New program theory in pharmacist-led patient-centered medication review in general practice: A qualitative pilot...

Area of Science:

• Primary Care Medicine
• Clinical Pharmacy
• Health Services Research

Background:

• Pharmacists are increasingly integrated into general practice to optimize prescribing and reduce workloads.
• A novel patient-centered medication review (MR) model was developed for primary care polypharmacy patients.
• This model emphasizes patient involvement through initial problem detection and joint GP-pharmacist meetings.

Purpose of the Study:

• To pilot test a new patient-centered medication review (MR) model.
• To supplement existing program theory regarding pharmacist-GP collaboration in primary care.

Main Methods:

• Qualitative descriptive nonparticipatory observations in two Danish general practices.
• Semistructured interviews with general practitioners (GPs), patients, and pharmacists.
• Realist evaluation principles were used to infer mechanisms linking context, intervention, and outcomes.

Main Results:

• The new MR model resulted in high satisfaction among both patients and GPs.
• Three core mechanisms identified: alignment in MR understanding between pharmacists and GPs, investment in relational work, and model flexibility.
• Flexibility enabled the model to accommodate diverse GP experiences, working styles, and patient knowledge.

Conclusions:

• The pilot demonstrates how pharmacists can effectively support GPs in primary care settings.
• Effective collaboration hinges on 'shared mental models' between pharmacists and GPs regarding polypharmacy management.
• Relational work is crucial for navigating differing perspectives and developing shared understanding.