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Pharmacist Integration Into General Practice in New Zealand

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Pharmacist Integration Into General Practice in New Zealand ORIGINAL SCIENTIFIC PAPER ORIGINAL RESEARCH: WORKFORCE Pharmacist integration into general practice in New Zealand Robert Haua , BPharm(Hons) , RegPharmNZ ; 1 , 2 Jeff Harrison , BSc(Hons) , PhD(Bristol) , DipClinPharm(Bath) , BCPS , MRPharmS , RegPharmNZ ; 1 Trudi Aspden , BPharm , PhD , RegPharmNZ 1 1School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. 2Corresponding author. Email: [email protected] J PRIM HEALTH CARE 2019;11(2):159–169 A B S T R A C T doi:10.1071/HC18103 Received 8 January 2019 INTRODUCTION: Pharmacist integration into general practice is gaining momentum internation- Accepted 23 May 2019 ally, with benefi ts noted in reducing medication errors, improving chronic disease manage- Published 18 July 2019 ment and alleviating general practitioner workforce shortages. Little is known about how general practice pharmacists are working in New Zealand. A I M : This study characterised the current landscape of pharmacist integration into general practice in New Zealand. M E T H O D S : An online questionnaire was developed, piloted and distributed to all pharmacists in New Zealand. R E S U L T S : Thirty-six responses were analysed. Respondents were more likely to be female, have been pharmacists for at least 10 years and all but one held formal postgraduate clini- cal pharmacy qualifi cations. Seven pharmacists were working as pharmacist prescribers. Primary health organisations (PHOs) were the most common employer, with funding primar- ily derived from either PHOs or District Health Boards. Pharmacist integration into general practice appears to have progressed further in particular regions of New Zealand, with most respondents located in the North Island. Tasks performed by respondents included medica- tion reviews, managing long-term conditions and medicines reconciliation. Increased job satisfaction compared with previous roles was reported by most respondents. Funding and a general lack of awareness about pharmacists’ professional scope were seen as barriers to further expansion of the role. DISCUSSION: This study describes the characteristics of pharmacists currently working in general practices in New Zealand and provides insights into key requirements for the role. Understanding the way practice pharmacists are currently employed and funded can inform general practices considering employing pharmacists. K E Y W O R D S : General practice; general practitioners; integration; intersectoral collaboration; pharmacist; primary health care Introduction (DHBs). 1 Th irty-one Primary Health Organisa- In New Zealand (NZ), the planning, purchasing tions (PHOs), funded by DHBs, deliver primary and provision of health services is largely delegated health-care services to their enrolled popula- to 20 geographically defi ned District Health Boards tions, primarily through general practices.2 M o s t CSIRO Publishing Journal Compilation © Royal New Zealand College of General Practitioners 2019 159 Th is is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License ORIGINAL SCIENTIFIC PAPER ORIGINAL RESEARCH: WORKFORCE Pharmacist-led interventions in primary care may WHAT GAP THIS FILLS contribute to reducing medication-related adverse eff ects and hospital admissions, 15 , 16 i n p a r t i c u l a r , What is already known: Pharmacist integration into general practice is by integrating pharmacists into general practice.17 attracting attention internationally. Hawke’s Bay, Waikato, Otago A large-scale, pharmacist-led intervention in and Southland regions of New Zealand have invested in having English general practices was eff ective in reducing pharmacists integrated into general practice. Economic benefi ts a range of medication errors.18 Meta-analyses have attributed to practice pharmacists have been savings in medication also identifi ed signifi cant improvements in various costs and freeing up general practitioner time, alongside improve- chronic disease states, including hypertension, di- ments to the quality of patient care in terms of reduced medication abetes, hyperlipidaemia and overall cardiovascular errors and improvements in chronic disease management. risk, as a result of pharmacist interventions within general practices.19 Integrating more pharmacists What this research adds: Pharmacists working in general practices in into general practice may also mitigate workforce New Zealand appear concentrated in certain regions. Pharma- shortages, noting that 27% of GPs and 17% of cists are performing patient-facing roles, quality improvement nurses in NZ intend to retire within 5 years. 