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POINT

  1. General
  2. Intended result
  3. Study set-up
  4. Time schedule
  5. Publications

Medicines may improve health, but can also cause damage. Research has shown that medicines can result in hospitalization and that in almost half of these hospitalizations, one or more prescription errors play a role.


Some of these hospitalizations can be prevented by performing a medicine assessment. Pharmacotherapy is optimized by involving the patient in pharmacotherapy and by having the pharmacist and the general practitioner perform a medicine assessment together with the patient.

General

It proves difficult to implement this intervention in daily practice and the intended effect of pharmacotherapy does not seem to be achieved.

In the POINT study, we created a new position: the pharmacist-pharmacotherapist in primary care practice. This pharmacist works on optimal pharmacotherapy geared to the individual patient and improves at-risk medication-related processes. This pharmacist's only responsibility is pharmacotherapeutic care; they have no duties in the pharmacy.

By having this pharmacist-pharmacotherapist be part of the primary care practice, we expect that the physician's trust in the pharmacist increases, that availability and accessibility of the pharmacist will increase and that the pharmacist's knowledge and expertise are sufficient to perform these care tasks.

Intended result

The different research groups measure and compare the following results at the beginning and end of the project period: Hospital Admissions Related to Medication (HARMs), medicine use and changes in medication (number of medicines, type of medicines, prescribed strength and dosage, changes in dosage, drug interactions, refill compliance, stopping/switching medication, missing co-medication, costs of medication), prescription indicators, patient satisfaction and costs based on invoiced healthcare.

The results are measured at population level in the general practices linked to the Network of General Practitioners of the Julius Center, Zorggroep Almere and the Registratie Netwerk Universitaire Huisartspraktijken Leiden en Omstreken. No measurements are performed at patient level.

The analyses are expected to be completed by the summer of 2019, after which they will be published.

Study set-up

The study is focused on the effectiveness and feasibility of the (non-dispensing) pharmacist-pharmacotherapist in general practice by comparing the results of three different groups. Every group has a different setting in which the pharmacist works and/or has been trained:

  1. The (non-dispensing) pharmacist-pharmacotherapist in general practice;
  2. The public pharmacist in the pharmacy who has attended intensive training in the assessment of medication;
  3. The public pharmacist in the pharmacy (regular care).

The pharmacist-pharmacotherapist in the first study group coordinates pharmacotherapeutic management in primary care and is responsible for optimizing the long-term medication of individual patients. The pharmacist-pharmacotherapist does this within the general practice, in the following manners:

  • pharmacotherapeutic patient care for individual patients during the pharmacist's consulting hour;
  • advice and training about pharmacotherapy to staff in the general practice;
  • taking responsibility for writing protocols and formulary in the general practice and keeping these up to date.
  • The pharmacist-pharmacotherapist will be responsible for pharmacotherapeutic care of complex patients: patients who take multiple medicines and have multiple disorders and are at a high risk of undertreatment and adverse effects of pharmacotherapy. The public pharmacist provided dispensing-related care, is manager of operational processes and identifies, signals and refers patients to the pharmacist-pharmacotherapist.

The feasibility of healthcare innovation in the first study group is studied by means of a qualitative investigation of how a pharmacist-pharmacotherapist can be implemented in every general practice at practice, regional and national level.

Time schedule

The total duration of the research project is 36 months. The intervention by the pharmacist-pharmacotherapist in general practice will take place over a period of 12 months, with an onboarding period of 3 months. The intervention will take place in 10 different general practices in the period from March 2014 to mid-2015.

The results in terms of hospital admissions related to medication, medication-related problems and the stakeholder study and educational program have since been published in the thesis by Ankie Hazen.Also see 'publications' in the right-hand menu) .

The final analyses are expected to be completed by the summer of 2019.

Publications

Thesis by Ankie Hazen: non-dispensing clinical pharmacists in general practice: training, implementation and clinical effects.

The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: A systematic review.

Hazen ACM, de Bont AA, Boelman L, Zwart DLM, de Gier JJ, de Wit NJ, Bouvy ML. Res Social Adm Pharm. 2017 Apr 22. pii: S1551-7411(16)30579-4.

Controversy and consensus on a clinical pharmacist in primary care in the Netherlands. Hazen AC, Wal AW, Sloeserwij VM, Zwart DL, Gier JJ, Wit NJ, Leendertse AJ, Bouvy ML, Bont AA. Int J Clin Pharm. 2016 Oct;38(5):1250-60.

Design of the POINT study: Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in a primary care Team (POINT). Hazen AC, Sloeserwij VM, Zwart DL, de Bont AA, Bouvy ML, de Gier JJ, de Wit NJ, Leendertse AJ. BMC Fam Pract. 2015 Jul 2;16:76.

Apotheker ondersteunt huisarts in de praktijk: het beste van 2 werelden. Farma Magazine June 2015

Flinke medicatiereductie, grote verbetering kwaliteit van leven. Pharmaceutisch Weekblad, May 8, 2015

Interventies leiden tot halvering medicatielijst. Pharmaceutisch Weekblad, Febr. 6, 2015