An exploration of the role of pharmacists within general practice clinics: the Pharmacists in Practice Study (PIPS)

The pharmacists will provide this intervention over a period of six months at each clinic. 1. Long patient consultations Participants will receive a 30-60 minute consultation with the pharmacist in a private room at the clinic (or a home visit if they prefer or are housebound) to perform a comprehensive medication review and identify medication-related problems (MRPs). Prior to the consultation, the pharmacist will discuss any health or medication-related issues with the GP or clinic staff, if needed. The pharmacist will also review participants’ general practice medical record (including progress notes, medication lists and pathology results) and dispensing histories if needed. The pharmacist will obtain written informed consent from the participant. In addition to reviewing the participant’s medication regimen, the pharmacist will assess medication adherence and knowledge. The pharmacist will provide counselling and education as needed on medication management and the use of medication devices, and reinforce lifestyle advice related to their health problems and medications. The pharmacist may provide the participant with a complete medication list and refer them to their community pharmacy for adherence aids (e.g. pill boxes, administration aids), if needed. Additionally, referral may be made to the GP or other health professionals as required. After the consultation, the pharmacist will write a short report outlining MRPs and recommendations, and provide this to the participant’s GP either electronically (via secure email or directly into the practice’s electronic medical record) or as a paper-based report, depending on the GP’s preference. The pharmacist may update the medication history within the practice’s medical record as needed. Following this, the pharmacist will discuss any issues with the GP, other staff and community pharmacist, if needed. Case conferencing may be organised where appropriate. 2. Short patient consultations Patients with potential medication issues (e.g. nonadherence, newly prescribed medicines) who do not require a comprehensive review of their complete medication regimen may receive a short consultation with the pharmacist. Data will be collected about these consultations, but the patients will not be consented for the study (no personal or identifying data will be collected). Referrals may be made by GPs or clinic staff, or patients may self-refer. The short patient consultation will last 15-30 minutes and provides an opportunity for the pharmacist to provide brief education and counselling on specific needs or answer questions. Short patient consultations will only be undertaken in the clinic. After the consultation, the pharmacist will write brief notes directly into the electronic medical record, and update records as needed. Examples of services to be provided in these consultations include: new medication counselling, adherence assessment, assessment of and education on device technique (e.g. using asthma inhalers), and provision of a medication list. 3. Drug information and education service for clinic staff The practice pharmacist will provide a drug information service for practice staff. Queries can be made to the pharmacist in person, by telephone or via email. All queries (and responses) will be documented by the pharmacist. Practice staff will also be invited to attend pharmacist-led group education sessions targeting topics relevant to them (e.g. new therapy or treatment protocols), and a weekly drug information newsletter may also be produced by the pharmacist and provided to staff. 4. Quality assurance activities The practice pharmacists will undertake a Drug Use and Evaluation (DUE) program in the clinic. The pharmacists will review current prescribing patterns, evaluate these against current best practice guidelines, and implement an intervention to address deficiencies identified using established DUE methodology. A pharmacotherapeutic area of concern or importance will be identified by the pharmacist in conjunction with the GPs and clinic staff. The practice team, with assistance from the research team, will decide upon audit criteria and measurement instruments will be derived from published clinical practice guidelines. The pharmacist will collect and evaluate data relevant to medication use in this area by retrospectively reviewing electronic medical records. Confidentiality of data will be ensured by de-identifying all information collected. Results and feedback will be provided to staff. Multifaceted strategies to improve the quality of prescribing in the selected area will be developed and implemented by the interdisciplinary team, and re-evaluated at the end of the study period. Patients will not be recruited or consented to this part of the study, and no identifying data will be collected.