Integrating pharmacists into GP practices can optimize treatment plans in primary care

Research undertaken by RCSI University of Medicine and Health Sciences suggests that integrating pharmacists into general practice (GP) teams facilitates collaboration to optimize treatment plans for patients with long-term medical needs and alleviate pressures on GP practices.

The study, conducted by researchers in RCSI's Department of General Practice and School of Pharmacy and Biomolecular Sciences, is published today in BMJ Open.

General practitioners (GPs) frequently manage medications for patients with multiple complex health conditions, further complicated by long-standing prescriptions from previous doctors and the evolving nature of treatment. Pharmacists are well placed to assist with this, working collaboratively with GPs to decide on the most appropriate treatment options.

Although not yet introduced in Ireland, general practice pharmacists are common in other countries and have been shown to provide essential support to GP teams, with the potential to optimize treatment and lower costs. The pilot study led by RCSI is the first evaluation of pharmacists in this role in Ireland.

Researchers selected four GP practices with approximately 35,000 patients to participate in the study over a six-month period. During this time, pharmacists were integrated into and worked in these practices reviewing prescriptions to support existing GP teams. They flagged 786 patients who had 1,521 potential issues relating to medication effectiveness or concerns over possible side effects. The most common medications involved were proton pump inhibitors used to suppress stomach acid, benzodiazepines used to treat anxiety or insomnia and anti-inflammatory drugs.

Over 50% of these issues resulted in a change being made by the patient's GP, such as reducing the dose or ending a prescription where the risks outweighed the benefits or the medication was no longer necessary. Overall, the changes to prescriptions in the four GP practices amounted to potential cost savings of approximately €57,000 each year.

Our findings clearly demonstrate the possible benefit of introducing general practice pharmacists to the Irish healthcare system. While further study is needed to establish the cost-effectiveness of such an initiative nationwide, implementing it would work towards alleviating the pressure our GPs are under and improving the quality of care for Irish patients."

Dr Frank Moriarty, Senior author, pharmacist and lecturer at the School of Pharmacy and Biomolecular Sciences

Leading the study alongside Dr Frank Moriarty are GP and Professor of Primary Care Medicine, Professor Susan Smith and research lecturer Dr Barbara Clyne, both from the RCSI Department of General Practice.

As demands on primary care increase, integrating pharmacists into GP practices has the potential to bring a more closely integrated model of care to patients with multiple complex needs. The best patient care in general practice includes multidisciplinary collaboration across healthcare professionals and I look forward to further studies in this area to explore the feasibility of introducing this practice in Ireland."

Susan Smith, Professor of Primary Care Medicine at RCSI

The research is supported by the Health Research Board (HRB), the Health Service Executive's National Quality Improvement team (HSE NQI Team), and the Royal College of Physicians of Ireland (RCPI) Research Collaboration in Quality and Patient Safety fund.