Effects of General Practice Pharmacists on Medication-Related Hospitalisations: Preliminary Results

General practice pharmacists can have an important contribution to safe and effective pharmacotherapy. Clinical pharmacy services provided by general practice pharmacists have demonstrated a reduction in the number of drug therapy problems and improvement in intermediate outcomes such as blood pressure, cholesterol and blood glucose2. So far, evidence on the effectiveness in terms of clinical outcomes such as morbidity or mortality is lacking. Hence, the aim of this study was to evaluate the effect of general practice pharmacists on medication‐related hospitalisations.

Design: A multicentre, pragmatic, controlled intervention study with pre‐post comparison (2013 versus June 2014–May 2015) comparing general practice pharmacist‐led care (intervention) with two current models of pharmaceutical care (usual care and usual care plus).
Setting: Twenty‐five general practices in the Netherlands
Participants: Patients at high risk of medication problems, defined as being aged 65 years or older and using five or more chronic medications
Intervention and controls: For the intervention group, ten specially trained pharmacists were employed in general practices to take integral responsibility for the pharmaceutical care. They provided a broad range of services both on patient level (e.g., clinical medication review) and practice level (e.g., quality improvement projects). In the control groups, pharmaceutical care was provided ‘as usual’ by general practitioners collaborating with a community pharmacist and ‘as usual plus’ where community pharmacists had an additional training in performing medication reviews.
Assessment of medication‐related hospitalisations: multistep and case‐by‐case by an expert panel of all acute hospital admissions, based on a modified version of the algorithm by Kramer et al3.
Analysis: a Poisson mixed model with adjusted rate ratios
The preliminary results showed that overall, 822 possible medication‐related hospitalisations were identified among 11,281 high‐risk patients during the intervention period. After adjustment for clustering and adjustment for potential confounders, the mean rates of medication‐related hospitalisations were lower in the intervention and usual care plus group than in the usual care group. As a result, the adjusted rate ratio of medication‐related hospitalisations was significantly lower in the intervention group compared to usual care. No difference was found between the intervention group and the usual care plus group.

General practice pharmacists play a vital role in improving medication safety by reducing medication‐related hospitalisations compared with usual care. Interestingly, outcomes in intervention and usual care plus practices did not differ. This is probably related to the fact that the usual care plus practices were already highly integrated care settings. Since the researchers chose not to randomise, the comparison is at risk of bias, even though the results were corrected for baseline differences. The hospitalisations were also possibly medication‐related, including various levels of certainty about the causality. To assess definite causality (if possible), data including interviews with involved doctors, pharmacists and patients would have been necessary. To conclude, high‐risk patients will benefit most from integrated pharmaceutical care and further implementation of general practice pharmacists should be promoted.