the spectrum of a person’s healthcare team. It highlights the benefits of using discussion time/opportunities for **clinical** purposes; the need to clarify information that could be made available via digital means wastes time and leads to frustrations that make communication between HCPs harder.

  3. Peter Crothers
    18/07/2019

    Just looking back at over our clinical interventions (for which we now get paid less that $4 a pop I believe) and they are overwhelmingly concerned with prescribing safety. Wrong doses, duplications, contraindications, drugs ceased by other prescribers and not recorded by the GP. Bear in mind a CI must result in an actual change of treatment. Even if we were getting paid the agreed $10, these presumably represent fantastic value, especially in the eyes of prescribers. At $4 they’re a real snip.

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