Pharmacist and physician collaborative prescribing: for medication renewals within a primary health centre.

OBJECTIVE

To determine if there is improvement in medication management when pharmacists and family physicians collaborate to prescribe medication renewals requested by fax.

DESIGN

Prospective, non-randomized controlled trial.

SETTING

W est Winds Primary Health Centre, an interdisciplinary health centre that includes an academic family medicine practice, located in Saskatoon, Sask.

PARTICIPANTS

All patients whose pharmacies faxed the health centre requesting prescription renewals between October 2007 and February 2008 were selected to participate in the study.

INTERVENTIONS

Medication renewal requests were forwarded to the pharmacist (who works in the clinic part-time) on days when he was working (intervention group). The pharmacist assessed drug-therapy issues that might preclude safe and effective prescribing of the medication. The pharmacist and physician then made a collaborative decision to authorize the requested medication or to request additional interventions first (eg, perform laboratory tests). When the pharmacist was not working, the physicians managed the renewal requests independently (control group).

MAIN OUTCOME MEASURES

Medication renewals authorized with no recommendations, medication-related problems identified, new monitoring tests ordered, and new appointments scheduled with health providers.

RESULTS

A total of 181 renewal requests were included (94 in the control group and 87 in the intervention group). The control group had significantly more requests authorized with no recommendations (75.5% vs 52.9%, P = .001). Those in the intervention group had significantly more medication-related problems identified (26 vs 10, P = .031); medication changes made (24 vs 10, P = .044); and new appointments scheduled with their family physicians (31 vs 21, P = .049).

CONCLUSION

There is an improvement in medication management when a pharmacist collaborates with family physicians to prescribe medication renewals. The collaborative model created significantly more activity with each renewal request (ie, identification of medication-related problems, medication changes, and new appointments), which reflects an improvement in the process of care.