An evaluation of the delivery of pharmaceutical care from a general practice surgery based pharmacy.
A longitudinal study was carried out on a population of 4,922 patients
served by a general practice surgery with three doctors. The purpose was to
investigate the opportunity which domiciliary care of elderly and infirm
patients offers to UK pharmacists working in primary care.
The aims of the study were: -
1) To identify indicators that could be used to identify patients in the
community who might benefit from domiciliary pharmaceutical care, and
which do not leave patients excluded.
2) To identify specific issues that would lead to better pharmaceutical care
3) To deliver a package of pharmaceutical care to these most "at risk"
patients in the population over approximately a year.
4) To evaluate the interventions made considering the viewpoints of all
parties found to be stakeholders.
5) To measure the scale of the challenge of domiciliary managed
pharmaceutical care in relation to the population in the study.
6) To provide indicators for the development of pharmaceutical care
including cost/ benefit and potential training requirements.
A simple qualitative study design was pursued, based upon semi-structured
interviews and field notes. A cohort of patients (n=149) identified as
candidates for domiciliary visiting, represented 3% of the surgery
population. After de-selection of unsuitable candidates, visits were made to
Three concepts for the organisation of information and three clusters of
criteria were identified and developed which would identify 94 out of 100
A large number of indicators for pharmaceutical care were identified and
described qualitatively under 14 headings. Though typical, these were not
claimed as a comprehensive set of issues which could have been
It was generally perceived that more of the pharmacist's interventions
produced positive effects than those that were neutral or actually did harm.
Some of the interventions were accepted by the GPs as very important, and
developing the extended role to include for instance a cardiovascular review
clinic; "in house" medication reviews was discussed. Domiciliary visits
were deemed useful though the GPs pointed out that making visits was time
consuming and, by implication, expensive.
Patients reported a high level of satisfaction with the visiting programme.
Satisfaction was explored in an attempt to differentiate sociometric issues from
professional ones. Rating satisfaction with a domiciliary pharmaceutical service
required that specific issues were identified and dealt with which reflected the
main concerns of patients about their medicines.
Most of the patients' concerns appeared to be centred around multiple
medication, widely perceived (in this cohort) to have potential to cause harm.
The author recommends that PCGs consider allocating part of the prescribing
budget to fund a domiciliary pharmaceutical care service to a small targeted
population through community pharmacies.
This could be a first step in offering new professional opportunities through
community pharmacies and might revitalise some which are currently in decline.