Tuesday, February 21, 2012

Pharmacist reviews in GP practices cut prescribing errors by 30% - Pulse

By Nigel Praities | 20 Feb 2012

Pharmacists will be invited into GP practices to conduct regular medicine reviews and tackle ‘hazardous' prescribing, under a new scheme ministers have urged clinical commissioning groups to implement.

The Department of Health-commissioned scheme – piloted in 72 practices around Manchester and Nottingham – found a resident pharmacist reduced the risk of prescribing errors by over a quarter.

The findings come after Pulse revealed earlier this month that the GMC-commissioned PRACTICE study found 4% of GP prescriptions contained prescribing errors and a further 1% monitoring errors – a finding set to prompt major changes in GP training.

The PINCER trial, published online by The Lancet this week, compared the effect of introducing pharmacists into practices to analyse prescribing errors, agree action plans and review patients, with simple computerised feedback on patient records.

Researchers found a 29% reduction at six months in the risk of prescribing errors – such as use of a non-selective NSAID in patients with a history of peptic ulcer or a ß-blocker in patients with asthma – in the pharmacist intervention group, compared with those in the computerised feedback group.

They also reported a 44% reduction in monitoring errors, such as the failure to carry out renal function, INR and liver function tests.

The study authors – based at the Universities of Nottingham and Manchester – said the results suggested the pharmacist scheme was cost-effective and should be considered for a national rollout.

Study leader Professor Tony Avery, professor of primary healthcare at the University of Nottingham and a GP in the city, said primary care pharmacists were currently too focused on cost: ‘This is eminently transferable to the NHS as it is. We are in times of financial restraint at the moment, and this is an effective way of reducing medication errors.'

A DH spokesperson said: ‘This study clearly demonstrates how pharmacists can improve safety and effectiveness of prescribing by GPs. Emerging CCGs will want to consider how to access the robust pharmaceutical expertise they will need to optimise medicines use.'

How pharmacists help cut risks

• Patients with asthma who have been prescribed ß-blockers – cut by 27%
• Patients with history of peptic ulcer prescribed an NSAID without PPI – cut by 42%
• Older patients on ACE inhibitors or loop diuretics without a renal function check – cut by 49%
• Methotrexate without a blood count or LFT – cut by 20%

Source: Lancet 2012, online 21 February

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