Evaluation of an embedded pharmacist model-of-care to mitigate the risk of medication-related harm in general practice, particularly from opioids

Abstract

The risk of medication-related harm in the community varies with context, medicines and patients. To reduce its impact, effective, dynamic strategies tailored to primary care are required. One nascent strategy is to embed a pharmacist in Australian general practice.

Recognised threats to patient safety are due to medication, patient, provider, and system factors, with concern about opioid use. The aim of the research was to identify high-risk situations and to evaluate the impact of an embedded general practice pharmacist (GPP) on mitigating these, focussing on opioid management.

Chapter 1: provided an overview of medication use in Australian general practice. Chapters 3 and 4 investigated background aspects: adverse drug events reported by general practitioners (GPs), and primary care pharmacists’ activities in opioid management.

Chapter 5: qualitatively evaluated the GPP’s influence on patients at-risk. Enhanced patient safety, collegiality, GPP’s influence on prescribing, particularly for opioids, interprofessional shared decision-making (IPSDM), challenging the status quo, and improved safety at transitions of care were observed.

Chapter 6: evaluated the GPP’s impact on optimising medicine use for 198 at-risk patients. Deprescribing resulted from over half of the consultations. Four themes relevant to deprescribing and IPSDM were identified.

Chapter 7: qualitatively evaluated GPP-led opioid management strategies, with data interpreted conceptually and aligned with an Opioid Stewardship (OS) framework.

Chapter 8: mapped strategies in establishing OS to i-PARIHS, an analytical framework. The GPP facilitated innovation and enabled patient review and opioid tapering: complete weaning for 42% of patients; reductions to safer dosages for 53%.

Chapter 9: An established GPP model improved medication safety, enhanced by system changes, IPSDM and the GPP’s implicit approach. Chapter 10: Future directions are to investigate transferability to other settings and medicines.