How effective are harmacists who study of interventions intended to influence prescribing work with medica zyxw P practitioners? A SHERIDAN TEAL, LUCIANNE RICKETTS, ANDREW BELTON, GEORGE ALLSOPP, JONATHAN SILCOCK and DAVID J. WRIGHT I zyxwvutsrqponmlkjihgfedcbaZYX Objective zyxwvutsr - This study was designed to describe the interventions made by pharmacists working within different therapeutic areas in medical practices in primary care and to estimate the effects on prescribing. Method - All medical practices and community pharmacists in one health authority area in England were invited to participate. Pharmacists were allocated to work with specific practices and training was provided in musculoskeletal, respiratory and anxiolytichypnotic (sedative)prescribing. Pharmacists negotiated and agreed with their medical practice the type of interventions which would meet the practice's needs. Pharmacists were remunerated to provide a maximum of eight three-hour sessions in each medical practice on each therapeutic area over a zyx 12- month period. Details of all interventions were recorded by each pharmacist and countersigned by a practice GP. A summary form was then sent to the health authority. Analysis of prescribing data before and after intervention in all practices was carried out using a predictive model to calculate estimated costs. Key findings - Twenty-seven pharmacists working with 39 medical practices participated in the study. Pharmacist interventions resulted in 165 dose changes, 368 drug changes, 470 drug discontinuations and 1,042 patient reviews. On average, Z3.99 was saved for each musculoskeletal intervention made. This compared with an additional cost of zyxwv E15.50 and Z17.92 for each intervention in sedative and respiratory prescribing, respectively. Analysis of prescribing data showed that the total spend in musculoskeletal and sedative prescribing in participating practices one year after intervention was lower than that predicted. Conclusion - Accurate recording of individual interventions with reasons, outcomes and direct cost consequences allows purchasers to make more informed decisions about the potential benefits of practice pharmacists. This method may, however, underestimate the pharmacist's indirect impact on prescribing since it does not take into account any educational effect on prescribers. PREVIOUS studies have shown that pharmacists working with medical practices in primary care can assist with the management of prescribing.1-6 The unit of analysis in these studies was usually the medical practice and change in net ingredi- ent cost (NIC) within different therapeutic areas was often the primary outcome measure. To move beyond justification of pharmacist input on cost containment grounds, some studies have monitored changes in prescribing quality indica- tors.597 However, even this approach is limited be- cause indicators, underpinned by numerous as- sumptions, are only available in a small number of therapeutic areas and their validity has been questioned. Few studies have described in detail the phar- macist activity that may have contributed to changes in NIC, for example, the interventions made, why they were necessary and the direct cost impact. Most studies have also failed to dis- cuss the relative effectiveness of pharmacist in- tervention in different therapeutic areas. This study aimed to accurately describe and compare the impact of the pharmacist within three differ- ent therapeutics areas in terms of service cost, di- rect effects on prescribing and the reasons for intervention. Calderdale and Kirklees PCTs, West Yorkshire Sheridan Teal, MRPharrnS, pharmaceutical adviser Lucianne Ricketts, MRPharrnS, PCT pharmacist Andrew Belton, MBChB, medical adviser George Allsopp, prescribing information analyst School of Pharmacy, University of Bradford, Richmond Road, Bradford, England BD7 1DP Jonathan Silcock, MSc, MRF'harmS, Boots teacher- practitioner David J. Wright, PhD, MRPharrnS, senior lecturer in pharmacy practice Correspondence: Dr Wright d.wright@ bradford.ac.uk Int] Pharm Pract 2002:10:185-90 SEF'TEMBER 2002, THE INTERNATIONAL JOURNAL OF PHARMACY PRACTICE zyxwvutsrq 185