Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics

Hamilton Health Sciences (HHS)

Status and phase

Completed

Phase 4

Conditions

Hypertension

Diabetes

Hyperlipidemia

Constipation

Pain

Treatments

Behavioral: optimizing processes of care

Behavioral: integration of pharmacist into primary care

Drug: optimizing therapeutic treatments

Study type

Interventional

Funder types

Other

Identifiers

NCT00157638

G03-02671

Details and patient eligibility

About

Recent health policy documents have endorsed an integrated model of collaboration between pharmacists and physicians in primary care. The integration of pharmacists into primary care has been identified as a priority for primary health care reform in Canada. However, the best way to do this has not been demonstrated or evaluated. This demonstration project shows the various ways in which pharmacists can be trained and integrated into different family practice settings, the processes and costs associated with doing this, and the outcomes observed. The main hypothesis is that pharmacist integration into family practice will optimize medication use, clinical care and clinical outcomes. This information provides policy makers with necessary information about collaboration between pharmacists and family physicians for their overall goal of reforming the delivery of primary health care to the population.

Full description

The overall goal of IMPACT was to improve patient outcomes by optimizing drug therapy through a community practice model that integrates pharmacists into family practices.

This multi-site demonstration project involved 7 pharmacists, approximately 70 physicians and approximately 150,000 patients. Within each practice site, a pharmacist with special clinical training worked 2.5 days per week for 2 years and coordinated a multifaceted intervention aimed at optimizing drug therapy to improve patient outcomes (blood pressure, cholesterol, diabetes, pain control, constipation, etc.) The integrated pharmacist conducted patient assessments for medication problems, optimized office system medication management (e.g. develop process for handling of medication samples), and provided education (academic detailing ) focussed on key therapeutic areas. Pharmacists were provided with ongoing support from a training and mentorship program and the services of the Ontario Pharmacists' Association Drug Information Centre.

The family physicians and other members of the practice worked closely with the pharmacist in implementing these strategic interventions. Family physicians from a range of practice models (Ontario Family Health Networks, Primary Care Networks, and other types of family physician group practices) participated in this project.

Quantitative and qualitative methods were used to evaluate the process of integration, pharmacist service uptake, drug-related patient outcomes, and the costs associated with program implementation for sustainability. The integration of the physicians and pharmacists at the practice sites were evaluated with the aim of generating a practical and transferable practice model. The main hypothesis was that pharmacist integration into family practice will optimize medication use, clinical care and clinical outcomes.

Sex

All

Ages

65+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

65 + years and any two of the following:

Elevated blood pressure
Elevated hemoglobin A1C
Elevated LDL-C
Diagnosis of hypertension and no blood pressure readings in past 12 months
Diagnosis of diabetes and no hemoglobin A1C readings in past 12 months
Diagnosis of hyperlipidemia and no cholesterol readings in past 12 months
Diagnosis of osteoarthritis or rheumatoid arthritis
Using narcotics
Diagnosis of hypertension, diagnosis of diabetes and not using an ACE inhibitor
Diagnosis of hypertension, elevated blood pressure and using an NSAID
Diagnosis of hyperlipidemia, elevate dLDL-C and not using a lipid lowering agent
Diagnosis of hypertension, high blood pressure and not using a potassium wasting diuretic