Non-dispensing pharmacist integrated in the primary care team: effect on the quality of physician's prescribing, a non-randomised comparative study.
Background Especially in elderly with polypharmacy, medication can do harm. Clinical pharmacists integrated in primary care teams might improve quality of pharmaceutical care. Objective To assess the effect of non-dispensing clinical pharmacists integrated in primary care teams on general practitioners' prescribing quality. Setting This study was conducted in 25 primary care practices in the Netherlands. Methods Non-randomised, controlled, multi-centre, complex intervention study with pre-post comparison. First, we identified potential prescribing quality indicators from the literature and assessed their feasibility, validity, acceptability, reliability and sensitivity to change. Also, an expert panel assessed the indicators' health impact. Next, using the final set of indicators, we measured the quality of prescribing in practices where non-dispensing pharmacists were integrated in the team (intervention group) compared to usual care (two control groups). Data were extracted anonymously from the healthcare records. Comparisons were made using mixed models correcting for potential confounders. Main outcome measure Quality of prescribing, measured with prescribing quality indicators. Results Of 388 eligible indicators reported in the literature we selected 8. In addition, two more indicators relevant for Dutch general practice were formulated by an expert panel. Scores on all 10 indicators improved in the intervention group after introduction of the non-dispensing pharmacist. However, when compared to control groups, prescribing quality improved solely on the indicator measuring monitoring of the renal function in patients using antihypertensive medication: relative risk of a monitored renal function in the intervention group compared to usual care: 1.03 (95% CI 1.01-1.05, p-value 0.010) and compared to usual care plus: 1.04 (1.01-1.06, p-value 0.004). Conclusion This study did not demonstrate a consistent effect of the introduction of non-dispensing clinical pharmacists in the primary care team on the quality of physician's prescribing.This study is part of the POINT-study, which was registered at The Netherlands National Trial Register with trial registration number NTR-4389.
['Sloeserwij|Vivianne M|VM|http://orcid.org/0000-0003-3521-8109', 'Zwart|Dorien L M|DLM|', 'Hazen|Ankie C M|ACM|', 'Poldervaart|Judith M|JM|', 'Leendertse|Anne J|AJ|', 'de Bont|Antoinette A|AA|', 'Bouvy|Marcel L|ML|', 'de Wit|Niek J|NJ|', 'de Gier|Han J|HJ|']
D000293:Adolescent D000328:Adult D000368:Aged D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009426:Netherlands D017063:Outcome Assessment, Health Care D010348:Patient Care Team D010593:Pharmaceutical Services D010595:Pharmacists D019338:Polypharmacy D010818:Practice Patterns, Physicians' D011320:Primary Health Care D024382:Professional Role D019984:Quality Indicators, Health Care D015203:Reproducibility of Results D055815:Young Adult
Non-dispensing pharmacist Quality Prescribing Pharmaceutical care Process indicator