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A community pharmacy-led deprescribing service – in collaboration with general practice (GP)

  • At: PPR 2022 (2022)
  • Type: Poster
  • Poster code: PM-01
  • By: ABRAHAMSEN, Bjarke (Danish College Of Pharmacy Practice, Pharmakon)
  • Co-author(s): Bjarke Abrahamsen, PhD, Danish College of Pharmacy Practice, Pharmakon, Denmark
    Rikke Nørgaard Hansen, Head of Department, Research and Development
    Charlotte Verner Rossing
  • Abstract:

    Background
    Deprescribing of inappropriate medication is becoming an increasingly important task for pharmacists. Here, we describe the results of a scoping review identifying roles and tasks for pharmacists in different settings and for all phases of the deprescribing process. Also, using the results from the scoping review we explored the possibility of collaboration between community pharmacists (CP) and GP in the deprescribing process.

    Purpose
    The purpose was two-fold: first, a review of the scope for pharmacists’ involvement in deprescribing within primary and secondary healthcare; second, conducting a pilot study where CP and GP develop and test a deprescribing service.

    Method
    For the scoping review, we searched the PubMed database (2015-2020) with search terms identified through PICO analysis. Furthermore, we identified relevant literature and ongoing projects by searching grey literature and contacting national and international pharmacy care networks. All identified literature was screened by the researchers according to inclusion criteria. A pilot study was carried out involving one CP and one GP. In a workshop, CP and GP developed a collaboration contract covering a deprescribing service targeting 20 patients. To facilitate testing and overcome potential obstacles, participants took part in bi-monthly follow-up phone meetings. Quantitative data for the deprescribing process was registered electronically by the CP throughout the intervention period of June-September 2021. We collected qualitative data for evaluation of the collaboration using post-intervention semi-structured interviews conducted with CP and GP.

    Results
    From PubMed, 387 studies were identified of which 18 were included. From grey literature and pharmacy care networks, five studies were included. A review of the included studies shows that pharmacists collaborate with patients, GPs and other healthcare professionals in deprescribing. These studies showed that pharmacists take part in identifying candidates for deprescribing, can deprescribe using an approved protocol with authorisation by the GP, and provide information about deprescribing to either healthcare professionals or patients. The involvement of pharmacists can take place in both primary and secondary healthcare settings. In the pilot study, CP and GP developed a deprescribing service targeting inappropriate use of proton pump inhibitors (PPI) with both parties involved in recruiting patients. A deprescribing guideline and patient interview were used to assess patients prior to the final approval of the GP. The deprescribing process was delivered by CP and consisted of an initial consultation and two follow-ups. After the final follow-up, an electronic status report was delivered to the GP. The pilot study showed that CP and GP were able to design, collaborate and deliver a deprescribing service for patients using inappropriate PPI. Of the 17 patients recruited, 16 experienced deprescribing, defined as stoppage of drug or dose reduction. CP and GP reported satisfaction with the collaboration, division of tasks and roles, and considered that there was indeed value for the patient.

    Conclusion
    The scoping review showed that pharmacists can contribute to all phases of the deprescribing process in primary and secondary healthcare. Also, a pilot demonstrated that general practitioners and community pharmacies can develop and collaborate successfully in a CP-led deprescribing service to patients.

Last update 4 October 2019

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