Impact statements
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Pharmacists can provide numerous services to improve the quality of care in the general practice setting by working in a team environment.
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Most general practice pharmacist-led clinical activities had the potential to improve patient care and decrease healthcare costs.
Introduction
Aim
Ethics approval
Method
Study design and setting
Participants and recruitment
Intervention
Activity | Expected outcome |
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Medication review | Improve medication safety with a focus on deprescribing |
Antimicrobial stewardship | Prevent overuse of antimicrobial agents and development of resistance |
Clinical audits | Improve quality of prescribing at practice level |
Point-of-care-testing | Monitor existing conditions and identify undiagnosed diseases |
Management of asthma | Improve asthma management and control patients’ symptoms |
Providing education to staff | Assist general practice staff to improve knowledge on medications, drug interactions, adverse effects, guidelines, correct use of medical devices |
Diabetes education | Improve diabetes care management through pharmacological and non-pharmacological interventions |
Updating medical records | Drug allergy/adverse drug reaction information |
Transitions of care | Accurate medicine reconciliation after hospital discharge |
Smoking cessation | Support people to quit smoking through pharmacological and non-pharmacological interventions |
Vaccination | Complement existing immunisation services by administering vaccines |
Collaboration with external services/healthcare professionals | Act as a conduit between the general practice and other external services e.g. community pharmacies, hospitals, RACF |
Data collection
Data analysis
Coding pharmacists’ activities
Evaluating the potential outcomes of pharmacist-led clinical activities
Results
Description of pharmacist-led activities
Activity | Reported by: pharmacists n (%) | Number of activities n (%) | Time spent per activity (minutes) mean ± SD | Estimated time saved for GPs per activity (minutes) mean ± SD | Description/outcomes |
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Medication review | 9 (100) | 932 (22) | 42.6 ± 25.0 | 33.5 ± 24.5 | Pharmacists’ interventions*: providing education (n = 735, 79%), monitoring the condition (n = 496, 53%), dose adjustments (n = 262, 28%), deprescribing (n = 252, 27%), referrals (n = 223, 24%), initiation of new therapy (n = 209, 22%) Acceptance of pharmacists’ recommendations by GPs: accepted (n = 698, 75%), partly accepted (n = 97, 10%), unknown (n = 96, 10%), no action required by GPs (n = 25, 3%), not accepted (n = 18, 2%) |
Antimicrobial stewardship | 7 (78) | 24 (1) | 84.4 ± 70.7 | 2.9 ± 8.2 | Collecting data/audit (n = 16, 67%), providing education (n = 8, 33%) |
Clinical audits | 9 (100) | 294 (7) | 84.3 ± 77.6 | N/A | Clinical audits related to: diabetes and no record of HbA1c (n = 40, 14%); inappropriate use of proton pump inhibitors (high dose [> 40 mg/day esomeprazole equivalent] with no relevant indication for > 4 weeks) (n = 39, 13%); people who were eligible for health checks, home medication reviews, and case conferences (n = 32, 11%); people who were eligible but not received vaccines (n = 27, 9%); anticoagulation therapy (AF patients at high risk of stroke/patients who had been prescribed dual antiplatelet therapy beyond indicated time) (n = 22, 7%); polypharmacy ( patients on 5 or more medicines) (n = 22, 7%); CKD patients who required dose adjustments (n = 19, 6%); medicines use in asthma/COPD (n = 15, 5%); opioids use in non-cancer pain (n = 15, 5%); osteoporosis (patients at high risk due to long-term use of systemic corticosteroids/had not been prescribed anti-osteoporosis medication for minimal trauma fractures/timely administration of denosumab) (n = 13, 4%); antipsychotics prescribed without monitoring BP, BGL, weight, cholesterol (n = 10, 3%); angiotensin converting enzyme inhibitors or angiotensin receptor blockers use in heart failure (n = 8, 3%); patients who eligible for vitamin D treatment (n = 8, 3%); inappropriate use of NSAIDs (older age, heart failure) (n = 7, 2%); patient records required updating (allergies/other socio-demographic details) (n = 7, 2%); other (n = 10, 3%) (contraception status of females prescribed valproate, product alerts, Hepatitis C treatment) |
Point-of-care-testing (POCT) | 6 (67) | 64 (2) | 20.8 ± 19.3 | N/A | Pharmacist-led POCT*—The number of patients screened for: blood pressure (n = 38, 59%), asthma/COPD (n = 27, 42%), blood glucose level (n = 21, 33%), AF (n = 7, 11%), other (n = 7, 11%) Outcomes: case identification (n = 26, 41%), no action required (n = 16, 25%), further reviews/referrals (n = 8, 13%), treatment initiated/added a medicine (n = 5, 8%), ceased medicines (n = 3, 5%), dose adjustments (n = 2, 3%), outcome not reported (n = 4, 6%) |
Asthma care | 7 (78) | 133 (3) | 30.7 ± 9.3 | 26.3 ± 8.9 | Pharmacists’ interventions*: Providing education—inhaler counselling (n = 59, 44%), lifestyle modifications (n = 43, 32%); recommended step-up of asthma prevention treatment 44 (33%), recommended step-down of asthma prevention treatment 14 (11%), developing asthma action plan (n = 39, 29%), changed medicines/device (n = 17, 13%) |
Providing education to general practice staff | 9 (100) | 301 (7) | 32.5 ± 24.1 | 27.8 ± 19.5 | Providing medicine information related to patients’ therapy (n = 175, 58%) Providing general education on guidelines, medicine availability, updates from Therapeutic Goods Administration, changes to Pharmaceutical Benefits Scheme (n = 126, 42%) |
