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Res Social Adm Pharm. 2018 Mar;14(3):228-240. doi: 10.1016/j.sapharm.2017.04.014. Epub 2017 Apr 22.

The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: A systematic review.

Author information

1
Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands. Electronic address: a.c.m.hazen@umcutrecht.nl.
2
Institute of Health Policy and Management, Erasmus University, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands. Electronic address: debont@bmg.eur.nl.
3
Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands. Electronic address: lboelman@gmail.com.
4
Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands. Electronic address: d.zwart@umcutrecht.nl.
5
Department of Pharmacotherapy, Epidemiology and Economics, University of Groningen, Antonius Deusinglaan 1, Building 3214, 9713 AV, Groningen, The Netherlands. Electronic address: degiercs@wxs.nl.
6
Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands. Electronic address: n.j.dewit@umcutrecht.nl.
7
Department of Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands. Electronic address: m.l.bouvy@uu.nl.

Abstract

BACKGROUND:

A non-dispensing pharmacist conducts clinical pharmacy services aimed at optimizing patients individual pharmacotherapy. Embedding a non-dispensing pharmacist in primary care practice enables collaboration, probably enhancing patient care. The degree of integration of non-dispensing pharmacists into multidisciplinary health care teams varies strongly between settings. The degree of integration may be a determinant for its success.

OBJECTIVES:

This study investigates how the degree of integration of a non-dispensing pharmacist impacts medication related health outcomes in primary care.

METHODS:

In this literature review we searched two electronic databases and the reference list of published literature reviews for studies about clinical pharmacy services performed by non-dispensing pharmacists physically co-located in primary care practice. We assessed the degree of integration via key dimensions of integration based on the conceptual framework of Walshe and Smith. We included English language studies of any design that had a control group or baseline comparison published from 1966 to June 2016. Descriptive statistics were used to correlate the degree of integration to health outcomes. The analysis was stratified for disease-specific and patient-centered clinical pharmacy services.

RESULTS:

Eighty-nine health outcomes in 60 comparative studies contributed to the analysis. The accumulated evidence from these studies shows no impact of the degree of integration of non-dispensing pharmacists on health outcomes. For disease specific clinical pharmacy services the percentage of improved health outcomes for none, partial and fully integrated NDPs is respectively 75%, 63% and 59%. For patient-centered clinical pharmacy services the percentage of improved health outcomes for none, partial and fully integrated NDPs is respectively 55%, 57% and 70%.

CONCLUSIONS:

Full integration adds value to patient-centered clinical pharmacy services, but not to disease-specific clinical pharmacy services. To obtain maximum benefits of clinical pharmacy services for patients with multiple medications and comorbidities, full integration of non-dispensing pharmacists should be promoted.

KEYWORDS:

Clinical pharmacist; Integrated care; Primary health care; Systematic review

PMID:
28506574
DOI:
10.1016/j.sapharm.2017.04.014
[Indexed for MEDLINE]
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