{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:37:36Z","timestamp":1787164656253,"version":"build-2736575974"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T00:00:00Z","timestamp":1697068800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Sydney Research Training Program Stipend"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The general practice pharmacist (GPP) role in Australia is evolving. A pilot GPP model of care developed to optimize medicines for patients at risk of medicine-related harm was evaluated. The aims of this study were 2-fold: to evaluate the GPP model of care on medicines optimization, with a focus on deprescribing, in a population at risk of harm due to their medicines, or clinical condition, and to explore the perspectives of study participants. This single practice study involved two phases. Phase 1 (September 2019\u2013May 2020): at risk patients were referred to the GPP for medication reconciliation, recommendations for optimization, and when appropriate, deprescribing support, especially for opioids. Medication plans were developed with patients, GPs, and the GPP. Quantitative data collected from patient records included demographics, discrepancies, medicines reviewed, GPP recommendations and uptake, and medicines deprescribed. Opioid-related data included dose changes from baseline, at 6 and 9 months, standardized to oral morphine equivalents. Descriptive statistics were used for analysis. Phase 2 (7\u201321 September 2020): qualitative evaluation using semi-structured interviews was undertaken, to explore the perspectives of GP and patient participants of the GPP model of care. Interview data were thematically analysed. The study had ethical approval. Phase 1: 198 multimorbid patients with multiple medications [median = 13 (9\u201316)] had at least one GPP consultation (n = 243). Discrepancies were resolved through 88% of GPP consultations; deprescribing commenced or occurred in 54%. Acceptance of GPP recommendations was 86%. Opioids were the most common medicines deprescribed (42% ceased). The baseline median opioid dose [44.4 (30\u201390) mg] was significantly reduced at 6 months [13.5 (0\u201340) mg] and 9 months [7 (0\u201330) mg], P &amp;lt; .0001. Phase 2: Thematic analysis of 28 interviews (10 GPs, 3 practice personnel, 10 patients, 5 carers) identified four key themes: safer foundation for deprescribing, deprescribing opportunities recognition, benefits of embedded GPP, and a supported approach to shared decision-making. General practice provides opportunities for medicine optimization and deprescribing. This study has demonstrated a GPP model of care that achieved functional deprescribing to reduce potential harm in a population at risk and addressed recognized barriers.<\/jats:p>","DOI":"10.1093\/ijpp\/riad061","type":"journal-article","created":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T16:23:14Z","timestamp":1690561394000},"page":"608-616","source":"Crossref","is-referenced-by-count":10,"title":["A pharmacist integrated into a general practice in Australia: an evolving model of care in medicines optimization"],"prefix":"10.1093","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3365-6650","authenticated-orcid":false,"given":"Margaret","family":"Jordan","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health, School of Pharmacy, University of Sydney , Sydney, NSW , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3772-7986","authenticated-orcid":false,"given":"Judy","family":"Mullan","sequence":"additional","affiliation":[{"name":"School of Medicine, Science, Medicine and Health Faculty, University of Wollongong , Wollongong, NSW , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adele","family":"Stewart","sequence":"additional","affiliation":[{"name":"Woonona Medical Practice , Woonona, NSW , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4189-8403","authenticated-orcid":false,"given":"Timothy F","family":"Chen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, School of Pharmacy, University of Sydney , Sydney, NSW , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,10,12]]},"reference":[{"key":"2023121919215091400_CIT0001","author":"World Health Organization","year":"2017"},{"key":"2023121919215091400_CIT0002","author":"World Health