Background: A non-dispensing pharmacist conducts clinical pharmacy services aimed at
optimizing patients individual pharmacotherapy. Embedding a non-dispensing
pharmacist in primary care practice enables collaboration, probably enhancing patient
care. The degree of integration of non-dispensing pharmacists into multidisciplinary
health care teams varies strongly between settings. The degree of integration may be a
determinant for its success.
Objectives: This study investigates how the degree of integration of a non-dispensing
pharmacist impacts medication related health outcomes in primary care.
Methods: In this literature review we searched two electronic databases and the
reference list of published literature reviews for studies about clinical pharmacy services
performed by non-dispensing pharmacists physically co-located in primary care
practice. We assessed the degree o integration via key dimensions of integration based
on the conceptual framework of Walshe and Smith. We included English language
studies of any design that had a control group or baseline comparison published from
1966 to June 2016. Descriptive statistics were used to correlate the degree of integration
to health outcomes. The analysis was stratified for disease-specific and patient-centered
clinical pharmacy services.
Results: Eighty-nine health outcomes in 60 comparative studies contributed to the
analysis. The accumulated evidence from these studies shows no impact of the degree
of integration of non-dispensing pharmacists on health outcomes. For disease specific
clinical pharmacy services the percentage of improved health outcomes for none, partial
and fully integrated NDPs is respectively 75%, 63% and 59%. For patient-centered
clinical pharmacy services the percentage of improved health outcomes for none, partial
and fully integrated NDPs is respectively 55%, 57% and 70%.
Conclusions: Full integration adds value to patient-centered clinical pharmacy services,
but not to disease-specific clinical pharmacy services. To obtain maximum benefits of
clinical pharmacy services for patients with multiple medications and comorbidities, full
integration of non-dispensing pharmacists should be promoted