Exploring the impact on performance of general practice-based pharmacists: a multiple Case Study

McNab, Duncan Stuart (2022) Exploring the impact on performance of general practice-based pharmacists: a multiple Case Study. PhD thesis, University of Glasgow.

Abstract

Introduction
In General Medical Practice, pharmacists are being employed to perform tasks previously undertaken by General Practitioners (GPs). While there is evidence of the benefit of pharmacists in different settings and performing specific tasks within a General Medical Practice setting, the impact of pharmacists in these new roles is not clear. The aims of this thesis are to evaluate the impact of pharmacists working in General Medical Practice and identify and explore factors that enhance their positive impact.

Methods
The thesis consists of two studies. First, a Systematic Review of controlled studies evaluating pharmacists completing one specific task (medication reconciliation) in the community after hospital discharge was undertaken. The effectiveness of this approach on the identification, resolution and clinical relevance of discrepancies was evaluated as was the impact on healthcare utilisation.

Next, four Case Studies set in General Medical Practices where pharmacists had been introduced were conducted. A mixed methods approach was used that involved analysis of case notes, observation of pharmacist work and interview of pharmacists and other members of the primary care team. Systems-based approaches directed data collection and analysis.

Evidence of impact on each of the Institute for Healthcare Improvement’s domains of quality was sought. The system was modelled and explored using the Functional Resonance Analysis Method to identify important context and mechanisms that supported positive outcomes.

Results
Pharmacists identified more discrepancies than when medication reconciliation was completed by GPs, but there was no statistically significant impact on patient outcomes or healthcare use.

Pharmacists increased safety and effectiveness of prescribing and overall, reduced GP workload; however, actions performed by pharmacists to increase safety and effectiveness increased workload in secondary care and within the practice for GPs and administrative staff.

Five mechanisms were identified across the four Case Studies to optimise the positive impact of pharmacist: team integration; pharmacists’ professional development; taking responsibility for assigned tasks; balancing thoroughness and efficiency and anticipating risks and preventing increased work. From this, thirteen recommendations were generated to support the effective implementation of pharmacists into General Medical Practice.

Conclusions
Although further research is required to provide evidence of the impact of implementing the recommendations and to support pharmacists’ development, these recommendations should be considered by all involved in the recruitment and management of pharmacists in General Medical Practice. This includes the pharmacists themselves, the practice, the employer, those with governance roles, regulators and politicians.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Subjects: R Medicine > R Medicine (General); R Medicine > RA Public aspects of medicine
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Supervisor's Name: Morrison, Professor Jill, Ross, Dr. Alastair and Bowie, Professor Paul
• Date of Award: 2022
• Depositing User: Theses Team
• Unique ID: glathesis:2022-83018
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 05 Jul 2022 13:36
• Last Modified: 05 Jul 2022 13:36
• Thesis DOI: 10.5525/gla.thesis.83018
• URI: https://theses.gla.ac.uk/id/eprint/83018

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