Organization","year":"2019"},{"key":"2023121919215091400_CIT0003","first-page":"34","article-title":"Overprescribing and rational therapeutics: barriers to change and opportunities to improve","volume-title":"Br J Clin Pharmacol","author":"Bennett","year":"2021"},{"key":"2023121919215091400_CIT0004","author":"World Health Organization","year":"2019"},{"key":"2023121919215091400_CIT0005","first-page":"352","article-title":"Physicians need to take the lead in deprescribing","volume-title":"Intern Med J","author":"Scott","year":"2015"},{"key":"2023121919215091400_CIT0006","first-page":"323","article-title":"Deprescribing: achieving better health outcomes for older people through reducing medications","volume-title":"J Pharm Pract Res","author":"Woodward","year":"2003"},{"key":"2023121919215091400_CIT0007","first-page":"3","article-title":"A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action","volume-title":"Eur J Intern Med","author":"Reeve","year":"2017"},{"key":"2023121919215091400_CIT0008","first-page":"l570","article-title":"Rationalising medications through deprescribing","volume-title":"BMJ","author":"Avery","year":"2019"},{"key":"2023121919215091400_CIT0009","first-page":"1473","article-title":"Communicating deprescribing decisions made in hospital with general practitioners in the community","volume-title":"Intern Med J","author":"Nguyen","year":"2021"},{"key":"2023121919215091400_CIT0010","first-page":"bjgpopen20X101096","article-title":"Barriers and facilitators to deprescribing in primary care: a systematic review","volume-title":"BJGP Open","author":"Doherty","year":"2020"},{"key":"2023121919215091400_CIT0011","author":"Australian Institute of Health Welfare","year":"2020"},{"key":"2023121919215091400_CIT0012","first-page":"37","article-title":"Deprescribing: a primary care perspective","volume-title":"Eur J Hosp Pharm","author":"Duncan","year":"2017"},{"key":"2023121919215091400_CIT0013","doi-asserted-by":"crossref","first-page":"403","DOI":"10.31128\/AJGP-08-20-5565","article-title":"Integration of non dispensing pharmacists into primary healthcare services","volume":"50","author":"Shaw","year":"2021","journal-title":"Aus J Gen Pract"},{"key":"2023121919215091400_CIT0014","first-page":"1609","article-title":"Evaluating the role and integration of general practice pharmacists in England: a cross-sectional study","volume-title":"Int J Clin Pharm","author":"Alshehri","year":"2021"},{"key":"2023121919215091400_CIT0015","first-page":"e035087","article-title":"Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study","volume-title":"BMJ Open","author":"Cardwell","year":"2020"},{"key":"2023121919215091400_CIT0016","first-page":"1155","article-title":"Clinical pharmacists in Dutch general practice: an integrated care model to provide optimal pharmaceutical care","volume-title":"Int J Clin Pharm","author":"Hazen","year":"2021"},{"key":"2023121919215091400_CIT0017","first-page":"235","article-title":"A pharmacist-led intervention to improve the management of opioids in a general practice: a qualitative evaluation of participant interviews","volume-title":"Int J Clin Pharm","author":"Jordan","year":"2022"},{"key":"2023121919215091400_CIT0018","first-page":"e665","article-title":"Impact of integrating pharmacists into primary care teams on health systems indicators: a systematic review","volume-title":"Br J Gen Pract","author":"Hayhoe","year":"2019"},{"key":"2023121919215091400_CIT0019","first-page":"228","article-title":"The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: a systematic review","volume-title":"Res Social Adm Pharm","author":"Hazen","year":"2018"},{"key":"2023121919215091400_CIT0020","first-page":"338","article-title":"The role of pharmacists in general practice: a realist review","volume-title":"Res Social Adm Pharm","author":"Anderson","year":"2019"},{"key":"2023121919215091400_CIT0021","first-page":"584","article-title":"Ensuring consistent reporting of clinical pharmacy services to enhance reproducibility in practice: an improved version of DEPICT","volume-title":"J Eval Clin Pract","author":"Rotta","year":"2015"},{"key":"2023121919215091400_CIT0022","first-page":"142","article-title":"The medication discrepancy taxonomy (MedTax): the development and validation of a classification system for medication discrepancies identified through