20 , 21 roles and roles aimed at improving practice effi ciencies. In the absence of a guiding framework, various funding and employ- Pharmacist integration into general practice is ment models have emerged, but funding constraints are reported gaining momentum internationally, specifi cally to be a major barrier to further expansion. Pharmacists respond- in England,22 , 23 A u s t r a l i a , 24 , 25 C a n a d a , 26 and the ing to the questionnaire generally had a positive view of the role. US. 27 , 28 A ft er committing to invest £143 million to recruit 2000 pharmacists into general practice 23,29 practicing pharmacists in NZ work in community by 2020–21, NHS England has recently pharmacies (78%), followed by hospital pharmacy announced that the new contract for general (13%). 3 Historically, the way community pharmacy practice includes recurrent funding for 70% of 22 services have been contracted and funded has the employment costs for practice pharmacists. resulted in community pharmacists being isolated In NZ, the integration of pharmacists into gen- eral practice appears to be in its infancy.30 – 32 from other primary health-care providers. Th e re- vised 2016 New Zealand Health Strategy promotes Little has been published about pharmacists working the integration of services across the health sector.4 in general practice in NZ, beyond a 2017 study Th e Ministry of Health’s Pharmacy Action Plan reporting 31 pharmacists working in this setting.33 2016 to 2020 also gives a clear direction to recognise Th erefore, the aim of this research was to characterise and promote the role of pharmacists as medicines pharmacist integration into general practice in NZ. experts. 5 Medication errors in primary care are a global Methods 6–9 issue, with one English study fi nding 1 in 20 An online questionnaire was created to address prescriptions written by general practitioners the research aims. Pharmacists eligible to com- (GPs) contained an error, and 1 in 550 contained plete the survey: a serious error. 9 Given 45.8 million funded 10 prescriptions were dispensed in NZ in 2018, deliver [ed] professional services from or within there is potential for substantial harm to occur. a general practice medical centre with a coor- Furthermore, international studies suggest 6–7% dinated, collaborative and integrated approach of hospital admissions are medication related, with an overall goal to improve the quality use with over two-thirds of these presumed avoid- of medicines of the practice population . 34 able and potentially due to errors. 11 – 13 A NZ study conducted between 2013 and 2015 estimated that Th e content of the questionnaire was informed by 28% of hospital patients experienced one or more international literature, 34 , 35 expert advisors and the episodes of medication-related harm, with 29% of research team’s experience as pharmacists. A series these originating in the community and precipi- of items using Likert scale responses was adapted tating an admission. 14 from a tool developed to assess how working in 160 JOURNAL OF PRIMARY HEALTH CARE ORIGINAL SCIENTIFIC PAPER ORIGINAL RESEARCH: WORKFORCE general practice changes pharmacists’ practices.34 spondents had completed clinical postgraduate Piloting involving pharmacists working in general study, and only one had not completed postgradu- practices and School of Pharmacy (University of ate study in clinical pharmacy. Auckland) academic staff was completed to ensure suffi cient content breadth and item clarity. Location and practice characteristics Qualtrics soft ware (Qualtrics, Provo, UT, USA) Figure 1 highlights where practice pharmacists was used to administer the questionnaire and are working in NZ. Most respondents worked manage data collection. Respondents accessed the questionnaire via a single generic link. Table 1. Practice pharmacist demographics ( n = 36) An invitation to participate was distributed by No. respondents (%) the continuing professional development recerti- Sex fi cation provider for pharmacists in NZ, in their Male 4 (11) March 2018 electronic newsletter, to all 3718 Female 32 (89) 36 practicing NZ pharmacists and members of the Age (years) Clinical Advisory Pharmacists Association. 25–34 8 (22) 35–44 8 (22) One month later, all PHO chief executive offi cers 45–54 11 (31) were asked to invite pharmacists working in their 55–64 8 (22) PHOs to participate in the study. Supervisor and ≥65 1 (3.0) advisor contacts were asked to help with recruit- Years registered ment, and all pharmacists were asked to forward 5–14 10 (28) on the participation request to other pharmacists 15–24 6 (17) 25–34 12 (33) working in general practice. 35–44 8 (22) Data were analysed using IBM SPSS Statistics 25 (IBM Corp, Armonk, NY, USA). 37 Percentages were rounded to two signifi cant fi gures. Where Table 2. Practice pharmacists highest
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