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Defining and Enhancing Collaboration between Community Pharmacists and Primary Care Providers to Improve Medication Safety
Abstract
Introduction
Over 4 billion prescriptions are dispensed each year to patients in the United States, with the number of prescriptions continuing to increase. There is a growing recognition of pharmacists’ potential in improving medication safety in community settings, in collaboration with primary care providers (PCPs). However, the nature of collaboration has not been well defined and barriers and strategies are not articulated.
Area covered
For this narrative review published studies were retrieved from PubMed between January 2000 and December 2020. Search terms included: “patient safety,” “medication safety, “collaboration,” “primary care physician,” and “community pharmacy.” Resulting articles were categorized as: defining collaboration, types of collaboration, and barriers and solutions to collaboration.
Expert opinion
It is important to understand the factors within a community pharmacy setting that limit or facilitate community pharmacists’ participation in medication safety activities. Strategies such as medication review are a common form of collaboration. Barriers to collaboration include misconceptions regarding roles, differences in access to clinical information and community pharmacy practice variability. Future recommendations include increasing training and utilization of pharmacists/PCP teams; increasing community pharmacists’ practice in emerging roles; and expanding the community pharmacist role in transitions of care from the hospital to the community.
... Indeed, a meta-analysis showed that a multidisciplinary collaboration as an intervention to reduce medication errors in the primary care setting tended to be effective (estimated reduction of 1% in hospital admissions, 29% in emergency department visits, and 2% in mortality) 21 . Two more recent systematic reviews (2022) reached the same conclusions, specifically on the pharmacist-nurse collaboration in primary care: it improved disease management, prevented adverse drug events, and reduced hospitalizations 22,23 . ...
Background: Medication-related errors represent a public health burden but are mainly preventable. A strategy to reduce medication errors could be pharmacist-nurse collaboration in weekly pillbox preparation. Unfortunately, there is little inventory in the literature on the actual pharmacist-nurse collaboration in weekly pillbox preparation and its added value in the healthcare practice. Objective: To assess the weekly pillbox preparation practices among home care nurses and community pharmacists, their collaboration for this service, and its added value, ultimately aiming to promote patient safety.
Methods: An extensive survey was launched in French-speaking Belgium in 2022. The study occurred across two populations: home care nurses and community pharmacists in French-speaking Belgium. A self-administered questionnaire was developed. Three main outcomes were reported: the pillbox preparation, the medication plan, and the opinion about the pharmacist-nurse collaboration. A descriptive statistical analysis was carried out.
Results: A total of 260 home care nurses and 204 community pharmacists answered the questionnaire. Our survey showed that weekly pillbox preparation was mainly performed by home care nurses (100%) than by community pharmacists (49%) in the primary care of the Belgian health system. There was only sometimes (or even no) remuneration for this service. Most home care nurses
(82.7%) and community pharmacists (57.6%) have already pointed out errors in the medication plan used for the weekly pillbox preparation. The pharmacist-nurse collaboration for the weekly pillbox preparation was rare in Belgium. However, the majority of community pharmacists and home care nurses (more than 90% of both groups) would like to collaborate for this act, with the principal motivation of improving patient safety.
Conclusion: Our survey showed that pharmacist- nurse collaboration in the weekly pillbox preparation was perceived as helpful in primary care with the ultimate goal of patient safety. Further studies are needed to examine the impact of this intervention and if it could be cost-effective.
... Research suggests that clear frameworks, guidelines, and expectations promote clarity, understanding, and accountability within teams, reducing conflicts and improving collaboration [49,50]. Moreover, regular communication and well-defined decision-making processes establish a shared understanding and facilitate smoother team interactions [51]. By incorporating these strategies informed by empirical data, universities can create an environment conducive to effective collaboration, conflict resolution, and positive team dynamics during collaborative tasks among university undergraduate students. ...
This study addresses potential conflicts during collaborative tasks among university undergraduate students and presents strategies to mitigate such conflicts at a university in South Africa. Drawing on the unique context of South Africa, characterised by its rich cultural diversity and historical challenges, Social Identity Theory (SIT) was used to theorise the study within a transformative paradigm, qualitative approach and participatory research design. Ten undergraduate students were sampled and interviewed. Thematic analysis was employed to make sense of the data. The study found that a lack of a culture of open dialogue and clear guidelines and expectations leads to conflict, and the study also found that promoting a culture of open dialogue and establishing clear guidelines and expectations during collaborative projects can help prevent potential conflicts among university undergraduate students during collaborative engagement. The study concludes that promoting a culture of open dialogue and fostering establishing clear guidelines and expectations provide undergraduate students with the tools to manage group conflicts.