medication reconciliation","volume-title":"Res Social Adm Pharm","author":"Almanasreh","year":"2020"},{"key":"2023121919215091400_CIT0023","author":"Faculty of Pain Medicine - Australian and New Zealand College of Anaesthetists (FPM-ANZCA)","year":"2021"},{"key":"2023121919215091400_CIT0024","first-page":"77","article-title":"Using thematic analysis in psychology","volume-title":"Qual Res Psychol","author":"Braun","year":"2006"},{"key":"2023121919215091400_CIT0025","first-page":"521","article-title":"Influence of a general practice pharmacist on medication management for patients at risk of medicine-related harm: a qualitative evaluation","volume-title":"Aust J Gen Pract","author":"Jordan","year":"2022"},{"key":"2023121919215091400_CIT0026","first-page":"544","article-title":"Non-dispensing pharmacists\u2019 actions and solutions of drug therapy problems among elderly polypharmacy patients in primary care","volume-title":"Fam Pract","author":"Hazen","year":"2019"},{"key":"2023121919215091400_CIT0027","first-page":"105","article-title":"A pharmacist-led pilot program to facilitate deprescribing in a primary care clinic","volume-title":"J Am Pharm Assoc","author":"Clark","year":"2020"},{"key":"2023121919215091400_CIT0028","first-page":"e006544","article-title":"Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis","volume-title":"BMJ Open","author":"Anderson","year":"2014"},{"key":"2023121919215091400_CIT0029","first-page":"1936","article-title":"Negotiating \u201cunmeasurable harm and benefit\u201d: perspectives of general practitioners and consultant pharmacists on deprescribing in the primary care setting","volume-title":"Qual Health Res","author":"Anderson","year":"2017"},{"key":"2023121919215091400_CIT0030","first-page":"341","article-title":"Swimming against the tide: primary care physicians\u2019 views on deprescribing in everyday practice","volume-title":"Ann Fam Med","author":"Wallis","year":"2017"},{"key":"2023121919215091400_CIT0031","first-page":"412","article-title":"Qualitative insights into the opioid prescribing practices of Australian GP","volume-title":"Fam Pract","author":"Prathivadi","year":"2020"},{"key":"2023121919215091400_CIT0032","first-page":"387","article-title":"Barriers and enablers to monitoring and deprescribing opioid analgesics for chronic non-cancer pain: a systematic review with qualitative evidence synthesis using the Theoretical Domains Framework","volume-title":"BMJ Quality & Safety","author":"Cross","year":"2022"},{"key":"2023121919215091400_CIT0033","first-page":"e000635","article-title":"Opioid stewardship: implementing a proactive, pharmacist-led intervention for patients coprescribed opioids and benzodiazepines at an urban academic primary care centre","volume-title":"BMJ Open Qual","author":"Tilli","year":"2020"},{"key":"2023121919215091400_CIT0034","first-page":"13","article-title":"The role of older patients\u2019 goals in GP decision-making about medicines: a qualitative study","volume-title":"BMC Fam Pract","author":"Weir","year":"2021"},{"key":"2023121919215091400_CIT0035","first-page":"738","article-title":"Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process","volume-title":"Br J Clin Pharmacol","author":"Reeve","year":"2014"},{"key":"2023121919215091400_CIT0036","first-page":"2057","article-title":"Beyond medication reconciliation: the correct medication list","volume-title":"JAMA","author":"Rose","year":"2017"}],"container-title":["International Journal of Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ijpp\/article-pdf\/31\/6\/608\/54639349\/riad061.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ijpp\/article-pdf\/31\/6\/608\/54639349\/riad061.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T14:22:41Z","timestamp":1702995761000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ijpp\/article\/31\/6\/608\/7308711"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,12]]},"references-count":36,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,10,12]]},"published-print":{"date-parts":[[2023,12,19]]}},"URL":"https:\/\/doi.org\/10.1093\/ijpp\/riad061","relation":{},"ISSN":["0961-7671","2042-7174"],"issn-type":[{"value":"0961-7671","type":"print"},{"value":"2042-7174","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,12,1]]},"published":{"date-parts":[[2023,10,12]]}}}