Evaluation of a pharmacist-led intervention to reduce prescribing costs in general practice
Introduction and aim It has been suggested that the employment of pharmacists in general practice might moderate the growth in prescribing costs. However, empirical evidence for this proposition has been lacking. The aim of this study was to evaluate a controlled trial of pharmacist-led intervention in general practice to determine whether intervention practices made savings relative to controls and if so, exactly how these savings were made and whether quality of prescribing was maintained. Since this process of rationalisation has implications for patients, an additional aim was to explore the views of patients on changes made to their medication. Methods The study was an evaluation of an initiative set up by Doncaster Health Authority. Eight practices received intensive input from five pharmacists for one year (September 1996 to August 1997) at a cost of £163 000. Changes in prescribing patterns were investigated using Prescribing Analysis and CosT (PACT) data by comparing these practices with eight individually matched controls for both the year of the intervention and the previous year. A postal survey of 314 patients who had undergone a change in medication between October 1997 and January 1998 was used to explore patient views. Results The evaluation showed that the rise in prescribing costs for intervention practices was significantly lower than for control practices (p=0.02S). Had the cost growth of the intervention group been as high as that of the controls, their total prescribing expenditure would have been around £347 000 higher. Detailed analysis showed that these savings were achieved by controlling both prescribing volume and cost per unit volume in areas believed to be without detriment to patient care. The majority of patients were reasonably satisfied or very satisfied with the way in which they found out about their medication change and satisfaction was positively associated with being told why the change was taking place, being given a choice and being told by the GP, a practice pharmacist or by letter. Conclusions Compared with previous studies, this evaluation has advantages in the fact that a control group was used to compare changes in prescribing patterns. The evaluation has shown that the use of pharmacists controlled prescribing expenditure sufficiently to off-set the costs of their employment. Results of the patient survey indicated that patients were not so much concerned about changes in medication per se, but rather the manner in which it was conveyed to them. These results have important implications for the control of prescribing costs in primary care. However, this study took place in motivated practices that had relatively high prescribing costs and this may limit the generalisability of the results.