Pharmaceutical review of repeat prescribing in general practice medicine and exploration of patients' views on health care and medicine

Repeat prescribing is a common and practical way to prescribe medication for patients with chronic conditions. However, lack of regular review has raised questions about the quality of the prescribing and how this affects patients' compliance and safety. The thesis consists of two main parts. Part One investigated how the effectiveness of repeat prescribing from a general practice surgery could be improved by having a community pharmacist reviewing and intervening on repeat prescriptions, in collaboration with the general practitioner (GP). Patients' experiences with the repeat prescription system, how they managed their medicines and if they perceived any intervention from the pharmacist were explored through domiciliary interviews. The pharmacist reduced the absolute risk (ARR) of drug-related problems (DRPs) by 26%, and the prescription number needed to treat (NNT) was found to be 3.8. Additionally, for every 19 prescriptions reviewed by the pharmacist, a DRP that resulted, or potentially resulted, in clinical improvement in patient care was identified and resolved. Part Two is developed from the experiences of Part One, and includes patients having drug- related consultations with the pharmacist in a general practice surgery. The consultations were followed by qualitative interviews to explore patients' perception of the consultation, their beliefs about medicines and empowerment issues, and how this relates to information provided on medicines. The complexity of how these factors relate were analysed and an empirical model developed and described. The pharmacist significantly reduced the number of repeat prescriptions with DRPs compared to the routine GP surgery procedure and was an effective method of solving DRPs, reducing risks and making significant clinical improvements to patient care. The study further recommends that pharmacists' repeat prescription review must extend beyond prescription-based interventions and move towards a distinct pharmaceutical care programme. This includes pharmacists acting as dependent prescribers responsible for the continuing of patient care with the authority to adjust doses and dosage forms as recommended in the Crown report (1999) but also incorporates the model on patients' beliefs about medicines to successfully implement interventions.