Abstract
Pharmacists embedded in general practice can improve medicines optimisation and patient safety, but Australia has been slower to adopt and fund this model than other comparable countries. Over the last decade there have been various local programs integrating pharmacists in general practice across Australia. This article summarises the results of an evaluation in Canberra from 2016–2021. Pharmacists predominantly conducted clinical activities, including medication reviews and clinical audits. General practitioner (GP) acceptance and implementation of medication review recommendations was high (75%). General practice pharmacists were able to achieve positive clinical outcomes in asthma and smoking cessation. Surveys and interviews identified that the general practice pharmacist role was welcomed by patients, GPs, and other healthcare professionals. Patient satisfaction was very high, with patients supporting the expansion of this pharmacy service. Collaboration between the pharmacists and other healthcare professionals was high. Some pharmacists left employment in general practice after less than a year. Introducing a clear job description could be beneficial in retaining pharmacists, improving trust and working relationships, and enhancing collaboration. The majority of clinical activities conducted by the pharmacists had the potential to improve patient care and decrease healthcare costs. Apart from healthcare savings, benefit–cost ratios of income generated and costs reduced by pharmacists when compared to salaries suggested that pharmacists may be cost-beneficial in some scenarios. Absence of funding for this model of care remains a barrier to wider adoption in Australia and needs addressing. This study was approved by the University of Canberra Human Research Ethics Committee (Project number: 15–235) and funded under the Primary Health Network Program (Grant number: 25097479).
Original language | English |
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Pages (from-to) | 271-281 |
Number of pages | 11 |
Journal | Journal of Pharmacy Practice and Research |
Volume | 53 |
Issue number | 5 |
DOIs | |
Publication status | Published - 7 Nov 2023 |
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In: Journal of Pharmacy Practice and Research, Vol. 53, No. 5, 07.11.2023, p. 271-281.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Pharmacists in Australian general practice
T2 - Discussion of the findings of an evaluation from 2016 to 2021
AU - Deeks, Louise S.
AU - Naunton, Mark
AU - Peterson, Gregory M.
AU - Sudeshika, Thilini
AU - Freeman, Christopher
AU - Sharma, Ravi
AU - Leavens, Stacy
AU - Kosari, Sam
N1 - Funding Information: Income for the pharmacist's salary can be generated from pharmacist participation in government-funded Medicare claimable activities, additional income from GP–patient consultations due to time saved for the GPs by the general practice pharmacist, and potentially direct payment from patients for pharmacist consultations. In Phase 1, activities undertaken by pharmacists that would otherwise be conducted by GPs were considered to be: medication reviews; post-hospitalisation medication reconciliation; drug selection; patient education; reviewing blood tests; updating medication records; liaison with community pharmacy; liaison with residential aged-care facilities; medication recalls; and smoking cessation. The time saved was converted to a monetary value according to the values for a 20-min GP private consultation or for a 20-min bulk-billed Medicare Benefits Schedule (MBS) item number 23 consultation. In addition to the pharmacist-specific HMRs, pharmacists in our studies demonstrated that they can contribute to various multidisciplinary MBS income-generating items, including health assessments for people over 75 years of age, GP management plans, case conferences, team care arrangements, and the asthma cycle of care. Some options for funding general practice pharmacists within the current healthcare structure were quantified for two pharmacists in Canberra in Phase 1.55 The time saved for GPs was estimated to be 23.9 h per month for a full-time pharmacist working 37.5 h per week. This compares to the values of time saved of 80 h, 35.6 h, and 19.6 h per month determined from practice pharmacists working in Westbourne Medical Centre (England),56 Dudley (England),57 and Inverclyde (Scotland).58 The variability in these values may be due to the differing scope of practice of the pharmacists. The pharmacists' activities generated income of AUD $7000 for general practices over 19 weeks.55 The benefit–cost ratios of income generated by the pharmacists compared to their salaries were 0.15–1.31 in 2016–2017 (Phase 1) and 0.28–1.77 in 2017–2018 (Phase 2), which suggests that pharmacists may become more cost-beneficial the longer they are established in general practice.55 At the conclusion of external funding, two of the three practices involved in Phases 1–2 and three of the eight practices in Phase 3 retained or tried to retain the pharmacist using their own funds. This is a very positive acknowledgement of the value placed on the pharmacist role within these practices. Further work is required to determine the ideal full-time equivalent (FTE) pharmacist per 10 000 patients (full time is 37.5 h working hours per week) taking into account other factors such as disease burden, age profile and deprivation. In Phase 1 of our study, practices had 0.18, 0.29, and 0.26 FTE pharmacists per 10 000 patients. This compares to average FTE pharmacists per 10 000 patients in England ranging from 0.19 (95% confidence interval [CI] 0.13–0.25) FTE in the South-East to 0.25 (95% CI 0.20–0.30) FTE in the North-East and Yorkshire.10 It should be noted that none of these FTE equivalents are based on economic evidence, and this is needed. Pharmacist-led clinical activities in Phase 3 were analysed to assess the potential clinical, economic, and organisational impact of using a modified version of the CLinical Economic Organisational (CLEO) tool.22,59 Of 2419 clinical activities, the potential clinical impact on patients was assessed as major for 787 (32.5%) and moderate for 407 (16.8%) activities.22 The significance of this observation is that around 50% of pharmacist activities could potentially reduce the risk of prolonged hospitalisation or permanent disability with the associated costs. This analysis suggests that general practice pharmacists improve patient safety, which has also been found internationally.60,61 Overall, 1528 (63.2%) clinical activities potentially decreased costs to the healthcare system.22 This is likely