Cardwell Karen, Clyne B, Moriarty F, Wallace E, Fahey T, Boland F, McCullagh L, Clarke S, Finnigan K, Daly M, Barry M, Smith S M
1Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland.
2Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland.
Pilot Feasibility Stud. 2018 Jul 5;4:122. doi: 10.1186/s40814-018-0311-7. eCollection 2018.
Prescribing for patients taking multiple medicines (i.e. polypharmacy) is challenging for general practitioners (GPs). Limited evidence suggests that the integration of pharmacists into the general practice team could improve the management of these patients. The aim of this study is to develop and test an intervention involving pharmacists, working within GP practices, to optimise prescribing in Ireland, which has a mixed public and private primary healthcare system.
This non-randomised pilot study will use a mixed-methods approach. Four general practices will be purposively sampled and recruited. A pharmacist will join the practice team for 6 months. They will participate in the management of repeat prescribing and undertake medication reviews (which will address high-risk prescribing and potentially inappropriate prescribing, deprescribing and cost-effective and generic prescribing) with adult patients. Pharmacists will also provide prescribing advice regarding the use of preferred drugs, undertake clinical audits, join practice team meetings and facilitate practice-based education. Throughout the 6-month intervention period, anonymised practice-level medication (e.g. medication changes) and cost data will be collected. A nested Patient Reported Outcome Measure (PROM) study will be undertaken during months 4 and 5 of the 6-month intervention period to explore the impact of the intervention in older adults (aged ≥ 65 years). For this, a sub-set of 50 patients aged ≥ 65 years with significant polypharmacy (≥ 10 repeat medicines) will be recruited from each practice and invited to a medication review with the pharmacist. PROMs and healthcare utilisation data will be collected using patient questionnaires, and a 6-week follow-up review conducted. Acceptability of the intervention will be explored using pre- and post-intervention semi-structured interviews with key stakeholders. Quantitative and qualitative data analysis will be undertaken and an economic evaluation conducted.
This non-randomised pilot study will provide evidence regarding the feasibility and potential effectiveness of general practice-based pharmacists in Ireland and provide data on whether a randomised controlled trial of this intervention is indicated. It will also provide a deeper understanding as to how a pharmacist working as part of the general practice team will affect organisational processes and professional relationships in a mixed public and private primary healthcare system.
为服用多种药物（即多重用药）的患者开处方对全科医生（GP）来说具有挑战性。有限的证据表明，将药剂师纳入全科医疗团队可以改善对这些患者的管理。本研究的目的是开发并测试一项干预措施，让药剂师在全科医疗诊所工作，以优化爱尔兰的处方开具情况，该国拥有公私混合的初级医疗保健系统。
这项非随机试点研究将采用混合方法。将有目的地抽取并招募四家全科医疗诊所。一名药剂师将加入诊所团队6个月。他们将参与重复配药管理，并对成年患者进行用药评估（包括处理高风险处方和潜在不适当处方、逐渐减少用药以及具有成本效益的通用处方）。药剂师还将提供有关首选药物使用的处方建议，进行临床审计，参加诊所团队会议并促进基于诊所的教育。在为期6个月的干预期内，将收集匿名的诊所层面用药数据（如用药变化）和成本数据。在6个月干预期的第4个月和第5个月将进行一项嵌套式患者报告结局测量（PROM）研究，以探讨该干预措施对老年人（年龄≥65岁）的影响。为此，将从每家诊所招募50名年龄≥65岁且多重用药情况严重（≥种重复用药）的患者子集，并邀请他们与药剂师进行用药评估。将使用患者问卷收集PROM和医疗保健利用数据，并进行为期6周的随访评估。将通过对关键利益相关者进行干预前和干预后的半结构化访谈来探讨该干预措施的可接受性。将进行定量和定性数据分析，并进行经济评估。
这项非随机试点研究将提供有关爱尔兰全科医疗诊所药剂师的可行性和潜在有效性的证据，并提供关于是否需要对该干预措施进行随机对照试验的数据。它还将更深入地了解作为全科医疗团队一员的药剂师将如何影响公私混合的初级医疗保健系统中的组织流程和专业关系。
