Studies
Pharmacist and Physician Collaborative Prescribing: For Medication Renewals within a Primary Health Centre
Author: McKinnon A, Jorgenson D
Intervention Type: Revision of Professional Roles, Introduction of Clinical Multidisciplinary Teams
Disease State: Not specific to any chronic disease
Research Objective
To determine if there is improvement in medication management when pharmacists and family physicians collaborate to prescribe medication renewals requested by fax
Methods
Design: Non-randomized controlled trial that was 10 weeks in duration
Study sample: Physicians and pharmacists (community, family health team (FHT))
Intervention:
Patients were enrolled in the intervention group if the renewal request from community pharmacist was received when the FHT pharmacist was working. If the pharmacist was not working, the patient was enrolled in the control group.
Group 1 – Intervention: Family Health Team (FHT) pharmacist received faxed medication renewal request from community pharmacy and reviewed patient's chart to determine if the medication renewal was appropriate without any type of further intervention/change (decision based on desired therapeutic effect and appropriate monitoring). Assessment was made with the family physician to either prescribe or not prescribe medication with or without any additional intervention.
Group 2 – Control: No intervention control group; renewal request directed to physician as per usual care
Medication Prescribing and Use Outcome(s)
- Number of medication renewal requests authorized with no recommendations or interventions
- Medication-related problems identified and resulting medication changes made
Other Outcome(s)
- Monitoring tests ordered
- New appointments scheduled
Key Results
- Significantly more patients in the control group had renewals authorized without intervention (75.5% vs. 52.9%, p=0.001), suggesting that the intervention group had more activity generated as a result of the renewal requests
- Intervention group had significantly more medication-related problem identified (26 vs. 10, p=0.031)
- Intervention patients were recalled for physician appointments more often (31 vs. 21, p=0.049)
- No significant difference in number of monitoring tests ordered
Key Implementation Issues
- Erratic nature in which the requests were received made this intervention a considerable workflow disruption for the FHT pharmacist
- May be more efficient for pharmacist to independently authorize prescriptions in scenarios where the patient had recently visited the physician or were scheduled to do so in the future and only consult physician in cases that require intervention
Citation(s)
Pharmacist and Physician Collaborative Prescribing: For Medication Renewals within a Primary Health Centre. McKinnon A, Jorgenson D. (2009). Canadian Family Physician, 55, e86-91.