BEST WAY TO FACECHAT INTERNATIONALY TRIAL
The 3D trial comprised 6-monthly comprehensive reviews with a focus on patient-centred care, and included a pharmacist reviewing the patients’ electronic medical records and making up to four medication recommendations for consideration during a face-to-face review between the GP and patient. 7 The study intervention was based on the 3 D’s: the Dimensions of health (including quality-of-life and patient priorities for their health) identifying and treating Depression and simplifying Drug treatments. The present study was nested within the 3D trial, a multicentre, cluster-randomised controlled trial of a complex intervention to improve quality of life for people with multimorbidity. 6 The aim of the current study was to explore GP and pharmacist views towards interprofessional working within the context of optimising medicines for patients with multimorbidity. The authors have previously explored GP and pharmacist perspectives on the usual practice of medication reviews and found that being efficient (getting it done) tended to take priority over being thorough (doing it well). Pharmacists could play a key role in tackling the workload associated with managing polypharmacy however, research into how best to integrate their skills is lacking. 4, 5 Practice pharmacists have non-dispensing roles, including dealing with prescription requests from patients and community pharmacists and reconciling medications following discharge from hospital, as well as consulting with and treating patients.
In response to increased primary care workload pressures in the UK, 4 there has been an increase in the number of practice pharmacists working as part of the primary care team. Clinicians are encouraged to follow evidenced-based guidelines for prescribing and, although there are some criteria-based tools (such as, STOPP/Start) 2 that highlight medications that are potentially harmful and could be deprescribed, these are outweighed by disease-specific guidelines that almost always recommend starting and intensifying treatment. 1 This can require complex clinical decisions, particularly with deprescribing (tapering down and stopping of medications), where issues such as loss of clinical benefit must be balanced against reductions in medication errors, adverse reactions, and prescribing burden. Through medicines optimisation, GPs and pharmacists are tasked with working with patients to ensure that they get the best possible outcomes from their medications.
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