Connie Sellors

Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics

The prevalence of suboptimal prescribing of medications is well documented. 1 , 2 Patients are often undertreated or not offered therapeutic treatments that are likely to confer benefit. 3 , 4 As a result, drug‐related hospital admissions are common and often preventable. 5 Improvements to the health‐care system are clearly needed in order to maximize the benefits that can be derived from medications. Many countries are changing their primary health‐care systems to improve the quality of health‐care delivery. 6 , 7 One main transformation is the use of multidisciplinary care teams to provide care in a coordinated manner often from the same location or by using the common medical record of the patients. It has been demonstrated that pharmacists can improve prescribing, reduce health‐care utilization and medication costs, and contribute to clinical improvements in many chronic medical conditions, such as cardiovascular disease, diabetes, and psychiatric illness. 8 , 9 , 10 , 11 However, the effect of integrating a pharmacist providing general services into a primary care group has not been extensively studied. The Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics (IMPACT) project was designed to provide a real‐world demonstration of the feasibility of integrating the pharmacist into primary care office practice. This article provides a description of the IMPACT project participants; the IMPACT practice model and the concepts incorporated in its development; some initial results from the program evaluation; sustainability of the model; and some reflections on the implementation of the practice model.

Developing a tool to measure contributions to medication-related processes in family practice.

Successful team care requires a shared understanding of roles and expertise. This paper describes the development and preliminary exploration of the psychometric properties of a tool designed to measure contributions to family practice medication-related processes. Our team identified medication-related processes commonly occurring in family practice. We assessed clinical appropriateness using a sensibility questionnaire and pilot-tested with 11 pharmacists, nurses and physicians. We performed a simulated exercise to group the processes and assessed the internal consistency of the groupings using Cronbachs alpha coefficient. We examined test-retest reliability using intra-class coefficient (ICC). Following three revisions, the final Medication Use Processes Matrix (MUPM) included 22 medication-related processes and scale descriptors reflecting contribution to each process. Mean sensibility ratings were high for each component. We developed five theoretical groupings (diagnosis & prescribing, monitoring, administrative/documentation, education, medication review) and found their overall internal consistency was good (α > 0.80). The test-retest reliability was strong (ICC > 0.80). Preliminary validation showed significant differences in how health professionals view interprofessional contributions toward medication-related processes. Interprofessional care requires a negotiated understanding of processes and contributions. The MUPM provides an explicit description of medication-related processes in primary care, measures perceived contributions and emerges as a new tool to measure collaborative care in family practices.

A Pharmacist Consultation Service in Community-Based Family Practices: A Randomized, Controlled Trial in Seniors:

Objective: To conduct a pilot study for a larger randomized trial investigating the efficacy and cost-effectiveness of a pharmacist consultation (PC) program for elderly patients in family practice. Design: Randomized, observer-blinded, controlled trial with two patient groups: PC and control. The study pharmacist interviewed each PC program participant in their physicians office, prepared a letter, and reviewed the drug regimen recommendations in the letter with the physician. The number and types of recommendations made, the proportion of the pharmacists recommendations implemented by physicians, and daily medication use and costs at the end of six months are reported. Setting: One hundred thirty-two patients aged 65 years and older from four family practices in Stoney Creek, Ontario, Canada, who regularly were taking four or more medications. Results: Patient participation rates demonstrated feasibility: 191 patients were eligible, with 132 (69.1%) of these consenting to be enrolled. A mean ± SD of 3.0 ± 1.7 recommendations per patient were made for 62 (93.9%) of 66 patients in the PC group, and 77.8% (119/153) of these recommendations were implemented or partially implemented by the physicians. After six months, the mean numbers of medication units were 14.7 ± 10.8 and 13.9 ± 8.2, p = 0.66. The mean daily medication costs were

Narrative reports to monitor and evaluate the integration of pharmacists into family practice settings.

2.73 ± 1.78 and

Examining physicians' perspectives during the integration of a pharmacist into family practice: Qualitative results from the IMPACT study

2.47 ± 1.78, p = 0.43 in the control and PC groups, respectively. Conclusions: This pilot study demonstrated the need, the feasibility, and the potential effects of the PC program. The results were used to design a larger trial in which physicians rather than patients were randomized to further evaluate the program.

A randomized controlled trial of a pharmacist consultation program for family physicians and their elderly patients

PURPOSE Narratives can capture unfolding events and negotiation of roles and thus can help to evaluate interventions in interdisciplinary health care teams. We describe a practical qualitative method, the narrative report, and its role in evaluating implementation research. METHODS We used narrative reports as a means to evaluate an intervention to integrate pharmacists into group family practices. The pharmacists submitted 63 written narrative reports during a 1-year period. Our interdisciplinary research team analyzed these reports to monitor the progress of the implementation, to identify pharmacists’ needs, and to capture elements of the integration process. RESULTS The monthly narrative reports allowed the research team to document early learning and calibrate the program in terms of clinical support, adapting roles, and realigning expectations. The reports helped the research team stay in tune with practice-related implementation challenges, and the preliminary summary of narrative findings provided a forum for sharing innovations among the integrating pharmacists. CONCLUSION The narrative report can be a successful qualitative tool to track and evaluate the early stages of an intervention in the context of evolving primary health care teams.

Collaboration Between Community Pharmacists and Family Physicians: Lessons Learned from the Seniors Medication Assessment Research Trial

Rationale:Physicians may have concerns about medical-legal issues, scope of practice, continuity of care, workload, and satisfaction as other health disciplines integrate into primary care. This st...