to have considerable economic benefit as it has been estimated that there were 250 000 medication-related hospital admissions with a cost of AUD $1.4 billion to the Australian healthcare system annually (2019–2020 data).62 The finding that the activities of pharmacists in general practice appear to reduce these costs strengthens the argument for wider implementation. Almost all the pharmacist-led clinical activities (n = 2367, 97.9%) had a positive organisational impact, thus improving the quality of care provided by the general practice.22 This included saving time for GPs, which may have economic benefits for the general practice.22 Other analyses have quantified the potentially substantial savings related to reduced medication-related problems. The PINCER trial in England demonstrated that pharmacists in general practice could be cost-effective when improving medication safety using an information technology intervention.63 Cost savings relating to unplanned hospital presentations has been investigated in a Queensland trial (REMAIN HOME).64 The trial determined that a general practice pharmacist medicine management consultation for patients recently discharged from hospital reduced hospital re-admission rates and emergency department presentations, with a cost–benefit ratio of 31:1.64 Research studies such as REMAIN HOME that clearly measure the health system savings generated by general practice pharmacists due to improved medicines use and patient safety may persuade governments to fund pharmacists to become embedded in more general practices across Australia. The authors would like to thank the pharmacists, staff, and patients from the participating general practices. We would like to acknowledge assistance with the preliminary data analysis from David Powling, Aaron Maina, and Guan Han Tay. Open access publishing facilitated by University of Canberra, as part of the Wiley - University of Canberra agreement via the Council of Australian University Librarians. Funding Information: We acknowledge the Capital Health Network for undertaking this pilot program using funding provided by the Australian Government under the Primary Health Network Program (Grant number: 25097479). Publisher Copyright: © 2023 The Authors. Journal of Pharmacy Practice and Research published by John Wiley & Sons Australia, Ltd on behalf of Society of Hospital Pharmacists of Australia.
PY - 2023/11/7
Y1 - 2023/11/7
N2 - Pharmacists embedded in general practice can improve medicines optimisation and patient safety, but Australia has been slower to adopt and fund this model than other comparable countries. Over the last decade there have been various local programs integrating pharmacists in general practice across Australia. This article summarises the results of an evaluation in Canberra from 2016–2021. Pharmacists predominantly conducted clinical activities, including medication reviews and clinical audits. General practitioner (GP) acceptance and implementation of medication review recommendations was high (75%). General practice pharmacists were able to achieve positive clinical outcomes in asthma and smoking cessation. Surveys and interviews identified that the general practice pharmacist role was welcomed by patients, GPs, and other healthcare professionals. Patient satisfaction was very high, with patients supporting the expansion of this pharmacy service. Collaboration between the pharmacists and other healthcare professionals was high. Some pharmacists left employment in general practice after less than a year. Introducing a clear job description could be beneficial in retaining pharmacists, improving trust and working relationships, and enhancing collaboration. The majority of clinical activities conducted by the pharmacists had the potential to improve patient care and decrease healthcare costs. Apart from healthcare savings, benefit–cost ratios of income generated and costs reduced by pharmacists when compared to salaries suggested that pharmacists may be cost-beneficial in some scenarios. Absence of funding for this model of care remains a barrier to wider adoption in Australia and needs addressing. This study was approved by the University of Canberra Human Research Ethics Committee (Project number: 15–235) and funded under the Primary Health Network Program (Grant number: 25097479).
AB - Pharmacists embedded in general practice can improve medicines optimisation and patient safety, but Australia has been slower to adopt and fund this model than other comparable countries. Over the last decade there have been various local programs integrating pharmacists in general practice across Australia. This article summarises the results of an evaluation in Canberra from 2016–2021. Pharmacists predominantly conducted clinical activities, including medication reviews and clinical audits. General practitioner (GP) acceptance and implementation of medication review recommendations was high (75%). General practice pharmacists were able to achieve positive clinical outcomes in asthma and smoking cessation. Surveys and interviews identified that the general practice pharmacist role was welcomed by patients, GPs, and other healthcare professionals. Patient satisfaction was very high, with patients supporting the expansion of this pharmacy service. Collaboration between the pharmacists and other healthcare professionals was high. Some pharmacists left employment in general practice after less than a year. Introducing a clear job description could be beneficial in retaining pharmacists, improving trust and working relationships, and enhancing collaboration. The majority of clinical activities conducted by the pharmacists had the potential to improve patient care and decrease healthcare costs. Apart from healthcare savings, benefit–cost ratios of income generated and costs reduced by pharmacists when compared to salaries suggested that pharmacists may be cost-beneficial in some scenarios. Absence of funding for this model of care remains a barrier to wider adoption in Australia and needs addressing. This study was approved by the University of Canberra Human Research Ethics Committee (Project number: 15–235) and funded under the Primary Health Network Program (Grant number: 25097479).
KW - general practice
KW - general practitioners
KW - pharmacist
KW - primary care
UR - http://www.scopus.com/inward/record.url?scp=85176274464&partnerID=8YFLogxK
U2 - 10.1002/jppr.1878
DO - 10.1002/jppr.1878
M3 - Article
AN - SCOPUS:85176274464
SN - 1445-937X
VL - 53
SP - 271
EP - 281
JO - Journal of Pharmacy Practice and Research
JF - Journal of Pharmacy Practice and Research
IS - 5
ER -