Adoption of clinical pharmacist roles in primary care: longitudinal evidence from English general practice

Background Over the past decade, the number of clinical pharmacists working within multidisciplinary teams in English general practices has expanded. Aim To examine changes in quality of prescribing after the adoption of clinical pharmacist roles in English general practices. Design and setting Longitudinal cohort study in English general practice. Method Two-way fixed-effects regression was used to compare differences in prescribing indicators in general practices with and without pharmacists between September 2015 and December 2019. Results Between September 2015 and December 2019, the proportion of practices employing a clinical pharmacist increased from 236/7623 (3.1%) to 1402/6836 (20.5%). Clinical pharmacist implementation resulted in statistically significant reductions in total costs of medicines per 1000 patients (−0.85%, 95% confidence interval [CI] = −1.50% to −0.21%), the total number of opioid prescriptions per 1000 patients (−1.06%, 95% CI = −1.82% to −0.29%), and the average daily quantity of anxiolytics per 1000 patients (−1.26%, 95% CI = −2.40% to −0.12%). Clinical pharmacist implementation also resulted in reductions in the total number of prescriptions per 1000 patients (−0.58%, 95% CI = −1.30% to 0.13%) and the total number of antibiotic prescriptions per 1000 patients (−0.51%, 95% CI = −1.30% to 0.27%) that trended towards statistical significance. There were no statistically significant differences in the share of broad-spectrum versus narrow-spectrum antibiotics (0.02%, 95% CI = −0.07% to 0.11%) and the oral morphine equivalence of high-dose opioids (>120 mg per 24 h) per 1000 patients (1.19%, 95% CI = −0.46% to 2.85%). Conclusion This analysis is limited by practice-level data but supports the hypothesis that clinical pharmacist implementation results in improvements in prescribing quality.