Non-dispensing clinical pharmacists in general practice: training, implementation and clinical effects

Abstract

Avoidable medication-related morbidity and mortality is a broadly acknowledged health care problem and is currently inadequately addressed. With the aging population, this problem is expected to increase. Elderly patients often have multimorbidity and use multiple medications, adding to the complexity of pharmacotherapy. As most of pharmacotherapy is initiated or continued in general practice, safety and effectiveness of pharmacotherapy needs to be improved in primary care. Research evidence indicates that community pharmacists can contribute to safe and effective pharmacotherapy, but are hampered to take up their role as pharmaceutical care provider. To make optimal use of their pharmaceutical knowledge, we propose that pharmacists minimize involvement in the dispensing process and focus on pharmaceutical care. These so-called non-dispensing pharmacists (NDPs) can then take integral responsibility for pharmaceutical care, without being distracted by logistics and pharmacy management. Once integrated in the primary care team, they will have full access to patients’ medical records. This integration will result in better collaboration with general practitioners (GPs), and consequently, the quality of pharmacotherapy will improve. Additional clinical training is required for pharmacists to develop as patient-centered care providers. Therefore, we developed the POINT practice model (Pharmacotherapy Optimization through Integration of a Non-dispensing pharmacist in a primary care Team). The NDPs who worked within the POINT practice model provided pharmaceutical care completely separated from the dispensing process. NDPs performed clinical medication reviews for patients with polypharmacy, medication reconciliation for patients discharged from the hospital and provided individual patient consultations to solve specific drug therapy problems. NDPs organised quality improvement projects to systematically identify and treat patients at risk of medication errors, and educated team members on optimal pharmacotherapy. With a series of both qualitative, quantitative and mixed-method studies, we evaluated the training, implementation and clinical effects of NDPs in general practice. The results from our study demonstrate that the risk on medication-related hospitalisations in practices with NDPs is lower compared to usual care. Non-dispensing pharmacists do effectively identify and solve drug therapy problems. Providing follow-up to patients is considered to be essential for optimal pharmaceutical care delivery. Additional post-graduate training, including peer provided reflective learning at the workplace, did help the NDP to develop skills and clinical expertise to add value as pharmaceutical care provider in general practice. Pharmacists in a general practice can develop a professional identity of patient-focused, clinical pharmaceutical care provider able to take responsibility for the patient’s pharmacotherapy. In short, high-risk patients will benefit most from integrated pharmaceutical care. Full integration of an NDP in clinical practice, adequate training and integral responsibility are key conditions of success for this new concept of pharmaceutical care provision.