Diabetes education (including as a CDE) | 2 (22) | 385 (9) | 36.8 ± 16.5 | 20.5 ± 13.2 | Pharmacists’ interventions*: providing education on diet/lifestyle modification (n = 201, 52%), self-blood glucose monitoring (n = 137, 36%), insulin storage/administration (n = 107, 28%); medication adjustments and providing education on medicines (n = 170, 44%); referrals (n = 6, 2%) |
Updating medical records | 4 (44) | 72 (2) | 113.9 ± 109.7 | N/A | Pharmacists updated 2519 patient records, including updating the allergy status (n = 1102, 44%); updating diagnosis, and social/lifestyle (n = 843, 33%); updating the medication list (n = 384, 15%); updating ADR (n = 190, 8%) for patients |
Transitions of care | 7 (78) | 160 (4) | 29.9 ± 14.5 | 29.4 ± 13.9 | Pharmacists’ interventions: medicine reconciliation (n = 89, 56%), providing education (n = 51, 32%), updating records for (n = 20, 13%) patients |
Smoking cessation | 6 (67) | 161 (4) | 34.9 ± 12.3 | 30.2 ± 7.0 | Of 161 smoking cessation sessions conducted by pharmacists, 86 (53%) were the first-time appointments and 75 (47%) were follow-up sessions. Of 86 patients, 36 (42%) patients were attempting to quit smoking, 21 (24%) patients reduced smoking, 14 (16%) quit smoking, and 4 (5%) did not quit smoking |
Vaccination | 5 (56) | 52 (1) | 35.1 ± 39.3 | N/A | Of 126 patients, the influenza vaccine was administered for 110 (87%), and the COVID-19 vaccine for 16 (13%) patients |
Collaboration and communication with external services/healthcare professionals | 9 (100) | 360 (8) | 46.0 ± 50.6 | 28.0 ± 31.0 | Activities related to collaboration with a community pharmacy included: queries related to adherence/prescriptions/patient records (n = 140, 39%); opioid maintenance treatment delivery (n = 74, 21%); obtaining medicine availability information (n = 71, 20%); referrals (HMR, dose aid administration/sleep apnoea) (n = 36, 10%); obtaining dispensing history (n = 23, 6%); drug disposal (n = 5, 1%) Activities related to collaboration with other services/healthcare professionals (n = 11, 3%) |
Service development | 9 (100) | 1111 (26) | 73.2 ± 72.0 | N/A | Planning for new service implementation (n = 290, 26%), meeting others about the service (n = 291, 26%), training for the role/continuous professional development (n = 288, 26%), administrative work (n = 127, 11%), booking appointments for patients (n = 115, 10%) |
Miscellaneous activities | 9 (100) | 221 (5) | 45.3 ± 36.8 | N/A | Doctors’ bag check/stock management or expiry check of the medicines in the general practice (n = 86, 39%); Project-related activities, medical assistance, and other activities (n = 135, 61%) |
Activity | Claimed MBS items | Generated income per pharmacist AU$ |
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Medication review | Health assessment 707 | 6408 |
GP management plan 721 | ||
Team care arrangement 723 | ||
Review of GP management plan or team care arrangement 732 | ||
Multidisciplinary case conferences 735, 747, 739, 750 | ||
Home medicines review 900 | ||
Point-of-care-testing | Contribution to spirometry 11,505 | 85 |
Asthma care | Asthma cycle of care: 265, 2546, 2552, 2558 | 1088 |
GP management plan 721 | ||
Multidisciplinary case conference 735 | ||
Diabetes education | Diabetes cycle of care 2525 | 8090 |
Diabetes education 10,951 | ||
Multidisciplinary case conference 735, 739 | ||
GP management plan 721 | ||
Team care arrangement 723 | ||
Allied health COVID telehealth 93,013 | ||
Transitions of care | Multidisciplinary case conference 735 | 96 |
GP management plan 721 | ||
Allied health COVID telehealth 93,013 | ||
Smoking cessation | Team care arrangement 732 | 37 |
GP mental health treatment plan 2713 |
Potential outcomes of pharmacist-led clinical activities
Dimension | Definition | Impact | Number of activities (%) |
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Clinical | The PI can lead to adverse outcomes on clinical status, knowledge, satisfaction, patient adherence and/or quality of life of the patient | Negative | 8 (0.3) |
The PI can have no influence on the patient regarding the clinical status, knowledge, satisfaction, patient adherence and or quality of life of the patient | Null | 189 (7.8) | |
The PI can improve knowledge, satisfaction, medication adherence and/or quality of life OR the PI can prevent harm that does not require monitoring/treatment | Minor | 926 (38.2) | |
The PI can prevent harm that requires further monitoring/treatment but does not lead to or does not extend a hospital stay | Moderate | 407 (16.8) | |
The PI can prevent harm which causes or lengthens a hospital stay OR causes permanent disability or handicap | Major | 787 (32.5) | |
The PI can prevent an accident that potentially causes the need for intensive care or the death of the patient | Avoids fatality | 5 (0.2) | |
The available information does not allow the evaluation of clinical impact | Undetermined | 97 (4.0) | |
Economic | The PI increases the cost of health care | Increase in cost | 7 (0.3) |
The PI does not change the cost of health care | No change | 787 (32.5) | |
The PI decreases the cost of health care | Decrease in cost | 1528 (63.2) | |
The available information does not allow the evaluation of economic impact | Undetermined | 97 (4.0) | |
Organisational | The PI reduces the quality of care | Negative | 0 |
The PI does not change the quality of care | No change | 27 (1.1) | |
The PI increases the quality of care | Positive | 2367 (97.9) | |
The available information does not allow the evaluation of organisational impact | Undetermined | 25 (1.0) |