Pharmacy involvement in formulary development: community pharmacists' views CARMEL M. HUGHES and GERALDINE McFERRAN

A postal survey was carried out in the Eastern health and social services board in Northern Ireland to evaluate the views of community pharmacists (n= 100) on pharmacy involvement in formulary development. There was one mailing, with a response rate of 66 per cent. Most respondents (78.7 per cent) agreed or strongly agreed that pharmacist involvement in formulary development was important. Almost two thirds of responding pharmacists said they would be prepared to approach a G P in relation to such collaborative work and 27 per cent had had previous contact with GPs on the subject. Respondents considered that their input would be particularly useful in improving prescribing, providing cost advice and developing a closer working relationship with GPs. Evaluation of current levels of interprofessional liaison in relation to prescribing issues showed that 33.3 per cent of the pharmacists were already contacted by a G P regularly and 45.4 per cent contacted a G P regularly. Most (80 per cent) rated their working relationship with the G P as useful or very useful. The results suggest that community pharmacists in the Eastern health and social services board are willing to become involved in formulary development, thereby extending the use of practice formularies in general practice and integrating community pharmacy more fully into the primary health care team.

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THE use of formularies in general practice has been advocated as a means of promoting rational and cost-effective prescribing.'.' However, it is also recognised that formulary development is time-consuming and, therefore, may not be feasi- ble for a number of general medical practitioners (GPs). A possible solution would be to involve appropriately trained community pharmacists, as suggested by the Audit Commission report on prescribing in general practice" and the pharma- ceutical care report.'

This would seem particularly pertinent in view of a recent communication from the management executive of the Department of Health and Social Services in Northern Ireland, setting targets for the active use of formularies in general practice in Northern Ireland:" Between 1995/96 and 1997/98, the number of practices actively using a practice prescribing formulary should increase from 50 per cent to 75 per cent. Involving community pharmacists in the formulary developmental pro- cess may go some way tawards attaining these targets .

In a previous study we evaluated the views of a randomly selected group of GPs in the Eastern health and social services board in Northern Ireland.6 Overall, the responding GPs appeared supportive of pharmacy involvement in formu- lary development and the results suggested that almost a quar te r had had some contact with pharmacists on the subject. The GPs felt that the community pharmacist's role in formulary devel-

opment was particularly useful in relation to providing cost advice and in improving prescrib- ing.

However, there is little information on the views of community pharmacists in Northern Ireland on this extended role. Therefore, the aim of the present study was to evaluate the opinions of community pharmacists, via a postal survey, on pharmacy involvement in formulary develop- ment.

Method

A structured questionnaire was sent by mail, without piloting, to 100 randomly selected named pharmacist contractors at registered pharmacy addresses in the Eastern health and social ser- vices board in January, 1995. The addresses had been obtained from the Ulster Chemists' Associa- tion. This board area is the most populous in Northern Ireland and has approximately 220 registered pharmacies. Some questions or state- ments required a yes/no response; others re- quired a graduated response, either to a five- point Likert scale or to a three- or four-point scale.

Results

There was a 66 per cent response rate from the community pharmacists. Of those who respond- ed, 56 per cent (n=37) were proprietor pharma-

Pharmacy Practice Research Group, School of Pharmacy, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL Carmel M. Hughes, PhD, MRPharrnS lecturer in pharmacy Geraldine McFerra t i , final year pharmacy student

Correspondence to: Dr Hughes

Inr J Pharm Prart 1996;4: 153-5

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I Table 1: Community pharmacists’ responses concerning their role in formulary development

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Question Response

Regularly Rarely Never Not completed Number Percentage Number Percentage Number Percentage Number Percentage

22 33.3 31 47 10 15.2 3 4.5

r- How often would the

GP contact you on prescri bi ng-related issues?

contact the GP on prescri bing-related issues?

How often would you 30 45.5 31 47 3 4.5 2 3.0

Question Response Yes No Not completed

Number Percentage Number Percentage Number Percentage How do you see your own role in formulary development:

Useful to improve prescribing? 59 89.4 4 6.1 3 4.5 Useful to discuss treatment options? 51 77.3 8 12.1 7 10.6 Useful in reducing doctor’s workload? 35 53 24 36.4 7 10.6 Useful for cost advice? 59 89.4 5 7.6 2 3.0 Useful to develop a closer working 59 89.4 3 4.5 4 6.1

relationship?

Table 2: Community pharmacists’ responses concerning current contact with GPs on orescribing-related issues

cists and 44 per cent (n=29) were pharmacy managers.

In general terms, 78.7 per cent of respondents (n=52) agreed or strongly agreed that community pharmacist involvement in formulary develop- ment was important, three per cent (n=2) dis- agreed and 18.2 per cent (n=12) neither agreed nor disagreed. When asked if they would ap- proach a G P in relation to such collaborative work, 65.2 per cent (n=43) responded positively and 33.3 per cent (n=22) negatively. Some 13.6 per cent (n=9) had previously contacted a G P in relation to formulary development; a separate 13.6 per cent (n=9) had been contacted by a G P regarding such collaborative work.

The respondents’ views concerning the precise role of the profession in formulary development are summarised in Table 1.

Table 2 indicates the extent of current inter- professional liaison in relation to prescribing issues.

When the pharmacists were asked to rate their doctor/pharmacist working relationship, 80.2 per cent (n=53) viewed the relationship as useful or very useful and 15.1 per cent (n=10) rated it as being of little benefit or non-existent.

