A Pharmacist without Sweets. Bending Incentives to Enlarge the Scope of Practice of Pharmacists in Primary Care

To improve patient safety in primary care regulatory agencies aim to enlarge the scope of pharmacists in primary care in the Netherlands.  We started a study to measure the effect upon patient safety of the employment of clinical pharmacists in practices of general practitioners (GPs).  For this study, we had to define the exact position and role of the clinical pharmacist in GP practices. We set two conditions. The first condition was to align the incentives for patient safety with pharmaceutical care. The second condition was to create a stable jurisdiction for the clinical community pharmacist.

The particular position of the clinical pharmacist in primary care in the Netherland is a perfect case to conceptualize incentives and interests as ‘incenterests’. Financial incentives are important features of the position of pharmacists in the community pharmacy. In addition to financial incentives, an uncertain jurisdiction shapes the professional behavior and identity of pharmacists.

To conceptualize the ‘incenterests’ for medication safety, we conducted a literature study, analyzed policy documents and did a pilot study.  In this pilot study, the first author acted as clinical pharmacist in GP practices. The data were analyzed with the agency theory in institutional economics and by sociological theory of new professionalism.

Based upon the analysis we came to the following intervention. From 2014 onwards, we will employ ten clinical pharmacists in GP practices.  As the pharmacists have a fixed income, they have no incentives to dispense medication nor to stop medication. In addition, the clinical pharmacists will become part of the community of GPs as they share the offices and their case notes within the GP practice.