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GPs ignore pharmacist advice ‘because it is unlikely to benefit patients’ finds study



GPs do not take notice of pharmacist recommendations on medication, because they believe the suggestions are ‘unlikely’ to benefit patients, according to new research.

Researchers at the Universities of Bristol, Bath, Reading, Sydney and Laval looked at the reasons why pharmacist advice in primary care has no effect on the number of medications prescribed by GPs.

The research is built upon the findings of previous work – the 3D study – which involved a randomised controlled trial of a model of patient care that sees pharmacists review patient records and make recommendations to GPs about the drugs prescribed.

This original study concluded that the approach, which was used for people with comorbidities, did not improve heath outcomes for patients.

In the new study, presented this month at the Society for Academic Primary Care annual conference, researchers found GPs did not follow the advice from pharmacists in more than half of cases.

A ‘high proportion’ of the 1,100 recommendations made by the pharmacists were ‘vague or indirect,’ said the researchers.

The study included 797 patients, with 76% having their medicine reviewed by a pharmacist.

Among those reviewed, 19% included no pharmacist recommendations. The rest of the patient records amassed 1,100 recommendations in total – but the researchers found one in five were ‘vague, indirect or a question’.

The authors found the most common recommendations were to stop or reduce medications (33%), swap medication (23%) and start or increase medication (13%), based on safety and treatment effectiveness.

They concluded: ‘A high proportion of pharmacist recommendations were vague or indirect and over half of the recommendations that advised a change in prescribing were not actioned by the GPs.

‘This explains why the 3D intervention had no effect on the number of medications prescribed. It is possible that the 3D study intervention improved the medication complexity (e.g. the number of doses per day).’

GPs who took part in the latest study told lead researcher Dr Polly Duncan that they tended to ignore pharmacist recommendations because they thought they were ‘more technical and unlikely to lead to patient benefit, such as switching the patient’s statin’.

Dr Duncan said: ‘GPs most valued recommendations that improved prescribing safety and two of the GPs talked about medication errors that had been picked up by the pharmacist.’

The new five-year GP contract, released in January by the BMA and NHS England, pledged to recruit 22,000 additional practice staff, including pharmacists, by 2023/24 to help GPs manage their workload.