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Pharmacist advice ignored by GPs more than half the time, finds study

The study saw pharmacists review patients' medicines and recommend changes to their GPs
The study saw pharmacists review patients' medicines and recommend changes to their GPs

Analysis of a study in which pharmacists reviewed patients’ medicines found that GPs did not implement recommended prescription changes in more than half of cases.

New research based on a study published in 2018 into patient-centred care found that over half of pharmacist recommendations for a change in prescribing were ignored by GPs, with a “high proportion” of the recommendations being described as “vague” or “indirect”.

The sub-study looked into the reasons why pharmacist recommendations in the original research had no impact on the number of drugs prescribed, and was presented by Dr Polly Duncan, GP and senior clinical research fellow at the University of Bristol, at the Society for Academic Primary Care annual conference earlier this month (July 4).

Of the 797 patients who had a pharmacist review as part of the study, 1,100 recommendations were made. The most common pharmacist recommendations were to stop or reduce a medicine (26%), switch to a medicine within the same class (18%), or review a medicine (16%).

In just 19% of cases, pharmacists did not recommend any changes to a patient's medication, yet the latest research presented by Dr Duncan found that there was “no effect on the number of drugs prescribed” in the remaining 81% of cases.

In fact, GPs ignored pharmacists' recommendations more than half the time, researchers concluded.

About the original study

The original study, conducted in 2015 by researchers at the universities of Bristol, Bath, Reading, Sydney and Laval in Canada and published in The Lancet in 2018, looked at the management of patients with multiple chronic illnesses, using a “3D approach” to primary care, where patients had their physical and mental health reviewed by a nurse and their medication reviewed by a pharmacist.

The pharmacists who took part in the study conducted a “remote medication review” on patients with three or more long-term conditions and made up to four recommendations for the GP to discuss with the patient.

Recommendations from both pharmacists and nurses were then fed back to their physician, but the approach “did not improve patients’ quality of life”, researchers concluded.

13 Comments
Question: 
Have you had advice ignored by a GP?

Are these the same GPs that think a frequency i.e TDS/BD alone constitutes a proper dosage regimen? How many times have we needed to contact them telling them something as simple as it's not legal to put "TDS" for directions on a gabapentin Rx etc. Some GPs are good, but I find others need to be spoon fed information and some are just downright incompetent. But I guess this is the case in any profession.

I think we need a more open and well documented channel regarding a pharmacist's advise to them. If they do not action it, then they should have to provide a proper reason. Pharmacists are very busy people, if a pharmacists is actually taking the time to contact the surgery and raise an issue, then it's obviously going to be something that needs attention.

Until they can show us actual cases, I don't buy this "vague" and "indirect" claim by them. I feel they just mean the pharmacist is not spoon feeding them fully.

Interleukin -2, Community pharmacist

What’s the advise based on in most cases ?  Is it a case of oh you can’t prescribe tramadol with citalopram for Mr Q cos there’s a risk of CNs toxicity ? Even though the patient s been on the combination for the better part of two decades and has gone far down the road towards dementia ? Until we re given full access to records and clinical notes am afraid sometimes community pharmacy interventions are out of touch with patients ‘ realities 

Pharmacist Pharmacist, Community pharmacist

Nothing new, GPs have always ignored pharmacists, but until recently they have started to trust us because we are helping them out in their surgeries

Beta Blocker, Primary care pharmacist

Very true.... speaking from experience. They offered me a permanent role within the surgery way before my probationary period was up!

Ranjeev Patel, Non Pharmacist Branch Manager

What's the difference between God and a junior doctor? God doesn't think he's a junior doctor!

This joke might seems light hearted, but many doctors do see themselves as better than the great unwashed, pharmacists included. I must admit that when I worked in hospital at least the doctors pretended to listen to my advice, in community when MURs first started, we had to send copies to the GP surgery. I had it on good advice from a friends wife who worked in a local surgey that all that paperwork from pharmacies went straight in the bin, the GPs never even saw it!

ABC DEF, Primary care pharmacist

I guess most GPs are too busy to even have a quick glance at these and all these feedback/advice forms simply get chucked into the bin straightaway or left at the bottom of the pile which they will never get looked at. Hopefully now with more pharmacists going into general practice these queries will now be passed on to them and followed up accordingly. 

Reeyah H, Community pharmacist

Can’t we remain positive that nearly half of the recommendations WERE accepted?! 

R A, Community pharmacist

well said

Kevin Western, Community pharmacist

The missing information, though I can guess, was did the GPs feed back to the Pharmacist why they didnt feel it was relevant? They cant expect improvement without some sort of communication

Tom Jerry, Community pharmacist

The outcome would have been the opposite if GP's were finacially rewarded for thier interventions...GP primary priority is always the Wonga, everthing else is tertiary; I predict over the next 10y there will be a migration of GP's from NHS to their own Private Clinics and will charge extortionately the NHS for any NHS work they are asked to undertake....

Tired Manager, Community pharmacist

Did we really need research to confirm this?

Thomas Wilde, Community pharmacist

So is the conclusion supposed to be that pharmacists don't give good advice or that they do but its ignored?

N O, Pharmaceutical Adviser

In my opinion very much the latter.

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