Integrating clinical pharmacists within general practice: protocol for a pilot cluster randomised controlled trial.

Area of Science:

• Geriatric Medicine
• Primary Care Pharmacy
• Health Services Research

Background:

• Managing multimorbidity and polypharmacy in older adults presents significant challenges in primary care.
• Potentially inappropriate prescribing is a major concern, increasing patient burden and healthcare costs.
• Integrating pharmacists into general practice teams shows promise for improving medication management.

Purpose of the Study:

• To conduct a pilot cluster randomised controlled trial (cRCT) of a General Practice Pharmacist (GPP) intervention.
• To assess the feasibility, intervention impact, costs, and appropriateness of proceeding to a definitive cRCT.
• To evaluate the effect of pharmacist integration on medication optimization in older patients with multimorbidity.

Main Methods:

• A pilot cRCT involving 8 general practitioner (GP) practices and 120 patients aged ≥65 years taking ≥10 regular medications.
• Intervention practices received integrated pharmacist support, while control practices received standard GP care.
• Feasibility outcomes included recruitment and retention rates; clinical outcomes focused on potentially inappropriate prescribing incidences.

Main Results:

• The study will report on recruitment rates, medication review uptake, and patient retention.
• Data on potentially inappropriate prescribing incidences, medication-related outcomes, and patient-reported measures will be collected.
• Economic and process evaluations will provide insights into the intervention's cost-effectiveness and implementation.

Conclusions:

• This pilot cRCT will determine the feasibility of a larger trial evaluating pharmacist integration in primary care.
• Findings will inform the design and implementation of future definitive trials for optimizing medication management in complex patient populations.
• The study aims to provide evidence for improved patient outcomes and healthcare efficiency through enhanced primary care pharmacy services.