The non-dispensing pharmacist in primary care : an interprofessional model to improve pharmaceutical care and patient safety

Abstract

Pharmacotherapy is an essential element of primary care. Generally, medication is very effective. Yet, medication can also cause harm. Especially elderly patients using multiple medications are at risk of such medication-related harm – a group that currently grows, given the aging population. Optimising pharmaceutical care is needed to minimise harm. Hereto, collaboration between general practitioner (GP), pharmacist and the patient are needed; yet this seems often suboptimal. A new, interprofessional model of pharmaceutical care provision, with a specially trained non-dispensing clinical pharmacist (NDP) integrated in primary care teams, seems promising based on international literature. In this thesis, we evaluate this interprofessional model in the Netherlands: I. its effects on safety and effectivity of pharmaceutical care and II. when, how and why these effects could be obtained. Our most important findings are that the NDP-model reduces the risk of medication-related hospitalisations in high-risk patients, compared to usual care. Also, patients experience less side-effects. These effects can be obtained when three key characteristics are present: 1. the NDP is integrated in the primary care team and works closely together with the GP; 2. the NDP and GP are fully aligned, the result of a process of collaboration and supported by additional education for the NDPs; 3. The NDP and GP acknowledge the need for improvement of current care, and eventual share responsibility over the together provided care. Based on the research in this thesis, we think the interprofessional model with an NDP in primary care is the future of pharmaceutical care and recommend further implementation.