Background
Preventable harms from medications are significant threats to patient safety in community settings, especially among ambulatory older adults on multiple prescription medications. Patients may partner with primary care professionals by taking on active roles in decisions, learning the basics of medication self-management, and working with community resources.
Objective
This study aims to assess the impact of a set of patient partnership tools that redesign primary care encounters to encourage and empower patients to make more effective use of those encounters to improve medication safety.
Methods
The study is a nonrandomized, cross-sectional stepped wedge cluster-controlled trial with 1 private family medicine clinic and 2 public safety-net primary care clinics each composing their own cluster. There are 2 intervention sequences with 1 cluster per sequence and 1 control sequence with 1 cluster. Cross-sectional surveys will be taken immediately at the conclusion of visits to the clinics during 6 time periods of 6 weeks each, with a transition period of no data collection during intervention implementation. The number of visits to be surveyed will vary by period and cluster. We plan to recruit patients and professionals for surveys during 405 visits. In the experimental periods, visits will be conducted with two partnership tools and associated clinic process changes: (1) a 1-page visit preparation guide given to relevant patients by clinic staff before seeing the provider, with the intention to improve communication and shared decision-making, and (2) a library of short educational videos that clinic staff encourage patients to watch on medication safety. In the control periods, visits will be conducted with usual care. The primary outcome will be patients’ self-efficacy in medication use. The secondary outcomes are medication-related issues such as duplicate therapies identified by primary care providers and assessment of collaborative work during visits.
Results
The study was funded in September 2019. Data collection started in April 2023 and ended in December 2023. Data was collected for 405 primary care encounters during that period. As of February 15, 2024, initial descriptive statistics were calculated. Full data analysis is expected to be completed and published in the summer of 2024.
Conclusions
This study will assess the impact of patient partnership tools and associated process changes in primary care on medication use self-efficacy and medication-related issues. The study is powered to identify types of patients who may benefit most from patient engagement tools in primary care visits.
Trial Registration
ClinicalTrials.gov NCT05880368; https://clinicaltrials.gov/study/NCT05880368
International Registered Report Identifier (IRRID)
DERR1-10.2196/57878
Background
Ajzen’s theory of planned behavior (TPB) postulates that individuals’ behavioral intention is influenced by their attitudes, subjective norms, and perceived behavioral control. Therefore, it can be used to broaden the understanding of particular behaviors, including healthcare workers’ professional activities.
Methods
In this study, we used TPB as a theoretical framework to evaluate semi-structured interviews with pharmacists and physicians to build an understanding of the interprofessional collaboration between them. Sixteen semi-structured interviews were conducted with pharmacists and eleven with physicians. The sample of participants comprised a diverse group with varying work experience and workplaces. Data were analyzed independently by two researchers following the thematic analysis method using ATLAS.ti software. Data saturation was set in the absence of new issues arising during the interviews.
Results
The content analysis allowed for the determination of six main themes: the relationship between previous experiences and attitudes towards collaboration, pharmacist’s role in collaboration, mutual reluctance toward collaboration, the role of decision- and policy-makers, knowledge and qualifications gaps regarding collaboration, and lack of organizational paths.
Conclusions
Despite both physicians and pharmacists displaying positive attitudes towards collaboration may foster their intention to establish a professional partnership, subjective norms (e.g., the lack of appropriate legal regulations) and perceived behavioral control (physicians’ lack of awareness about pharmacists’ qualifications and the low level of interpersonal skills) might impede the process.
Background:
Healthcare authorities worldwide search for ways to develop integrated care and interprofessional collaboration. In Belgium, Medical-Pharmaceutical Concertation (MPC) was introduced as a format to promote constructive dialogues between GPs and community pharmacists (CPs) with a focus on pharmacotherapy.
Objective:
To evaluate the implementation of MPC from the perspective of healthcare authorities and GPs/CPs.
