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Non-dispensing pharmacist integrated in the primary care team: effect on the quality of physician’s prescribing, a non-randomised comparative study

Background Especially in elderly with polypharmacy, medication can do harm. Clinical pharmacists integrated in primary care teams might improve quality of pharmaceutical care. Objective To assess the effect of non-dispensing clinical pharmacists integrated in primary care teams on general practition...

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Autores principales: Sloeserwij, Vivianne M., Zwart, Dorien L. M., Hazen, Ankie C. M., Poldervaart, Judith M., Leendertse, Anne J., de Bont, Antoinette A., Bouvy, Marcel L., de Wit, Niek J., de Gier, Han J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522101/
https://www.ncbi.nlm.nih.gov/pubmed/32789761
http://dx.doi.org/10.1007/s11096-020-01075-4
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author Sloeserwij, Vivianne M.
Zwart, Dorien L. M.
Hazen, Ankie C. M.
Poldervaart, Judith M.
Leendertse, Anne J.
de Bont, Antoinette A.
Bouvy, Marcel L.
de Wit, Niek J.
de Gier, Han J.
author_facet Sloeserwij, Vivianne M.
Zwart, Dorien L. M.
Hazen, Ankie C. M.
Poldervaart, Judith M.
Leendertse, Anne J.
de Bont, Antoinette A.
Bouvy, Marcel L.
de Wit, Niek J.
de Gier, Han J.
author_sort Sloeserwij, Vivianne M.
collection PubMed
description Background Especially in elderly with polypharmacy, medication can do harm. Clinical pharmacists integrated in primary care teams might improve quality of pharmaceutical care. Objective To assess the effect of non-dispensing clinical pharmacists integrated in primary care teams on general practitioners’ prescribing quality. Setting This study was conducted in 25 primary care practices in the Netherlands. Methods Non-randomised, controlled, multi-centre, complex intervention study with pre-post comparison. First, we identified potential prescribing quality indicators from the literature and assessed their feasibility, validity, acceptability, reliability and sensitivity to change. Also, an expert panel assessed the indicators’ health impact. Next, using the final set of indicators, we measured the quality of prescribing in practices where non-dispensing pharmacists were integrated in the team (intervention group) compared to usual care (two control groups). Data were extracted anonymously from the healthcare records. Comparisons were made using mixed models correcting for potential confounders. Main outcome measure Quality of prescribing, measured with prescribing quality indicators. Results Of 388 eligible indicators reported in the literature we selected 8. In addition, two more indicators relevant for Dutch general practice were formulated by an expert panel. Scores on all 10 indicators improved in the intervention group after introduction of the non-dispensing pharmacist. However, when compared to control groups, prescribing quality improved solely on the indicator measuring monitoring of the renal function in patients using antihypertensive medication: relative risk of a monitored renal function in the intervention group compared to usual care: 1.03 (95% CI 1.01–1.05, p-value 0.010) and compared to usual care plus: 1.04 (1.01–1.06, p-value 0.004). Conclusion This study did not demonstrate a consistent effect of the introduction of non-dispensing clinical pharmacists in the primary care team on the quality of physician’s prescribing. This study is part of the POINT-study, which was registered at The Netherlands National Trial Register with trial registration number NTR‐4389. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11096-020-01075-4) contains supplementary material, which is available to authorized users.
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spelling pubmed-75221012020-10-14 Non-dispensing pharmacist integrated in the primary care team: effect on the quality of physician’s prescribing, a non-randomised comparative study Sloeserwij, Vivianne M. Zwart, Dorien L. M. Hazen, Ankie C. M. Poldervaart, Judith M. Leendertse, Anne J. de Bont, Antoinette A. Bouvy, Marcel L. de Wit, Niek J. de Gier, Han J. Int J Clin Pharm Research Article Background Especially in elderly with polypharmacy, medication can do harm. Clinical pharmacists integrated in primary care teams might improve quality of pharmaceutical care. Objective To assess the effect of non-dispensing clinical pharmacists integrated in primary care teams on general practitioners’ prescribing quality. Setting This study was conducted in 25 primary care practices in the Netherlands. Methods Non-randomised, controlled, multi-centre, complex intervention study with pre-post comparison. First, we identified potential prescribing quality indicators from the literature and assessed their feasibility, validity, acceptability, reliability and sensitivity to change. Also, an expert panel assessed the indicators’ health impact. Next, using the final set of indicators, we measured the quality of prescribing in practices where non-dispensing pharmacists were integrated in the team (intervention group) compared to usual care (two control groups). Data were extracted anonymously from the healthcare records. Comparisons were made using mixed models correcting for potential confounders. Main outcome measure Quality of prescribing, measured with prescribing quality indicators. Results Of 388 eligible indicators reported in the literature we selected 8. In addition, two more indicators relevant for Dutch general practice were formulated by an expert panel. Scores on all 10 indicators improved in the intervention group after introduction of the non-dispensing pharmacist. However, when compared to control groups, prescribing quality improved solely on the indicator measuring monitoring of the renal function in patients using antihypertensive medication: relative risk of a monitored renal function in the intervention group compared to usual care: 1.03 (95% CI 1.01–1.05, p-value 0.010) and compared to usual care plus: 1.04 (1.01–1.06, p-value 0.004). Conclusion This study did not demonstrate a consistent effect of the introduction of non-dispensing clinical pharmacists in the primary care team on the quality of physician’s prescribing. This study is part of the POINT-study, which was registered at The Netherlands National Trial Register with trial registration number NTR‐4389. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11096-020-01075-4) contains supplementary material, which is available to authorized users. Springer International Publishing 2020-08-13 2020 /pmc/articles/PMC7522101/ /pubmed/32789761 http://dx.doi.org/10.1007/s11096-020-01075-4 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Research Article
Sloeserwij, Vivianne M.
Zwart, Dorien L. M.
Hazen, Ankie C. M.
Poldervaart, Judith M.
Leendertse, Anne J.
de Bont, Antoinette A.
Bouvy, Marcel L.
de Wit, Niek J.
de Gier, Han J.
Non-dispensing pharmacist integrated in the primary care team: effect on the quality of physician’s prescribing, a non-randomised comparative study
title Non-dispensing pharmacist integrated in the primary care team: effect on the quality of physician’s prescribing, a non-randomised comparative study
title_full Non-dispensing pharmacist integrated in the primary care team: effect on the quality of physician’s prescribing, a non-randomised comparative study
title_fullStr Non-dispensing pharmacist integrated in the primary care team: effect on the quality of physician’s prescribing, a non-randomised comparative study
title_full_unstemmed Non-dispensing pharmacist integrated in the primary care team: effect on the quality of physician’s prescribing, a non-randomised comparative study
title_short Non-dispensing pharmacist integrated in the primary care team: effect on the quality of physician’s prescribing, a non-randomised comparative study
title_sort non-dispensing pharmacist integrated in the primary care team: effect on the quality of physician’s prescribing, a non-randomised comparative study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522101/
https://www.ncbi.nlm.nih.gov/pubmed/32789761
http://dx.doi.org/10.1007/s11096-020-01075-4
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