Table 3 Six categories included under the process domain with GPs’ citations
Categories under process domain | Statement | GP |
|---|---|---|
Reasons for referral of patients to clinical pharmacist by general practitioner | The patient came to the nurse for prescription renewal and muttered about taking to many medicines. The nurse proposed the CMR. | GP 3 |
The patient takes a lot of medicines, has kidney insufficiency and is sensitive to medicines changes. So, I wished that we lower the risk in prescribing as much as possible. | GP 9 | |
… patients with many Rx medications and adverse reactions. They present the biggest challenge. | GP 10 | |
… special patients’ groups like kidney insufficiency, liver insufficiency, pregnant women …. We don’t know much about new biological target medicines or patients on chemotherapy... Groups of patients with unusual therapy for a GP office … | GP 9 | |
I think the patient was referred to the CMR via anticoagulation office … It was not done by me … | GP 11 | |
Communication of general practitioner with the patients after clinical medication review | Yes, we were in contact via telephone and email. The patient was not here in person though, which is of course different. | GP 12 |
In this case we will need some more time to explain everything to the patient as she is very attached to her medicines. We didnot explain it by phone, we invited her to come in. | GP 13 | |
We have not yet scheduled the next visit and the things are also not of the serious nature …. So, in few months we will talk about it. | GP 14 | |
Sometime in May [CMR was performed mid-March], when medicines run out. We can’t even make appointments earlier … | GP 10 | |
Patient care based on clinical pharmacist recommendations | The patient has the control visit already scheduled, so we will start with the implementation then. | GP 15 |
We will check cholesterol … He won’t be taking statins for 6 weeks not, so we will see what the starting point will be. And then how much it will be decreased … | GP 16 | |
… if the values will raise three times above the upper reference limit …. We will send the patient to the diabetes clinic prematurely to change the medication … | GP 3 | |
Follow up of patients by a clinical pharmacist | It depends how successful will I be with the implementation. If it will be ok, I don‘t see the need. If it doesn‘t work out, then probably. | GP 10 |
Clinical medication review service performance challenges | It looks like we [GPs] are not interested, however when you have 70 patients a day … | GP 17 |
It’s all about time, to critically assess every patient in front of you and decide if you need to refer him. And then I guess there would be more referrals. | GP 18 | |
We will see … The patient has multiple medicines for this condition, I believe we could discontinue that one …. However, we need time to do that, and we don’t have it … | GP 10 | |
You know, there is a lot of work with this. If you want to refer someone, its additional workload … | GP 19 | |
I believe that when we get used to each other it will be better … we got used to it already [during the pilot project] and then there was the gap and it got out of routine …. | GP 13 | |
Sending medical documentation around is risky, I might need it in between, … | GP 20 | |
The CP was able to talk with this patient … But with many others it is not possible – dementia, decreased cognitive function … they are not able to communicate. | GP 21 | |
Potential improvements of clinical medication review service | When I get the reports, I see how useful they are. And then more time you refer, more time you remember. Because you are satisfied with the feedback information and then you recall referring more times … | GP 17 |
We had the idea for the CP to come during office hours to select patients … but currently the CP is not allowed to do that. | GP 15 | |
We need to be more aware that we have a CP in the house and be reminded more times. | GP 9 | |
… when they will see how good this is … every novelty is at first “phaa” … why would anybody stick around my patient records … but then …. | GP 6 | |
It would be nice if the CP could notify us about changes of medicines at the market … It is done once a month, at the meetings, but sometimes it would be useful to notify us right away by email so that we don’t send patients up and down. | GP 13 | |
To cite and reference more of clinical studies … like she did in this case … | GP 14 | |
It would be nice to personally talk with the CP sometimes … | GP 22 |