Integration of a consultant pharmacist into a general practice: development of a collaborative care model

Teamwork, communication and collaboration among healthcare professionals are important for the safe and effective delivery of health care. Australia’s ageing populationand the increasingburdenof chronicdiseasespresent opportunities and imperatives for healthcare professionals to practise collaboratively. In Australia, a review of all hospital admission studies conservatively estimates that 2–3% of admissions aremedication-related. The associated annual costs of these adverse drug event-related admissions are estimated at $1.2 billion. Further, 10% of patients seeing a general practitioner (GP) had had an adverse medication event in the previous 6months. Poor communication has been consistently highlighted as the most important common factor contributing to medication errors. Increased interprofessional collaboration between doctors and pharmacists has the potential to reduce medication-related morbidity and mortality. Home Medicine Reviews (HMRs) assess a patient’s use of medicines with the main objective of optimising quality use of medicines and reducingmedicine-related problems, including adverse drug events. Initiated by GPs and facilitated by pharmacists, the program has been operational since 2001. The evidence supporting the benefits of HMRs is continually expanding. For example, HMRs have been shown to be effective in delaying the time to next hospitalisation for patients with heart failure and patients prescribed warfarin. The targeted use of HMR for those patients most likely to benefit is likely to be costeffective. Although it is recognised that pharmacists are highly trained yet under-utilised professionals in the Australian healthcare system, co-location of accredited pharmacists within general practice is currently relatively rare. Recent research has provided the impetus for other accredited pharmacists to design and implement variations of their models of practice outside of the research setting and the notion has been gradually gaining traction. Various barriers have been identified to the integration of pharmacists into healthcare teams, including practitioner perceptions and issues around patient confidentiality. Described here is a novel model of integration of a consultant pharmacist into a general practice that was purposefully developed to overcome such barriers and build strong interprofessional relationships.