Supporting Prescribing in Irish Primary Care: General Practice Pharmacist Study
Condition: Polypharmacy; Multimorbidity
Study type: Interventional

Summary: 
      The aim of this pilot study is to develop and test an intervention (defined as the General
      Practice Pharmacist [GPP] intervention) involving pharmacists working with General
      Practitioners (GPs) to optimise prescribing in Ireland. The study will determine the costs
      and potential effectiveness of the GPP intervention and, through engagement with key
      stakeholders, will explore the potential for an RCT of the GPP intervention in Irish general
      practice settings.
    

Detailed description: 
      Improving the quality and safety of prescribing for people with multiple chronic conditions
      and multiple medicines is a challenge for General Practitioners (GPs) and consequently, there
      has been an increased emphasis on ways to support GPs throughout this process. The
      integration of pharmacists into the general practice team is one approach being explored
      internationally and studies have shown that pharmacists, working as part of the general
      practice team, have influenced the safety and quality of prescribing. However, the evidence
      base is weak as there have been few high quality randomised controlled trials (RCTs)
      conducted and a range of modest effect sizes reported. Moreover, it is unclear whether such
      interventions can result in clinically significant improvements in patient outcomes. In
      Ireland, pharmacists are not integrated into general practice teams, therefore the
      feasibility of the integration of pharmacists into general practice warrants further
      exploration in the Irish primary care setting, prior to evaluation in a full scale RCT. The
      aim of this study is to develop and pilot test an intervention involving pharmacists, working
      within GP practices, to optimise prescribing in Ireland, which has a mixed public and private
      primary healthcare system.
    

Intervention name(s): Main Study; PROM Study
Intervention type(s): Other; Other
Intervention description(s): The pharmacist will participate in the management of repeat prescribing and undertake medication reviews (which will address high risk prescribing and potentially inappropriate prescribing, deprescribing and cost-effective and generic prescribing) with adult patients. Pharmacists will also provide prescribing advice regarding the use of preferred drugs, undertake clinical audits, join practice team meetings and facilitate practice-based education. Throughout the six-month intervention period, anonymised practice-level medication (e.g. medication changes) and cost data will be collected.; For this, a sub-set of patients (n=200) aged ≥65 years on ≥10 repeat medicines will be recruited and invited to a medication review with the pharmacist. PROMs and healthcare utilisation data will be collected using patient questionnaires and a six-week follow-up review with these patients will also be conducted.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Uncontrolled feasibility study based in general practices with a sub-set of patients completing a nested study collecting secondary patient reported outcome measures
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Polypharmacy; Multimorbidity; General Practice; Pharmacist