Identifying the Important Outcomes to Measure for Pharmacy-Led, Clinical Services: a Nominal Group Technique Approach

The global population is ageing with over 60s now outnumbering the under 5s; however, this does not translate into a healthier ageing population (1). Within developed countries, use of healthcare services by adults increases with age (2). This demand – coupled with high patient expectations and the movement of service provision from secondary to primary care (3) - has translated into a primary care crisis. Primary care settings (e.g. medical centres, community-based clinics and general practices) report increased demand for their services - for example, within England, between 2010/11 and 2014/15 GP consultations increased by over 15% (3). Meanwhile, the GP and nurse workforce increased by only 4.75% and 2.85% respectively, suggesting an overall increase in workload(3). This is supported through reports of burnout levels within the workforce, especially physicians (4). To reduce the pressure on primary care physicians, a multi-disciplinary approach is being increasingly used in primary care involving the input of nurses (5), healthcare assistants (6), paramedics (7), and pharmacists (8). The role of pharmacists has expanded to offer clinical roles – for example reviewing medication and prescribing (9). Pharmacists are increasingly offering their expertise within a wide range of secondary care environments alongside the wider multi-disciplinary time (e.g. within emergency departments (10); oncology (11); psychiatry (12); paediatrics (13)). The clinical roles of pharmacists are expanding within primary care also, with services delivered across North America, Europe, the Middle East, Asia, South America, and Australia (14, 15) – which are becoming enshrined within national health service funding models (16-18). When integrating pharmacists within primary care, pharmacists are perceived by GPs as offering valuable clinical input, and are considered vital members of the primary care team (8).