Managing costs and access to healthcare in the Netherlands: impact on primary care

Pharmacists in general practice: what do they do? A qualitative case study

BACKGROUND

Pharmacists working in general practice are a relatively new phenomenon in many European countries. Providing insight into what pharmacists do in general practice may support further implementation of general practice-based pharmacist roles and enhance their contribution to health care.

AIM

To explore the tasks performed by pharmacists in general practice in Sweden.

METHOD

A case study was conducted in 7 general practices in Uppsala County, Sweden, where pharmacists were employed. Activities performed by pharmacists were self-reported during March 2021. Participant observations and semi-structured interviews with pharmacists were conducted between October and November 2021. Self-reported activities were categorised and analysed using descriptive statistics. Qualitative data were analysed using conventional content analysis.

RESULTS

In total, 174 activities were self-reported by 8 pharmacists. Two pharmacists were observed for 2 days each, and 6 pharmacists were interviewed. Their main task was conducting medication reviews in older patients with polypharmacy. In addition, they handled a broad variety of drug-related questions and treatment follow-up. Pharmacists described working in a more efficient and needs-based manner over time. They stressed that working at the practice increased their accessibility to and their collaborative work with other healthcare professionals, and enabled them to meet patients face-to-face. Future challenges include defining tasks more clearly, assuming greater responsibility for patient care, and meeting the growing demand for pharmacists in general practice.

CONCLUSION

Pharmacists in general practice in Sweden perform a broad variety of tasks related to identifying, resolving and preventing drug-related problems, mainly in older patients with polypharmacy.

The association of socioeconomic status on treatment strategy in patients with stage I and II breast cancer in the Netherlands

Background

Previous studies have shown that socioeconomic status (SES) influences breast cancer therapy. However, these studies were performed in countries with unequal access to healthcare. Therefore, the aim of this study is to investigate whether SES also contributes to the likelihood of receiving a certain therapy in the Netherlands, a country with supposedly equal access to healthcare.

Materials and methods

From the Netherlands Cancer Registry, 105,287 patients with newly diagnosed stage I or II breast cancer diagnosed between 2011 and 2018 were selected for analysis. SES was calculated from the average incomes of each postal code, which were divided into 10 deciles. Primary outcome was the effect of SES on the likelihood of undergoing surgery and secondary outcome was the effect of SES on the likelihood of the type of surgery. Both outcomes were corrected for patient, tumor, and hospital characteristics and were expressed as odds ratio (OR) with 95% confidence interval (CI).

Results

SES did not affect the likelihood of a breast cancer patient to undergo surgery (OR 1.00 per 10% stratum). In contrast, increased age and higher tumor stage were the most important factors determining whether patients underwent surgery.

Patients with higher SES were less likely to undergo mastectomy (OR 0.98). Additionally, more recently diagnosed patients were less likely to undergo mastectomy (OR 0.93 per year) while patients with higher tumor stage were more likely to undergo mastectomy (OR 3.42).

Conclusion

SES does not affect whether a patient undergoes surgery; however, higher SES increased the likelihood of BCT.