The effect of pharmaceutical review of repeat prescriptions in general practice

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Abstract
Objectives: To investigate how a community pharmacist can affect the quality of repeat prescribing, and to develop a model for general practitioner (GP) and pharmacist co-operation. Methods: Repeat prescriptions with three or more items were reviewed by a community pharmacist and randomly allocated to a trial or control group. Drug-related problems (DRPs) were discussed at joint meetings with the GP and the pharmacist. A modified Delphi technique was used to evaluate the clinical significance of the DRPs identified by the pharmacist. Setting: The repeat prescription review and meetings took place in a GP surgery in an inner city location between November, 1995, and October, 1997. Key findings: The pharmacist reviewed 511 repeat prescriptions, representing 3,018 prescribed items. Ninety repeat prescriptions (36.3 per cent) in the trial group and 86 repeat prescriptions (34.1 per cent) in the control group were identified as having DRPs. The GP agreed with 92.3 per cent of the interventions in the trial group, while only 12.8 per cent of the interventions in the control group were routinely resolved by the GP. The difference in interventions dealt with between the trial and the control group is statistically significant (X2=94.14, P<0.001). The absolute risk reduction (ARR) was 26 per cent, and the prescription number needed to treat (NNT) was 3.8. For every 19 prescriptions reviewed, an intervention that results, or potentially results, in clinical improvement in patient care was made by the pharmacist. Conclusion: The pharmacist significantly reduced the number of DRPs associated with repeat prescriptions compared with routine surgery procedure. Pharmacist review of repeat prescriptions is an effective method of solving DRPs, reducing risk and making significant clinical improvements to patient care.