Characterising pharmacist interventions from person-centred medicines reviews in general practice settings

Background
With pharmacist roles in general practices not widely implemented, it is not clear what interventions are undertaken as part of patient-centred medicines reviews in that setting.

Objectives
To describe the types of general practice pharmacist interventions from person-centred medicines reviews with patients with hyperpolypharmacy (on ≥10 regular medicines) and/or at high risk of medicines-related harm, and evaluate their significance, rates of acceptance and implementation, and resulting changes in medicines numbers.

Methods
Four pharmacists were integrated into ten general practice settings, who conducted medicines reviews following the ‘7 Steps to Appropriate Polypharmacy’ approach, and liaised with general practitioners, other healthcare professionals, and patients to make review-related interventions and follow up. Intervention significance was classified using Eadon grading. General practitioner acceptance and implementation of recommendations to alter prescriptions was recorded. Descriptive and inferential statistics were performed on summary data.

Results
Between January 2021 and December 2022, 1471 patients consented to data collection (mean age: 76 years, 88.3% with hyperpolypharmacy). A mean of twelve interventions/patient was made. For patients with complete intervention data (n = 1181), 38.7% of 14,592 interventions were recommendations to alter prescriptions; of these with known outcomes (n = 5537), 95% were accepted and 82.7% implemented. Prescription alterations comprised stops (55.9%), decreased doses (19.0%), starts (18.9%), and increased doses (6.2%). Nearly all interventions were deemed ‘significant’ (98.4%); 29% of patients had ≥1 ‘very significant’ intervention, of which 75% related to stopping a medicine. Patients had a mean of 13.8 pre-review medicines and 12.3 post-review medicines (mean difference − 1.5 [SD 2.0], p < 0.0001), with an 11.2% reduction in medicines and 11.6% fewer patients with hyperpolypharmacy post review.

Conclusion
Pharmacist interventions from person-centred medicines reviews in general practice were highly accepted, generating substantial medicines reductions and improved care for patients at high risk of medicines-related harm. Future research should explore the longer-term sustainment of these reviews in more diverse healthcare contexts.