The role of pharmacists in general practice: A realist review

doi:10.1016/j.sapharm.2018.06.001

Research in Social and Administrative Pharmacy

Volume 15, Issue 4, April 2019, Pages 338-345

https://doi.org/10.1016/j.sapharm.2018.06.001 Get rights and content

Abstract

Background

The review was carried out to inform the evaluation of the clinical pharmacists in general practice pilot scheme, a world leading initiative to improve health care delivery in England. Around 500 pharmacists are already working in general practice as part of the pilot, launched in July 2015.

Objectives

The review attempts to explain the how pharmacists working in general practice is being implemented in the UK and beyond, what works well, what does not work so well and everything in-between.

Methods

This realist review was conducted to the RAMESES standards. Studies were identified by searching three databases, Medline, Embase and Scopus. Additional papers were gathered from reference lists, Google searches and via the find similar citations feature.

Results

A total of 83 papers and articles were initially identified from Medline (19), Embase (31) and Scopus (32). With close reading, the final review consisted of 43 papers relating to 38 studies. Most of the research was undertaken in the field of pharmacy practice and over half of the studies investigated the perspectives of different stakeholders using questionnaires or qualitative methods.

Conclusion

The pharmacist working in general practice is still a relatively new concept and further more in-depth research is still required. However, from this small number of studies, the common barriers and facilitators to the implementation can be identified. The review also lists mechanisms that will be needed to ensure the effective implementation of this initiative.

Section snippets

Background

The General Practice Forward View¹ recognises some of the key issues in efficiently and effectively managing the frontline demand and supply of health care in the United Kingdom (UK). The ageing population and the rise in long term health conditions has impact on an increasing demand for Primary Care. General Practitioner (GP) consultations increased between 1996 and 2008 by an estimated 11%, and nurse consultations by 150%.² At the same time government spending on healthcare, and in particular

Aims

To identify what works for whom in what circumstances in relation to the role of pharmacists in general practice.

Strategic objectives

The review attempts to explain the outcomes of how pharmacists in GP practices is being implemented, what works well, what does not work so well and everything in-between.

Operational objectives

•
Identify studies of pharmacists working in general practice.
•
Identify additional relevant publications, for example, policy documents, reports that contribute to theory building about what works for whom in what circumstances.
•
Gain familiarity with dataset by close reading.
•
Produce a descriptive summary of the data to summarize

Study design

A descriptive realist review which was conducted to the RAMESES standards.¹¹

Realist review

Pawson et al.¹² described realist review as “what works, for whom, in what circumstances and why” Health care interventions are complex and often have outcomes that are dependent on context. When complex health care interventions fail to achieve their desired outcomes, the explanation frequently provided is because they are both complex and context dependent. Realist reviews can help make sense of these types of

Sample

The studies were gathered via systematically searching through three databases (Medline, Embase and Scopus). A snowballing technique was used to gather further papers using Google searches, reference lists and the search similar citations function. Though at first glance it seemed that there were some relevant papers related to the questions asked, many were deemed unrelated when the titles and abstracts were read. Of the 83 papers, 40 were irrelevant, had significant flaws or were so small and

Results

A total of 83 papers and articles were initially identified from Medline (19), Embase (31) and Scopus (32). With close reading, the final review consisted of 43 papers relating to 38 studies (See Fig. 1 study flow chart). Most of the research was undertaken in the field of pharmacy practice and over half of the studies investigated the perspectives of different stakeholders using questionnaires or qualitative methods. The results are presented as answers to the 6 descriptive questions and then

Discussion

This study adds to the existing literature on pharmacists in GP practices by bringing it together and evaluating it in the form of a provisional realist analysis. Fig. 2 portrays a provisional unifying model of the above five mechanisms and the contextual influences on them. Key findings from this analysis are firstly that patients value pharmacist independent prescribers and those patients whom have a better understanding of pharmacist services and what pharmacists are clinically able to do,

Acknowledgments

The work on this review was partially funded by a Wellcome Trust biomedical vacation scholarship for Kevin Zhan.

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View full text

The role of pharmacists in general practice: A realist review

Abstract

Background

Objectives

Methods

Results

Conclusion

Section snippets

Background

Aims

Strategic objectives

Operational objectives

Study design

Realist review

Sample

Results

Discussion

Acknowledgments

Value Health

Res. Soc. Adm. Pharm.

Res Soc Adm Pharm

Res Soc Adm Pharm

General practice forward view

The state of medical education and practice in the UK

Now or Never: Shaping Pharmacy for the Future. The Report of the Commission on Future Models of Care Delivered through Pharmacy

The 2022 GP: our profession, our patients, our future

Br J Gen Pract

Commissioning and Contracting for Integrated Care

The Future of Primary Care

More than 400 pharmacists will be recruited to GP surgeries by next year

BMJ

GP surgeries will get 1500 more pharmacists after successful pilot

Br. Med. J. (Clin. Res. Ed.)

NHSE Building the Workforce – the New Deal for General Practice

Rameses publication standards: realist syntheses

BMC Med

Realist review–a new method of systematic review designed for complex policy interventions

J Health Serv Res Pol

Patients' views of a pharmacist-run medication review clinic in general practice

Br J Gen Pract

Pharmacists', general practitioners' and consumers' views on integrating pharmacists into general practice

J Pharm Pract Res

(Patients' preferences for an increased pharmacist role in the management of drug therapy

Int J Pharm Pract

Pharmacist consultations in general practice clinics: the Pharmacists in Practice Study (PIPS)

Res Soc Adm Pharm

Exploring Patients' experiences of pharmacists working within general practices

Int J Pharm Pract

Patient views about polypharmacy medication review clinics run by clinical pharmacists in GP practices

Int J Clin Pharm

The potential role for a pharmacist in a multidisciplinary general practitioner super clinic

Aus Med J