Adoption of clinical pharmacist roles in primary care: longitudinal evidence from English general practice

Michael Anderson; Igor Francetic

doi:10.3399/BJGP.2024.0320

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Adoption of clinical pharmacist roles in primary care:
Kevork Hopayian

Published on: 31 January 2025
Adoption of clinical pharmacist roles in primary care: Longitudinal evidence from English general practice
Michael Anderson and Igor Francetic

Published on: 09 October 2024
Enhancing Clinical Pharmacist Integration in Primary Care: A Call for Broader Focus on Patient Outcomes and Deprescribing
Edoardo Cervoni

Published on: 25 September 2024

Published on: (31 January 2025)
Page navigation anchor for Adoption of clinical pharmacist roles in primary care:
Adoption of clinical pharmacist roles in primary care:
Kevork Hopayian, General Practitioner, University of Nicosia & Sessional GP
Dr Cervoni’s points are valid in terms of methodology¹ but I just wonder if there is any debate to be had over these particular reductions in prescribing. Reducing opioid prescribing and anxiolytic prescribing ARE patient outcomes, desirable ones at that. They were the largest effects that achieved statistical significance (after overall prescribing costs) reported in this study. They were reduced by 1.06% and 1.26% respectively which sounds small but, as Dr Cervoni and the authors have said, translated to individual patients that is not such a small matter.
This valuable study sought to answer the question of the value of medication reviews, but I would like to raise a broader question. Why are patients on these long-term medications not achieving the same results in a clinical review? The greater ideal is to review people, not medication.

Reference

Cervoni E. Enhancing Clinical Pharmacist Integration in Primary Care: A Call for Broader Focus on Patient Outcomes and Deprescribing. BJGP letter. 2024. https://bjgp.org/content/early/2025/01/27/BJGP.2024.0320/tab-e-letters#enhancing-clinical-pharmacist-integration-in-primary-care-a-call-for-broader-focus-on-patient-outcomes-and-deprescribing
Competing Interests: None declared.
Published on: (9 October 2024)
Page navigation anchor for Adoption of clinical pharmacist roles in primary care: Longitudinal evidence from English general practice
Adoption of clinical pharmacist roles in primary care: Longitudinal evidence from English general practice
Michael Anderson, GP Academic, University of Manchester
Other Contributors:
Igor Francetic, Health Economist, University of Manchester
We thank Edoardo Cervoni for his comments on our manuscript. We agree that there is value in conducting further research into the impact of clinical pharmacist implementation on individual patient indicators. This is discussed in detail in the section on implications for research, which outlines future avenues for research around the implications of clinical pharmacist implementation at the patient-level for medication adherence, patient satisfaction, polypharmacy, and hospital utilisation. Such research would require investment to access a linked patient-level primary and secondary care dataset, for example incorporating Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) data. This is something we will proactively explore when suitable funding calls are launched by research funders. Nonetheless, we argue that our manuscript still provides valuable insights into positive practice-level impacts of clinical pharmacist implementation that can form the basis for future research moving forward. The gap in the literature addressed by our manuscript is primarily linked to the existence of very few national-level quantitative studies that have examined the impact of clinical pharmacist implementation in England.

Competing Interests: None declared.
Published on: (25 September 2024)
Page navigation anchor for Enhancing Clinical Pharmacist Integration in Primary Care: A Call for Broader Focus on Patient Outcomes and Deprescribing
Enhancing Clinical Pharmacist Integration in Primary Care: A Call for Broader Focus on Patient Outcomes and Deprescribing
Edoardo Cervoni, GP and ENT Specialist with special interest in Otology, The Grange Surgery, Birkdale
I commend the authors for their thorough exploration of the role of clinical pharmacists in general practice. However, several areas warrant further examination to enhance our understanding of this important topic.

While the article highlights reductions in prescribing costs and the number of prescribed items, it does not adequately assess how these changes impact patient outcomes. Prescribing efficiency should be linked to clinical outcomes, such as reduced hospital admissions and improved quality of life. The article lacks connections to patient health improvements or reductions in adverse drug reactions, which are critical for evaluating the real-world impact of clinical pharmacist implementation. Previous research indicates that cost savings from reduced prescribing do not always correlate with enhanced patient health outcomes¹.

Additionally, the paper focuses heavily on pharmacological interventions, neglecting the role of clinical pharmacists in promoting non-pharmacological approaches and deprescribing unnecessary medications. This omission underestimates their potential to address polypharmacy, particularly among elderly patients, where pharmacist-led deprescribing has shown significant benefits².

The use of practice-level aggregate data can obscure individual patient variations. The article acknowledges this limitation but fails to explore how factors such as multimorbidity or socio-economic status may influence the ef...
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I commend the authors for their thorough exploration of the role of clinical pharmacists in general practice. However, several areas warrant further examination to enhance our understanding of this important topic.

While the article highlights reductions in prescribing costs and the number of prescribed items, it does not adequately assess how these changes impact patient outcomes. Prescribing efficiency should be linked to clinical outcomes, such as reduced hospital admissions and improved quality of life. The article lacks connections to patient health improvements or reductions in adverse drug reactions, which are critical for evaluating the real-world impact of clinical pharmacist implementation. Previous research indicates that cost savings from reduced prescribing do not always correlate with enhanced patient health outcomes¹.

Additionally, the paper focuses heavily on pharmacological interventions, neglecting the role of clinical pharmacists in promoting non-pharmacological approaches and deprescribing unnecessary medications. This omission underestimates their potential to address polypharmacy, particularly among elderly patients, where pharmacist-led deprescribing has shown significant benefits².

The use of practice-level aggregate data can obscure individual patient variations. The article acknowledges this limitation but fails to explore how factors such as multimorbidity or socio-economic status may influence the effectiveness of pharmacist interventions³.

Furthermore, while the article suggests that pharmacists impact antibiotic prescribing through mechanisms like antimicrobial stewardship, it lacks empirical evidence to support these claims. Clarifying these mechanisms is essential for a comprehensive understanding⁴.

In conclusion, while the article provides valuable insights into the role of clinical pharmacists, it should further explore the implications for patient outcomes and cost-effectiveness to present a more balanced view.

References

1. Tarrant C, Lewis R, Armstrong N. Polypharmacy and continuity of care: medicines optimisation in the era of multidisciplinary teams. BMJ Qual Saf 2023; 2(3):121-124. doi: 10.1136/bmjqs-2022-015082.

2. Jaam M, Naseralallah LM, Hussain TA, Pawluk SA. Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: A systematic review and meta-analysis. PLoS One 2021; 16(6):e0253588. doi: 10.1371/journal.pone.0253588. Erratum in: PLoS One 2023; 18(11):e0294195.

3. Wei ET, Gregory P, Halpern DJ, Felton M, Goldstein BA, Yeatts J, Shah K, Smith BH. Impact of a clinical pharmacist on provider prescribing patterns in a primary care clinic. J Am Pharm Assoc 2003; 62(1):209-213.e1. doi: 10.1016/j.japh.2021.10.007.

4. Teoh L, Sloan AJ, McCullough MJ, Thompson W. Measuring Antibiotic Stewardship Programmes and Initiatives: An Umbrella Review in Primary Care Medicine and a Systematic Review of Dentistry. Antibiotics (Basel) 2020; 9(9):607. doi: 10.3390/antibiotics9090607.
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Competing Interests: None declared.