Effects of non-dispensing pharmacists integrated in general practice on medication-related hospitalisations.

AIMS: To evaluate the effect of non-dispensing pharmacists (NDPs) integrated in general practice on medication-related hospitalisations, drug burden index and costs in patients at high risk of medication problems (being 65 years or older and using five or more chronic medications).

METHODS: This was a multicentre, non-randomised, controlled intervention study with pre-post comparison (2013 versus June 2014 to May 2015) in 25 general practices in the Netherlands, comparing NDP-led care (intervention) with two current pharmaceutical care models (usual care and usual care plus). In the intervention group, ten specially trained NDPs were employed in general practices to take integral responsibility for the pharmaceutical care. They provided a broad range of medication therapy management services both on patient level (e.g. clinical medication review) and practice level (e.g. quality improvement projects). In the control groups, pharmaceutical care was provided 'as usual' by general practitioners and community pharmacists, or 'as usual plus' when pharmacists were additionally trained in performing medication reviews.

RESULTS: Overall, 822 medication-related hospitalisations were identified among 11,281 high-risk patients during the intervention period. After adjustment for clustering and potential confounders, the rate ratio of medication-related hospitalisations in the intervention group compared to usual care was 0.68 (95% CI: 0.57 to 0.82) and 1.05 (95% CI: 0.73 to 1.52) compared to usual care plus. No differences in drug burden index or costs were found.

CONCLUSIONS: In general practices with an integrated NDP, the rate of medication-related hospitalisations is lower compared to usual care. No differences with usual care plus were found.