Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Australia.
School of Medicine, Science, Medicine and Health Faculty, University of Wollongong, Wollongong, NSW, Australia.
Int J Pharm Pract. 2023 Dec 19;31(6):608-616. doi: 10.1093/ijpp/riad061.
The general practice pharmacist (GPP) role in Australia is evolving. A pilot GPP model of care developed to optimize medicines for patients at risk of medicine-related harm was evaluated. The aims of this study were 2-fold: to evaluate the GPP model of care on medicines optimization, with a focus on deprescribing, in a population at risk of harm due to their medicines, or clinical condition, and to explore the perspectives of study participants. This single practice study involved two phases. Phase 1 (September 2019-May 2020): at risk patients were referred to the GPP for medication reconciliation, recommendations for optimization, and when appropriate, deprescribing support, especially for opioids. Medication plans were developed with patients, GPs, and the GPP. Quantitative data collected from patient records included demographics, discrepancies, medicines reviewed, GPP recommendations and uptake, and medicines deprescribed. Opioid-related data included dose changes from baseline, at 6 and 9 months, standardized to oral morphine equivalents. Descriptive statistics were used for analysis. Phase 2 (7-21 September 2020): qualitative evaluation using semi-structured interviews was undertaken, to explore the perspectives of GP and patient participants of the GPP model of care. Interview data were thematically analysed. The study had ethical approval. Phase 1: 198 multimorbid patients with multiple medications [median = 13 (9-16)] had at least one GPP consultation (n = 243). Discrepancies were resolved through 88% of GPP consultations; deprescribing commenced or occurred in 54%. Acceptance of GPP recommendations was 86%. Opioids were the most common medicines deprescribed (42% ceased). The baseline median opioid dose [44.4 (30-90) mg] was significantly reduced at 6 months [13.5 (0-40) mg] and 9 months [7 (0-30) mg], P < .0001. Phase 2: Thematic analysis of 28 interviews (10 GPs, 3 practice personnel, 10 patients, 5 carers) identified four key themes: safer foundation for deprescribing, deprescribing opportunities recognition, benefits of embedded GPP, and a supported approach to shared decision-making. General practice provides opportunities for medicine optimization and deprescribing. This study has demonstrated a GPP model of care that achieved functional deprescribing to reduce potential harm in a population at risk and addressed recognized barriers.
澳大利亚的全科药剂师（GPP）角色正在发展演变。本研究评估了一种优化有药物相关风险的患者用药的 GPP 照护模式试点。本研究的目的有两个：一是评估 GPP 照护模式在药物优化方面的效果，重点是减少因药物或临床状况而有用药风险的患者的处方数量；二是探讨研究参与者的观点。本单诊所研究包含两个阶段。第一阶段（2019 年 9 月至 2020 年 5 月）：有风险的患者被转介给 GPP 进行药物重整、优化建议，并且在适当的情况下，提供减少处方支持，尤其是减少阿片类药物的处方。药物方案由患者、全科医生和 GPP 共同制定。从患者记录中收集了定量数据，包括人口统计学特征、差异、审查的药物、GPP 建议及采纳情况以及减少的药物数量。阿片类药物相关数据包括从基线开始，6 个月和 9 个月时的剂量变化，标准化为口服吗啡等效剂量。采用描述性统计方法进行分析。第二阶段（2020 年 9 月 7 日至 21 日）：采用半结构式访谈进行定性评估，以探讨全科医生和患者参与者对 GPP 照护模式的看法。对访谈数据进行了主题分析。该研究获得了伦理批准。第一阶段：198 名患有多种疾病的患者（中位数=13 岁（9-16 岁））接受了至少一次 GPP 咨询（n=243）。88%的 GPP 咨询解决了差异问题；54%开始或实施了减药。对 GPP 建议的接受率为 86%。阿片类药物是最常见的减少处方数量的药物（42%停止使用）。基线时阿片类药物的中位数剂量[44.4（30-90）mg]在 6 个月时[13.5（0-40）mg]和 9 个月时[7（0-30）mg]显著降低，P<0.0001。第二阶段：对 28 次访谈（10 名全科医生、3 名诊所工作人员、10 名患者和 5 名照顾者）的主题分析确定了四个关键主题：减少处方数量的更安全基础、减少处方数量机会的识别、嵌入式 GPP 的好处以及支持共同决策的方法。全科医生提供了优化药物和减少处方数量的机会。本研究证明了 GPP 照护模式能够实现功能减少处方数量，从而降低风险人群的潜在风险，并解决了公认的障碍。
