How direct healthcare professional communications are operationalised by general practitioners and community pharmacists in Ireland: a national cross sectional study

Abstract Introduction Direct Healthcare Professional Communications (DHPCs) are safety alerts issued to healthcare professionals to prompt changes in use of specific medicines. However, their effectiveness is variable. A 2025 systematic review of 31 European DHPCs issued between 2008 and 2022 found that only 29% of 103 intended outcomes demonstrated a high impact, while 23% had limited/no measurable effect.1 Consequently, DHPCs often require repetition to reinforce key messages, i.e. despite prescribing restrictions introduced in 2019, fluoroquinolones continued to be used outside approved indications, prompting the issuance of an additional DHPC in June 2023.2 To date, there has been limited research examining use of DHPCs in primary care. Aim To examine how general practitioners (GPs) and community pharmacists (CPs) implement DHPCs in Ireland, explore barriers to DHPC implementation and preferences for receiving medicines safety updates. Methods A national cross-sectional survey of GPs and CPs, developed de-novo in collaboration with the Irish Health Products Regulatory Authority (HPRA), was conducted in June 2024. GPs and CPs were invited to participate via national gatekeepers (Irish College of GPs, Pharmaceutical Society of Ireland). The questionnaire collected data on: 1) GP/community pharmacist demographics (e.g. age); 2) medication safety update experiences, beliefs and perceptions (e.g. medication safety information preference); and 3) practical implementation of DHPCs (e.g. barriers/enablers to implementation). Following piloting, the survey was administered via email using Qualtrics. Data were analysed using R Studio with descriptive statistics presented. Qualitative responses were analysed thematically. Results In total, 277 GPs and 219 CPs completed the survey, response rates of 6% and 8% respectively. Most GPs (n = 227, 82%) and CPs (n = 196, 89%) used DHPCs as their primary source of medicine safety updates. Practice protocols for sharing DPHCs once received differed across the two professional groups. For example, DHPCs were more likely to be disseminated and discussed at a pharmacy practice meeting (n = 64 pharmacists, 29%) compared with GP practice meetings (n = 24 GPs, 9%). Following the 2023 DHPC fluoroquinolone DHPC, 128 GPs (46%) and 160 CPs (61%) reported increased awareness, while 168 GPs (61%) reduced their fluoroquinolone prescribing, and 82 CPs (37%) reported discussing risks with patients during dispensing. More than one-third of GPs (n = 98, 35%) identified time constraints as the most important barrier to DHPC implementation, followed by absence of prescribing notifications on patient electronic health records (EHRs) n = 36 GPs (13%), n = 39 CPs (18%). As a preferred way to support implementation, a total of 257 GPs (93%) and 198 CPs (90%) identified patient EHR prescribing alerts, aligned with DHPC recommendations, integrated at the point of patient care. A total of 230 GPs (83%) and 164 CPs (75%) indicated their willingness to receive remote clinical support (e.g. from a pharmacist/GP) to implement DHPC recommendations. Conclusion This is the first national survey on DHPC implementation in primary care which included two healthcare professional groups. Despite the low response rate, this study extends the literature on DHPCs as to the best of our knowledge no prior studies have examined their operationalisation once received into GP practices or community pharmacies.