New program theory in pharmacist-led patient-centered medication review in general practice - a qualitative pilot study

Background: Pharmacists are increasingly engaged in general practice to contribute to rational prescribing and to reduce the workloads. To further improve patients' outcomes, a new patient-centered medication review (MR) model in primary care for polypharmacy patients was developed. This model involves patients in an initial ‘problem detection meeting’ with the pharmacist and in a meeting with the pharmacist and the General Practitioner (GP) to discuss MR findings. Objectives: To pilot test the new MR model to supplement existing program theory. Methods: Qualitative descriptive nonparticipatory observations of the MR model were carried out in two general practices in Denmark to identify Context elements and determine how the Intervention was enacted. Semistructured interviews with GPs, patients and the pharmacist were conducted to establish Outcomes. Through principles of realist evaluation, Mechanisms, i.e., links connecting Context, Intervention and Outcomes, were inferred. Results: The new model led to satisfaction among patients and GPs. Three central mechanisms were: 1) alignment between the pharmacist and the GP in their understanding of MR work; 2) investment in relational work; and 3) flexibility, allowing the model to fulfill the needs of GPs despite differences in experiences with polypharmacy, working styles, and knowledge of enrolled patients. Conclusion: The new model illustrates how pharmacists can support GPs. New program theory regards the importance of compatible perspectives between pharmacists and GPs on appropriate polypharmacy work, i.e., ‘shared mental models’, the ways GPs can develop their mental models when interacting with pharmacists, and the usefulness of relational work when the models clash.