Pharmacists working in GP surgeries 'could spot prescribing errors, save thousands of euro'

Pharmacists working in GP surgeries 'could spot prescribing errors, save thousands of euro'

A study, whereby pharmacists were embedded within GP practices, found 786 patients with 1,521 prescribing issues, almost 60% of which related to high-risk or potentially inappropriate prescribing.

Pharmacists working directly in GP surgeries could spot prescribing errors and save tens of thousands of euro for patients and the taxpayer, according to new research.

A study, whereby pharmacists were embedded within GP practices, found 786 patients with 1,521 prescribing issues, almost 60% of which related to high-risk or potentially inappropriate prescribing.

It also found that "Medication changes made during the study equated to approximately €57,000 in cost savings, assuming they persisted for 12 months."

The study, 'Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study', was carried out by an eight-person team on behalf of the General Practice Pharmacist (GPP) Study Group. 

It was also the first study examining the role of GP-based pharmacists in Ireland and the feasibility of evaluating this role.

The research, published by BMJ Open, saw a pharmacist join the practice team in four general practices for six months from September 2017 to March 2018 at 10 hours per week, undertaking face-to-face or chart-based medication reviews for adult patients, providing prescribing advice, supporting clinical audits and facilitating practice-based education.

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The researchers noted that as more people face difficulties in managing different health problems as they get older, they can also move across different sections of the healthcare system, while GPs "may also be co-ordinating prescribing from multiple specialists and attempting to balance benefits and risks from several medications".

It said GP-based pharmacists exist in a number of health systems internationally, including Canada, the UK and the USA, but "unlike countries such as the UK, pharmacists in Ireland have not been formally integrated into the GP team, nor do they have prescribing rights."

In terms of the reviewing work carried out by pharmacists in the study period, as pharmacists do not have prescribing rights in Ireland, "the GP maintained clinical autonomy and implemented any changes to prescriptions, typically with non-urgent issues addressed at patients’ next appointments and patients being contacted where more immediate changes were required".

According to the results: "Across four practices, 786 patients were identified as having 1,521 prescribing issues by the pharmacists.

"A total of 1521 potential issues were identified, a total of 59.6% relating to high-risk or potentially inappropriate prescribing, 9.5% where medicines could be deprescribed and 31.0% where a non-preferred drug was prescribed.

"The most common PIP (Potentially inappropriate prescribing)/high-risk prescribing indicators identified involved long-term proton pump inhibitors at maximal dose, short-acting benzodiazepines, non-steroidal anti-inflammatories, the prescribing of duplicate therapeutic classes in the same patient and tricyclic antidepressants "Issues relating to de-prescribing medications were addressed most often by the prescriber (59.8%), compared with cost-related issues (5.8%).

"Medication changes made during the study equated to approximately €57,000 in cost savings, assuming they persisted for 12 months."

It said 96 patients aged 65 years and over and using more than one type of medication were then recruited from the four practices for additional data collection and two-thirds were followed up.

A cost analysis was conducted to determine the costs saved or incurred for changes in prescribing due to the GPP intervention and only considered direct costs relating to medication changes.

The total cost of three pharmacists’ salaries across four practices was €31,200, with additional practice-related costs such as room rental and GP time for meeting with the pharmacist amounting to €22 880.

"Overall cost savings that would accrue over a 12-month period following prescription changes amounted to €56,669," it said.

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