Table 4 Five categories included under the outcome domain with GPs’ citations
Categories under outcomes domain | Statement | GP |
|---|---|---|
Evaluation of clinical pharmacists’ recommendations by general practitioners | This about lercanidipine was useful, that if we would titrate the dosing slower, the patient might have not had problems. Its good warning for the next time. | GP 6 |
The advice was to try ezetimibe and I really haven’t tried it yet. So yes, I will try that. | GP 16 | |
It’s interesting … the CP suggested to decrease the number of medicines with introduction of three active substances in one pill … I found the advice very suitable. | GP 3 | |
The patient has diabetic polyneuropathy, which was untreated until now as the patient was not showing or talking about any problems. The CP recommended duloxetine … We will check the symptoms and start duloxetine if needed. | GP 12 | |
I prescribed trazodone; the patient didn’t take it out of fear for adverse reactions. The CP proposed mirtazapine or quetiapine instead … The problem is how to convince the patient … I am willing to prescribe any of the options. | GP 4 | |
The patient will take this report to a pulmonologist. It ‘s theophylline in high doses and roflumilast, which I don‘t really know. The medicines were prescribed by pulmonologist, so we will see what he has to say. | GP 10 | |
For this recommendation we decided the patient will consult with the cardiologist. | GP 8 | |
We didn‘t accept this recommendation as her asthma is under control, she practically never uses salbutamol. Therefore, I don‘t feel its necessary. And I prefer to do only one to two changes in therapy at once. | GP 4 | |
I don’t think it’s reasonable to turn whole therapy around to have one medicine less at this high number of medicines. ... we [GP together with the patient] have decided not to switch … The patient is very sensitive about his medicines … he was not very keen on the proposed switch. | GP 19 | |
Sometimes you accept the recommendation, and it confuses the patient. I had cases when it didn‘t work out. He was fine on previous medication when we changed it was not ok. | GP 20 | |
I prescribed the medicine already and wanted to know if it is appropriate. I got confirmation. | GP 9 | |
The report responds directly to the question. First, second and third line of treatment together with dosing are suggested. Even more, the CP proposed combination for other medicines to be joined in one pill. | GP 9 | |
Perfect. Short, to the point, important thing underlined … | GP 14 | |
Barriers for the implementation of clinical pharmacists’ recommendations | The patient is reluctant to take warfarin from the start, he is actively looking for changes at the skin. And we talked about it several times … but still insists … | GP 11 |
When it comes to the unfortunate zolpidem … there nothing we can do … This is the therapy from which the patient will not back down … | GP 13 | |
Clinical medication review service benefits | Â | Â |
 Assurance of evidence-based pharmacotherapy | Having a lot of medicines means comorbidity, large number of hurt organ systems and therefore it is always good with such large number of medicines to have professional, evidence-based assessment, and recommendations if we can discontinue some of the medicines. | GP 21 |
 Benefits for the patients | It’s a way to get closer to the patients, give them the medicines that suits them and discontinue those, which cause them problems … . | GP 14 |
It was important to decrease the number of daily doses. The patient was taking medicines four times a day and it was decreased to two. | GP 7 | |
The patient was satisfied and was reassured the medication are not causing any harm and are appropriately chosen. | GP 1 | |
It helps them with adherence as they know how to take the medicines, they discuss and side effects … | GP 17 | |
The CP asks them also about OTCs, food supplements, … We usually don’t ask about it and secondly, we don’t know much about these medicines. The CP counsels them about it – what is reasonable and appropriate to use, what is not, if there are any interaction with regular prescription medicines, … | GP 7 | |
 Benefits for the GPs | It means the quality of patient care from pharmacological aspect is higher. It gives us confirmation of our work. | GP 10 |
… for me especially management of patients with multimorbidity. For us, young doctors, these are the biggest challenge to manage … The patients are new to you, with already several prescribed medicines … | GP 16 | |
Even if it’s only medical record review and the CP doesn’t see the patient … I can prescribe the medicines safely. | GP 14 | |
I believe in personal referrals. Sometimes it’s easier just to review records. But when there is conversation with the patient …. more information is gathered. | GP 3 | |
I personally learned a lot and I use the knowledge in everyday practice. | GP 7 | |
It useful because the CP warns us about some things that are maybe not reasonable or recommended, especially in elderly population. | GP 13 | |
Patients are more honest about their medicine taking habits. And about OTCs and food supplements, it‘s new information for us. | GP 15 | |
I heard the last CP’s lecture was a big success. I was unfortunately not there, but colleagues told me it was very good, useful. | GP 8 | |
It happened few times, I detected an issue that the specialist hasn’t and then patients brought them the CMR report, and they implemented recommendations. | GP 10 | |
General practitioners’ satisfaction | I am very, very satisfied. It‘s a precise, concise review. And it’s simple. It just read it and I don‘t have any reasons not to prescribe as its recommended, because it makes it so simple | GP 20 |
Patients’ satisfaction | Patients say great things about it, that she [CP] takes the time for them, she really listens, and they get useful information. | GP 12 |