Supporting Prescribing in Irish Primary Care: a Non-Randomised Pilot Study of a General Practice Pharmacist (GPP) Intervention to Optimise Prescribing in Primary Care
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 100
- 试验地点
- 1
- 主要终点
- Changes in the number of medicines patients were prescribed.
研究概览
简要总结
The aim of this pilot study is to develop and test an intervention (defined as the General Practice Pharmacist [GPP] intervention) involving pharmacists working with General Practitioners (GPs) to optimise prescribing in Ireland. The study will determine the costs and potential effectiveness of the GPP intervention and, through engagement with key stakeholders, will explore the potential for an RCT of the GPP intervention in Irish general practice settings.
详细描述
Improving the quality and safety of prescribing for people with multiple chronic conditions and multiple medicines is a challenge for General Practitioners (GPs) and consequently, there has been an increased emphasis on ways to support GPs throughout this process. The integration of pharmacists into the general practice team is one approach being explored internationally and studies have shown that pharmacists, working as part of the general practice team, have influenced the safety and quality of prescribing. However, the evidence base is weak as there have been few high quality randomised controlled trials (RCTs) conducted and a range of modest effect sizes reported. Moreover, it is unclear whether such interventions can result in clinically significant improvements in patient outcomes. In Ireland, pharmacists are not integrated into general practice teams, therefore the feasibility of the integration of pharmacists into general practice warrants further exploration in the Irish primary care setting, prior to evaluation in a full scale RCT. The aim of this study is to develop and pilot test an intervention involving pharmacists, working within GP practices, to optimise prescribing in Ireland, which has a mixed public and private primary healthcare system.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 100 Years(Adult, Older Adult)
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •for primary care practices:
- •≥1000 older patients (aged ≥65 years) on their patient panel.
- •Inclusion criteria for patients:
- •Aged ≥65 years
- •Taking ≥10 repeat medications
- •Able to attend their primary care practice and participate in data collection.
排除标准
- •for patients:
- •Psychiatric or psychological morbidity or cognitive impairment sufficient to impair the provision of informed consent
- •Life-limiting illness likely to lead to death or major disability during the study follow-up period
- •Patients who have already had a medication review/interacted with the pharmacist during the study period
研究组 & 干预措施
Main Study
A pharmacist will join the practice team for six months.
干预措施: Main Study (Other)
PROM Study
A nested Patient Reported Outcome Measure (PROM) study will be undertaken during month four and five of the six-month intervention period to explore the impact of the intervention in older adults (aged ≥65 years).
干预措施: PROM Study (Other)
结局指标
主要结局
Changes in the number of medicines patients were prescribed.
时间窗: Six months.
We recorded the number of medicines that were stopped, started or changed as a result of the pharmacist doing a medication review.
Prevalence of potentially inappropriate prescribing.
时间窗: Six months.
We recorded the prevalence of potentially inappropriate prescribing identified by the pharmacist using validated indicators STOPP (Screening Tool of Older People' Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). STOPP and START are validated, explicit criteria used to identify potentially inappropriate prescribing in older people (those aged 65+ years).
次要结局
- Patients' self-rated health-related quality of life.(Six months.)
- Self-rated attitudes of patients towards deprescribing of their medications.(Six months.)
- Patients' self-rated treatment burden.(Six months.)
- Patients' self-rated beliefs about medicines(Six months.)
- Patients' self-rated health-related quality of life (VAS).(Six months.)
研究者
Susan Smith
Prof Susan M Smith
Royal College of Surgeons, Ireland
