Medication prescribing is one of the commonest medical interventions and there have been marked increases in patients taking multiple medicines with related adverse effects. We have developed an intervention involving practice based pharmacists working with GPs to optimise prescribing in Irish general practice settings. Study design and setting. Non-randomised pilot study in four GP practices in Dublin (approx. 10,000 patients), with parallel Process and Economic Evaluations. Intervention. The intervention will have the following components: 1. Research pharmacist to join the GP team for six months and participate in routine management of repeat prescribing. 2. Medicines reviews which target: a. High risk and potentially inappropriate prescribing. b. Deprescribing. c. Use of MMP preferred drugs and generic prescribing.
d. Assessment of need for common preventive drugs such as statins and proton pump inhibitors. e. Review of nursing home patients with focus on de-prescribing in the context of reduced life expectancy. 3. Practice based training. The pharmacist will sit in on regular clinical meetings in practices and will conduct training sessions as needed based on identified needs. Comparison data will be available from the parallel related SPPiRE trial and from the PCRS database, which can provide a contemporaneous national control group. Outcomes.
We will collect practice level data on medicines outcomes and undertake a nested sub-study with individual patient consent (n=200) to collect patient reported outcome measures (PROMs). We will also collect related cost and qualitative data to inform the Economic and Process Evaluations. Conclusion
This pilot study involves a collaboration between primary care researchers with a track record in medicines safety research and the national MMP. It will determine the feasibility and potential for a definitive randomised controlled trial to evaluate the cost effectiveness of a GP-based pharmacist medicines optimisation programme that aligns with National Strategy on Quality and Patient Safety.
