Introduction

Much of the literature has suggested that pharmacists' medication review for nursing home patients might optimise patient's drug use.^1.2However, there have been few studies of GPs and nursing home staff views of working with pharmacists.³ The aim of this study is therefore to explore GPs' and nurses' perspectives of pharmacist's medication review for nursing home patients.

Method

Ten GPs and eight nursing staff, whose patients had already received a single medication review by Primary Care Trust (PCT) pharmacists, were interviewed by the first author. All interviews were tape-recorded, transcribed and analysed in accordance with the principle of grounded theory.⁴

Findings

Overall, the medication reviews undertaken by the PCT pharmacists were accepted by the GPs and the nursing staff: 1) useful for picking up individual patients' problems; and 2) helpful to have another medical profession to liaise between a nursing home and a surgery. However, they suggested that a single medication review service may not result in a sustainable change in optimised medication use and that it should be provided regularly. The lack of continuity and accessibility were perceived by both the GPs and nursing staff as a potential barrier to collaboration with the PCT pharmacists. In addition, the GPs stated that recommendations made by the PCT pharmacists were usually helpful but the final decision of prescribing should be made by the GPs. One GP clearly stated that most of the pharmacist's recommendations were "interference". The nursing staff perceived the PCT pharmacists as "someone coming from outside and doing inspections".

Discussion

Barriers to implementation of the PCT pharmacist's medication review were identified in this study: 1) GP's fear of being interfered with; 2) limitations of changes in GP's prescribing; 3) isolation of PCT pharmacists; and 4) the PCT pharmacist's lack of continuity and accessibility. The last one especially was found to be the most hindering factor to developing relationships with the GPs and nursing staff. Close liaison with the nursing staff is particularly important for the PCT pharmacists to identify drug-related problems which are not detected by checking prescriptions or computer records. The PCT pharmacists may need to understand non-clinical factors which influence the GP's decision making on their prescribing, such as patients' expectations, empirical judgement and nursing staff's expectation. Having regular and effective communication (i.e. verbal communication) with the GPs and nursing staff could be of benefit for the PCT pharmacists as to: 1) obtain recognition from the GPs and nursing staff that the PCT pharmacists are in their arena; 2) facilitate the PCT pharmacist to grasp the entire prescribing scenario along with identifying drug-related problems; and 3) increase their credibility among GPs and nursing staff. These mature relationships could lessen the barriers perceived by the GPs and the nursing staff and improve collaboration with GPs without threatening their territory.

References

1. Furniss L, Burns A, et al. Effects of pharmacist's medication review in nursing homes . Br J Psyc 2000;176:563-567.
2. Obenchain LA. Effectiveness of drug-regimen review in eliminating unnecessary drugs. Consult Pharm 1991;6 (10): 845-847
3. Schweizer AK, Hughes CM, Morrison D. The current and future role of the pharmacist in nursing and residential homes. Health Services research & Pharmacy Practice Conference 2001.
4. Strauss AL, Glaster BG . Discovery of grounded theory: strategies for qualitative research. New York: Aldine. 1967