Discussion

Formulary development in general practice has been encouraged, but many GPs have been reluc- tant to undertake this additional workload. The assistance of community pharmacists would seem advantageous if only to reduce the workload, and results from the authors’ previous study of the views of GPs from the same health board as this study suggest that the medical profession may be receptive to such assistance: almost 60 per cent of

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the GPs who responded in that study felt tha community pharmacist involvement in formular development was important and 63 per cent saic they would be prepared to approach a pharmacis with a view to such collaborative work. They fel that the community pharmacist’s role was partic ularly useful in terms of providing cost advice anc improving prescribing.6

In the present study, community pharmacist too appeared to be enthusiastic regarding thei role in formulary development. As shown above almost 80 per cent of respondents agreed o strongly agreed that they had a part to play. Onl: 3 per cent disagreed, compared with 7.5 per cen of the G P respondents in the previous stud: disagreeing with such involvement.

Almost two-thirds said they would approach i G P in relation to formulary development, an( over a quarter had previously contacted or beel contacted by a G P regarding such collaborativl work.

The latter results represent two distinct groups there was no overlap between positive response, to the questions about GPs contacting pharma cists and about pharmacists contacting GPs. Thi, finding agrees with that of the previous surve! where almost a quarter of responding GPs ha( had some contact with community pharmacist: over formulary development.

When asked about their precise role in formu lary development, almost 90 per cent of thc pharmacists believed that their input would bc particularly useful in improving prescribing, pro viding cost advice and developing a closer work ing relationship. This again agrees closely with thc findings in the GP survey. Over three-quarters o the pharmacists considered that their input woulc be useful in discussing treatment options, and jusi

154 THE IYTERhATIONAL JOURYAL OF PHARMACY PRACTICE. SEPTEMBER 1996

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Over half felt that it would assist in reducing GPs’ workload.

One third of the pharmacists were already contacted regularly by a G P about prescribing- related issues while about two-thirds were rarely or never contacted. Nearly half already contacted a GP on a regular basis about prescribing-related issues though over half rarely or never did so. Most viewed their working relationship with the G P as useful or very useful; just over 15 per cent rated it as being of little benefit o r non-existent. These results are almost identical to those report- ed for the GPs.

Clearly, the community pharmacists in this study group have demonstrated an interest in formulary development with GPs, mirroring our previous study where GPs appeared receptive to pharmaceutical input.6 In a more wide-ranging survey, Nathan and Sutters7 sought the opinion of community pharmacists and GPs regarding ratio- nal prescribing, formularies and prescribing- related issues.

On the question of providing assistance with formularies, 52 per cent of community pharma- cists in their study felt they would like to become involved, compared with 33 per cent of GPs. Those figures are lower than the values in this study, yet Nathan and Sutters interpreted their results as indicating substantial willingness in both professions to collaborate on formulary development.

Similarly, Bond et a1,8 describing a postal survey seeking the views of GPs on a proposed wider role for pharmacists, reported that 11 per cent of G P respondents had contact with their local community pharmacist to obtain advice on formulary production.

A number of community pharmacist respon- dents in the present investigation expressed con- cern about training needs and remuneration for formulary development. Their concerns about training might be addressed by a formulary levelopment and training package which has now been produced by the Eastern health and social services board. Remuneration may be more diffi- :ult to secure, although anecdotal evidence has suggested that a number of practices, particularly those that are fundholding, may be prepared to pay for such a service.

If the use of general practice formularies is to 3e extended, liaison between GPs and community 3harmacists would seem an effective way of achieving this aim. The results presented in this 3aper suggest that both professions are willing to :ollaborate in such work. This is particularly mcouraging in view of the targets set for active brmulary use in general practice in Northern reland.’ In addition, liaison of this kind inte- ;rates the pharmacy profession more fully into

the primary health care team, a concept which has been discussed in a recent British Medical Journal editorial.”

Marinker and Reilly have also set out the benefits of including pharmacy in primary health care and general practice.“’ It was suggested that primary care pharmacists, based in practices, would be responsil)le for the pharmaceutical care of the practice popidation as well as for formulary management, midication review, prescription query, pharmacokinetic assessment, compliance assessment and clrug counselling.

The emergence of the primary care pharmacist is still some wa? off, h i t the results presented here suggest that commit ni ty pharmacists and general practitioncrs i n tiit. Eastern health and social services Iioa r t l arc prepared to collaborate on foriiiular! tlt.\clopnient, which may lead to fur- thcr iiitCrIirof(’shioiia1 activities and a more inte- gratctl primat-! hralth care system.

References

1. (:onstrnc*ting a Iirac-tire formulary: a learning exerciw. /)rug 7 ’ h ~ r / l i t11 1991 ;29:25-6. 2. Fic.ltl, ,J . l’rac*tic*c* f;irinnlaries. Practitioner

3. A ~)rc~sc~ri l~t ion for itnprovernent: Towards more rational 1ircwriI)iiig i n general practice. Audit Commission rcyiort. 1,ondon: HM Stationery Office, 1994. 4. Pharinacwrtical care: The future for community pharmacy. Keport of thc joint working party on the future role of community pharmaceutical services. Lontfon: Koyal I’harmaceutical Society of Great Britain on liehalf of the Department of Health and the pharmaceutical profession, 1992. 5. Health and Personal Social Services Management Plan 1995/96-1997/98. Department of Health and Social Services, Northern Ireland, Management Executive, 1994. 6. Hughes CM, McFerran G. A survey of GPs’ views on pharmacist involvement in formulary development. Pharm J 1995;255:R38. 7. Nathan A, Sutters CA. A comparison of community pharmacists’ and general practitioners’ opinions on rational prescribing, formularies and other prescribing related issues. J R SOC Health

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