Reviewing Repeat Prescribing — General Practitioners and Community Pharmacists Working Together

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Abstract
In the United Kingdom, patients receiving medication to treat chronic conditions frequently obtain treatment via repeat prescriptions. This reduces the workload of general practitioners (GPs) but increases the potential for patients to receive inappropriate and unnecessary medication over long periods of time. The aim of this project was to determine the potential role that community pharmacists could fulfil in reviewing and rationalising medication received on repeat prescriptions. Volunteer pharmacists and general practitioners in two health authorities in England formed 47 GP-pharmacist partnerships. Each GP identified up to 50 patients receiving six or more “repeat” medicines. Pharmacists reviewed GP notes and record systems to identify potential problems. Discussions addressing the identified problems and possible solutions were held between the GP-pharmacist partners. Three months later the pharmacists revisited the surgeries to review GP notes to determine whether changes had occurred. On completion of the project, focus groups were held with participating GPs and pharmacists to ascertain their views on the project. In total, repeat prescriptions for 1,564 patients were investigated which resulted in 13,194 medicines being reviewed. The pharmacists identified 9,762 potential “problems” of which the most common were: drugs no longer required, inappropriate quantity ordered, and unsatisfactory directions. The GPs agreed with 58 per cent of identified problems and acted upon 56 per cent of these (32 per cent of the original total). In general, the involvement of pharmacists was beneficial in terms of rationalising prescribing and reducing possible drug interactions and adverse drug reactions resulting from multiple supplies of potentially inappropriate and unnecessary medication. Furthermore, pharmacists were able to rationalise patients' supplies to help improve the actual management of medication in terms of ordering and collecting supplies and coping with complex daily regimens.