General practitioner practice-based pharmacist input to medicines optimisation in the UK: pragmatic, multicenter, randomised, controlled trial

Nadia Farhanah Syafhan, Sayer Al Azzam, Steven D. Williams, Wendy Wilson, Jayne Brady, Peter Lawrence, Mark McCrudden, Mustafa Ahmed, Michael G. Scott, Glenda Fleming, Anita Hogg, Claire Scullin, Robert Horne, Harblas Ahir, James C. McElnay*

*Corresponding author for this work

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Abstract

Background: Changing demographics across the UK has led to general practitioners (GPs) managing increasing numbers of older patients with multi-morbidity and resultant polypharmacy. Through government led initiatives within the National Health Service, an increasing number of GP practices employ pharmacist support. The purpose of this study is to evaluate the impact of a medicines optimisation intervention, delivered by GP practice-based pharmacists, to patients at risk of medication-related problems (MRPs), on patient outcomes and healthcare costs. Methods: A multi-centre, randomised (normal care or pharmacist supplemented care) study in four regions of the UK, involving patients (n = 356) from eight GP practices, with a 6-month follow-up period. Participants were adult patients who were at risk of MRPs. Results: Median number of MRPs per intervention patient were reduced at the third assessment, i.e. 3 to 0.5 (p < 0.001) in patients who received the full intervention schedule. Medication Appropriateness Index (MAI) scores were reduced (medications more appropriate) for the intervention group, but not for control group patients (8 [4–13] to 5 [0–11] vs 8 [3–13] to 7 [3–12], respectively; p = 0.001). Using the intention-to-treat (ITT) approach, the number of telephone consultations in intervention group patients was reduced and different from the control group (1 [0–3] to 1 [0–2] vs 1 [0–2] to 1 [0–3], p = 0.020). No significant differences between groups were, however, found in unplanned hospital admissions, length of hospital stay, number of A&E attendances or outpatient visits. The mean overall healthcare cost per intervention patient fell from £1041.7 ± 1446.7 to £859.1 ± 1235.2 (p = 0.032). Cost utility analysis showed an incremental cost per patient of − £229.0 (95% CI − 594.6, 128.2) and a mean QALY gained of 0.024 (95% CI − 0.021 to 0.065), i.e. indicative of a health status gain at a reduced cost (2016/2017). Conclusion: The pharmacist service was effective in reducing MRPs, inappropriateness of medications and telephone consultations in general practice in a cost-effective manner. Trial registration: ClinicalTrials.Gov, NCT03241498. Registered 7 August 2017—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03241498

Original languageEnglish
Article number4
JournalJournal of Pharmaceutical Policy and Practice
Volume14
Issue number1
DOIs
Publication statusPublished - 04 Jan 2021

Bibliographical note

Funding Information:
The authors wish to thank to patients who participated; research leads for Northern Health and Social Care Trust (NHSCT), Northern Ireland (Dianne Gill), North West Coast Academic Health Science Network (AHSN), England (Andy Cairns and Andy Shakeshaft), Wessex AHSN, England (Claire Howard and Vicki Rowse), Eastern AHSN, England (Carol Roberts and Paula Wilkinson); practice staff at the Ballymoney Family Practice, Family Practice Antrim Health Centre, Westbourne Medical Centre, The Adam Practice, Pendle View Medical Centre, Wingate Medical Centre, Fern House Surgery and Douglas Grove Surgery; Colette Goldrick, Association of the British Pharmaceutical Industry (ABPI) for her encouragement and support throughout the study and finally the ABPI and the Indonesia Endowment Fund for Education (LPDP) for financial support.

Funding Information:
This study was partially funded by Association of the British Pharmaceutical Industry (ABPI) (grant number MOIC001). NFS was sponsored by the Indonesia Endowment Fund for Education (LPDP) (20160422046233).

Publisher Copyright:
© 2021, The Author(s).

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

  • Clinical pharmacist
  • General practice
  • Healthcare resource utilisation
  • Medicines optimisation
  • Practice-based pharmacist

ASJC Scopus subject areas

  • Pharmacology, Toxicology and Pharmaceutics(all)
  • Health Policy

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