Methods:
Mixed-methods approach, including semi-structured interviews with stakeholders and service users, observations of MPC meetings and surveys in GPs/CPs. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed inductively.
Results:
The implementation of MPC took a slow start. Parties involved had divergent views on the goals of the MPC: stakeholders focused on measurable results, while service users aimed on improving interprofessional communication. Additionally, service users felt that the lack of local structures hindered consensus building and implementation of agreements in daily practice. Support from professional associations was considered indispensable for the implementation of MPC. In order to organize this efficiently, the establishment of an independent institution, coordinating the MPC initiative, was highly recommended.
Conclusion:
The study confirms that a thorough context assessment prior to implementation of a complex project is needed and that a step-wise approach should be respected to achieve effective interprofessional relationships.
The role of pharmacy in healthcare continues to evolve as pharmacists gain increased clinical responsibilities in the United States, such as the opportunity to prescribe hormonal contraception. Currently, North Carolina (NC) pharmacists do not have this ability. While previous research focused on the perceptions of community pharmacists surrounding this practice, no previous research surveyed all pharmacists in a state. This cross-sectional, web-based survey was distributed to all actively licensed pharmacists residing in the state of NC in November 2018. The primary objective was to determine the likelihood of NC community pharmacists to prescribe hormonal contraception. Secondary outcomes included: evaluation of all respondent support and perceptions of this practice as advocacy occurs on the state organization level and unified support is critical; opinions regarding over-the-counter (OTC) status of contraception; and potential barriers to prescribing. Overall, 83% of community pharmacists were likely to prescribe hormonal contraception. No differences in likelihood to prescribe were detected between geographic settings. Community pharmacists reported that the most common barriers to impact prescribing were added responsibility and liability (69.8%) and time constraints (67.2%). Fewer than 10% of respondents felt that hormonal contraception should be classified as OTC (7.9%). Noncommunity pharmacists were significantly more likely to agree that prescribing hormonal contraception allows pharmacists to practice at a higher level, that increased access to hormonal contraception is an important public health issue, and that rural areas would benefit from pharmacist-prescribed hormonal contraception. Overall, this study found a willingness to prescribe and support from the majority of both community and noncommunity pharmacists. Limitations of the study included a low response rate and potential nonresponse bias. Future research is needed to address solutions to potential barriers and uptake of this practice, if implemented.
Background:
Interprofessional collaboration between pharmacists and physicians in primary care has been linked to improved patient outcomes. How professionals position themselves and each other can shed light upon their relationship, and positioning theory can be used as a tool to better understand intergroup relations.
Objectives:
1) To identify how community pharmacists position themselves, and how they are positioned by general practitioners. 2) To assess how well these positions correspond, how the positions align with a proactive position for the pharmacists, and discuss how the positions could potentially impact collaboration.
Methods:
In this qualitative study, data were collected through six focus group interviews held between June and October 2019, three with pharmacists and three with physicians. The focus group interviews were conducted using a semi-structured interview guide. Data were audio recorded, transcribed verbatim, and analyzed using the Systematic text condensation method. Positioning theory was used as a theoretical framework to identify the positions assigned to community pharmacists by the pharmacists themselves and by the physicians.
Results:
Twelve pharmacists and ten physicians participated. The pharmacists positioned themselves as the "last line of defense", "bridge-builders", "outsiders" - with responsibility, but with a lack of information and authority - and "practical problem solvers". The physicians positioned pharmacists as "a useful checkpoint", "non-clinicians" and "unknown".
Conclusions:
The study revealed both commonalities and disagreements in how community pharmacists position themselves and are positioned by general practitioners. Few of the positions assigned to pharmacists by the physicians support an active role for the pharmacists, while the pharmacists´ positioning of themselves is more diverse. The physicians´ positioning of pharmacists as an unknown group represents a major challenge for collaboration. Increasing the two professions´ knowledge of each other may help produce new positions that are more coordinated, and thus more supportive towards collaboration.
Background:
Collaborative care approaches between general practitioners (GPs) and pharmacists have received international recognition for medication optimization and deprescribing efforts. Although specialist providers have been shown to influence deprescribing, their profession so far remains omitted from collaborative care approaches for medication optimization. Similarly, while explorative studies on role perception and collaboration between GPs and pharmacists grow, interaction with specialists for medication optimization is neglected. Our qualitative study therefore aims to explore GPs', community pharmacists' and specialist providers' role perceptions of deprescribing, and to identify interpersonal as well as structural factors that may influence collaborative medication optimization approaches.
