Adoption of clinical pharmacist roles in primary care: longitudinal evidence from English general practice.

Abstract

Background: Over the past decade, the number of clinical pharmacists working within multidisciplinary teams in English general practices has expanded.

Aim: To examine changes in quality of prescribing after the adoption of clinical pharmacist roles in English general practices.

Design and setting: Longitudinal cohort study in English general practice.

Method: Two-way fixed-effects regression was used to compare differences in prescribing indicators in general practices with and without pharmacists between September 2015 and December 2019.

Results: Between September 2015 and December 2019, the proportion of practices employing a clinical pharmacist increased from 236/7623 (3.1%) to 1402/6836 (20.5%). Clinical pharmacist implementation resulted in statistically significant reductions in total costs of medicines per 1000 patients (-0.85%, 95% confidence interval [CI] = -1.50% to -0.21%), the total number of opioid prescriptions per 1000 patients (-1.06%, 95% CI = -1.82% to -0.29%), and the average daily quantity of anxiolytics per 1000 patients (-1.26%, 95% CI = -2.40% to -0.12%). Clinical pharmacist implementation also resulted in reductions in the total number of prescriptions per 1000 patients (-0.58%, 95% CI = -1.30% to 0.13%) and the total number of antibiotic prescriptions per 1000 patients (-0.51%, 95% CI = -1.30% to 0.27%) that trended towards statistical significance. There were no statistically significant differences in the share of broad-spectrum versus narrow-spectrum antibiotics (0.02%, 95% CI = -0.07% to 0.11%) and the oral morphine equivalence of high-dose opioids (>120 mg per 24 h) per 1000 patients (1.19%, 95% CI = -0.46% to 2.85%).

Conclusion: This analysis is limited by practice-level data but supports the hypothesis that clinical pharmacist implementation results in improvements in prescribing quality.