Return to PJ Online Home Page
The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR32

The care of patients with chronic illness in primary care

By Keith Wilson, Jill Jesson, John Varnish and Rob Pocock

Introduction Repeat prescriptions account for 65 per cent of items and 75 per cent of primary care drug expenditure.1 One in three people in the United Kingdom have a chronic disease or disability and general medical practitioner (GP) consultation with such patients varies with the type of illness, medication and individual preferences. However, lengthy gaps offer pharmacists an opportunity to participate in patient's care. Contribution to the management of chronic conditions is one of the primary areas for Pharmacy in a New Age.2
The aim of this study was to evaluate the contribution pharmacists could make to patient care without extra training or protocols during a repeat prescription pilot study when remuneration was patient based.

Method The study involved two GP surgeries and seven community pharmacies in Birmingham. It has a naturalistic design with minimum intervention from the researchers.
A sample of patients with chronic conditions was identified by a series of screening techniques:

  • identification of patients on regular repeat prescriptions dispensed by the project pharmacies
  • confirmation of repeat status patients by pharmacists
  • final screen by the relevant GP on clinical grounds

A total of 1,050 patients were identified and mailed a piloted self-completion questionnaire. After follow-up, the response rate was 72 per cent, with 618 willing to enter the study.
Prior to the study, all pharmacists attended an induction meeting and support was provided by regular visits from pharmacist members or the research team. During the study, pharmacists were remunerated on a patient per capita basis of £30.86 per three-month period for the provision of pharmaceutical care.
At the end of the six-month project intervention, structured interviews were undertaken with 220 patients in their own home.

Focal points

  • A sample of patients with repeat prescriptions was recruited and entered into a repeat dispensing pilot study
  • Surveys were undertaken prior to the project and after completion of the project
  • The initial survey data shows a low level of intervention from pharmacists
  • During the project, patients recognised an improvement in consumer care but overall there was little evidence of improved professional care
  • There were differences between pharmacies and inter-pharmacist and pharmacy data reveals more than aggregate data

Results Eighty-seven per cent of the repeat patients were exempt from prescription charges; 69 per cent had up to four items, 14 per cent had six; over 84 per cent had been on repeats for over two years.
Before the intervention 85 per cent said that their pharmacist did not "take time to talk to you about your health and medication without you asking". After the intervention, 93 per cent of those interviewed could not name their pharmacist and a majority (70 per cent) had not experienced any difference in the way they were dealt with by the pharmacist.
The majority had not been asked by the pharmacist about their general health (94 per cent), side effects (83 per cent) or whether they had taken all the medicines from their last supply (84 per cent). Only 7 per cent were provided with advice on a new drug.
Closer analysis revealed considerable variation in services delivered by the seven pharmacies. However, 77 per cent said the pharmacist did come out of the dispensary to talk to them and a small majority (59 per cent) considered that the overall process of reception improved during the project. Ninety-six per cent considered overall service as more friendly and personal, 6 per cent recognised that the intervention has a positive impact upon health.

Discussion This study gave pharmacists an opportunity and a financial incentive to be creative and proactive in the care offered to patients with chronic health conditions. Although patients perceived improvements in consumer care, it was disappointing that there was little evidence of overall improvement in pharmaceutical care. However, there was a considerable variation in results for different pharmacies.
Key factors for success were the physical resource in pharmacies, the relationship with the GP practice and the attitude and confidence of individual pharmacists. The study shows that attention to these factors is essential if pharmacy as a profession is to achieve its goal of greater involvement in health care management. It is unlikely that all pharmacists and pharmacies can make an equal contribution to all aspects of pharmaceutical care and that successful implementation of a repeat dispensing system will need to be underpinned by multi-disciplinary training.

Pharmacy practice group, Aston University; MEL Research, Birmingham

References

1. Purves I, Kennedy J. The quality of general practice repeat prescribing. Newcastle upon Tyne: Sowerby Unit for Primary Care Informatics, University of Newcastle upon Tyne; 1998.
2. Royal Pharmaceutical Society. Building the future: a strategy for a 21st century pharmaceutical service. London: The Society; 1997.