GP questions study claiming pharmacists in practices lead to better outcomes

Doug Hendrie

4/04/2018 2:51:19 PM

Prominent healthcare quality expert Dr Evan Ackermann has told newsGP there are issues with a study suggesting placing pharmacists in general practices leads to a reduction in drug-related problems.

Dr Evan Ackermann believes the fact there is no consensus on what constitutes a drug-related problem is a ‘methodologic weakness’ of studies into pharmacists’ role in general practice.
Dr Evan Ackermann believes the fact there is no consensus on what constitutes a drug-related problem is a ‘methodologic weakness’ of studies into pharmacists’ role in general practice.

The International Journal of Clinical Pharmacy (IJCP) study published in March, ‘Pharmacists in general practice: A focus on drug‑related problems’, found that ‘pharmacists have a valuable role to play in the detection and resolution of DRP [drug-related problems] as part of the general practice team’.
Several medical and pharmaceutical organisations praised the study for demonstrating GPs and pharmacists could work effectively in tandem. However, Chair of the RACGP Expert Committee – Quality Care (REC–QC) Dr Evan Ackermann told newsGP the new study had methodological flaws.
While the RACGP has long supported trialling the involvement of non-dispensing pharmacists in general practices, the challenge, according to Dr Ackermann, is proving that doing so can improve effectiveness, safety and efficiency of GP services and patient outcomes with medication management.
‘Studies [in this area] to date have been quite variable in study quality and outcomes and, unfortunately, this [IJCP] paper continues to repeat the methodologic weaknesses of previous studies,’ Dr Ackermann said.
‘The key concern is how to define what a drug-related problem is, what is significant and what is not. The [study] authors’ note there is no international consensus on this, and the system they have used has not been tested for validity/reliability, either.
‘Drug-related problems sound important, but often the “problem” is so minute to be clinically irrelevant.’
Dr Ackermann gave the example of a documentation error of drugs intended to be taken in the morning but taken at night instead.
The study authors note that, ‘the data collected about recommendations made by pharmacists lacked specific detail on the agent associated with each recommendation. This limited the ability of the research team to assess the potential clinical significance of the pharmacist recommendations’.
This admission, Dr Ackermann said, means the clinical impact of each drug-related problem is unknown.
‘The study does not answer whether the pharmacy recommendations were relevant at all,’ he said.
In addition, the study reported that GP acceptance of pharmacist recommendations varied between 30% and 100%.
‘This variability was not explained by the data and again highlights the weakness of the approach taken,’ Dr Ackermann said. ‘Studies in this area should continue, but robust methodology is important to ensure evidence can be linked to real clinical outcomes for patients.

‘Unfortunately, this study adds little and does not support the exuberance of some comments on the study.’

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Richard Smith   25/05/2018 2:39:55 PM

Electronic prescribing, clinical software with decision support, audits and medical practitioners are the present solution and do not need pharmacists at all, especially if they were replaced by vending machines.