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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