GP Pharmacists change views on pharmacy scope of care

Having a pharmacist in a general practice can be a powerful tool for changing other healthcare practitioners’ attitudes towards pharmacy scope of care, a pilot study has shown.

Presenting at PSA18, the University of Canberra’s Dr Mark Naunton discussed some of the lessons from a pilot led by colleague Louise Deeks, in which three pharmacists of differing experience levels spent an average of 15 hours a week in ACT general practices.

From 2016 to 2017, each of the pharmacists saw their roles evolve significantly.

‘In the first year, what we were seeing is that pharmacists were initiating the activity mostly – 80% of it was pharmacist initiated,’ Dr Naunton said.

‘In the second year, we began to see such better collaboration and cooperation and it was the GPs that were initiating the activity. Just over 40% of the activities were initiated by the GPs in the second year.’

The type of activities undertaken by the pharmacists also changed as time went on, with an increase in medicines reviews and in the provision of information around quality of practice.

Dr Naunton said each of the pharmacists developed distinct roles in their practices.

‘The first pharmacist focused on smoking cessation, acting as a health coach within the general practice setting,’ he said.

‘The second pharmacist really became the asthma champion within the practice, spending a lot of time developing asthma action plans, educating patients, adjusting asthma medications and making recommendations to the general practitioner.

‘The third pharmacist, interestingly, was in a practice with a shortage of nurses and started taking roles that nurses had been doing – things like cognitive screening, blood pressure tests, all those sort of things.’

Significantly, the pilot demonstrated how quickly a pharmacist’s presence can change attitudes among healthcare professionals about the scope of a pharmacist’s care. Within the practices involved in the pilot, support for whether pharmacists should be able to prescribe, for instance, increased from 60% in 2016 to 80% in 2017.

‘As the pharmacist’s role develops, we’re seeing a greater acceptance within the general practice setting,’ Dr Naunton said.

Though limited in scope, the pilot revealed strong financial and clinical outcomes.

‘Pharmacists were identifying patients who should perhaps be on anticoagulants, making the recommendation and then following up to see if they had had an anticoagulant started,’ Dr Naunton said.

‘When we did a cost-benefit analysis, we were seeing an estimated $150,000 [saving] over five years to the healthcare system.’

One of the strongest examples of clinical benefit came from the asthma educator pharmacist.

By testing the asthma control test scores of relevant patients of that pharmacist on a 25-point scale (where anything less than 19 is deemed poorly controlled), researchers found that in 2016 the mean asthma control test score rose from 15.6 on initial visits to 17.5 on the most recent visit (n10, p<0.05).

In 2017, the mean score for initial visits was 13.5, rising to 20.1 by the most recent visit (n13, p<0.05).

‘As that pharmacist role became more established, what we were seeing was more and more patients with worse asthma control were being referred to the pharmacist and their mean asthma control by the second visit had moved up into well-controlled, so we saw some very significant shifts in these patients,’ Dr Naunton said.

He said some of the most compelling proof of the value of GP Pharmacists came after the pilot ended.

‘Two of the three pharmacists have continued to be employed within the general practices after this pilot has ended, so the practices themselves have said they want to continue to have those pharmacists here,’ he said. ‘The impact has been significant.’