Method:
Seven focus-group discussions with GPs, community pharmacists and community specialists were conducted in Hesse and Lower Saxony, Germany. The topic guide focused on views and experiences with deprescribing with special attention to inter-professional collaboration. We conducted conventional content analysis and conceptualized emerging themes using the Theoretical Domains Framework.
Results:
Twenty-six GPs, four community pharmacists and three community specialists took part in the study. The main themes corresponded to the four domains 'Social/professional role and identity' (1), 'Social influences' (2), 'Reinforcement' (3) and ´Environmental context and resources' (4) which were further described by beliefs statements, that is inductively developed key messages. For (1), GPs emerged as central medication managers while pharmacists and specialists were assigned confined or subordinated tasks in deprescribing. Social influences (2) encompassed patients' trust in GPs as a support, while specialists and pharmacists were believed to threaten GPs' role and deprescribing attempts. Reinforcements (3) negatively affected GPs' and pharmacists' effort in medication optimization by social reprimand and lacking reward. Environmental context (4) impeded deprescribing efforts by deficient reimbursement and resources as well as fragmentation of care, while informational and gate-keeping resources remained underutilized.
Conclusion:
Understanding stakeholders' role perceptions on collaborative deprescribing is a prerequisite for joint approaches to medication management. We found that clear definition and dissemination of roles and responsibilities are premise for avoiding intergroup conflicts. Role performance and collaboration must further be supported by structural factors like adequate reimbursement, resources and a transparent continuity of care.
Little is known about the types of drug information inquiries (DIIs) prescribers caring for older adults ask pharmacists during routine practice. The objective of this research was to analyze the types of DIIs prescribing clinicians of Programs of All-Inclusive Care for the Elderly (PACE) made to clinical pharmacists during routine patient care. This was a retrospective analysis of documented pharmacists’ encounters with PACE prescribers between March through December, 2018. DIIs were classified using a developed taxonomy that describes prescribers’ motivations for consulting with pharmacists and their drug information needs. Prescribers made 414 DIIs during the study period. Medication safety concerns motivated the majority of prescribers’ inquiries (223, 53.9%). Inquiries received frequently involved modifying drug therapy (94, 22.7%), identifying or resolving adverse drug events (75, 18.1%), selecting or adjusting doses (61, 14.7%), selecting new drug therapies (57, 13.8%), and identifying or resolving drug interactions (52, 12.6%). Central nervous system medications (e.g., antidepressants and opioids), were involved in 38.6% (n = 160) of all DIIs. When answering DIIs, pharmacists made 389 recommendations. Start alternative medications (18.0%), start new medications (16.7%), and change doses (12.1%) were the most frequent recommendations rendered. Prescribers implemented at least 79.3% (n = 268) of recommendations based on pharmacy records (n = 338 verifiable recommendations). During clinical practice, PACE prescribers commonly ask pharmacists a variety of DIIs, largely related to medication safety concerns. In response to these DIIs, pharmacists provide medication management recommendations, which are largely implemented by prescribers.
Background
Patients often carry medication lists to mitigate information loss across healthcare settings. We aimed to identify mechanisms by which these lists could be used to support safety, key supporting features, and barriers and facilitators to their use.
Methods
We used a mixed-methods design comprising two focus groups with patients and carers, 16 semistructured interviews with healthcare professionals, 60 semistructured interviews with people carrying medication lists, a quantitative features analysis of tools available for patients to record their medicines and usability testing of four tools. Findings were triangulated using thematic analysis. Distributed cognition for teamwork models were used as sensitising concepts.
Results
We identified a wide range of mechanisms through which carrying medication lists can improve medication safety. These included improving the accuracy of medicines reconciliation, allowing identification of potential drug interactions, facilitating communication about medicines, acting as an aide-mémoire to patients during appointments, allowing patients to check their medicines for errors and reminding patients to take and reorder their medicines. Different tools for recording medicines met different needs. Of 103 tools examined, none met the core needs of all users. A key barrier to use was lack of awareness by patients and carers that healthcare information systems can be fragmented, a key facilitator was encouragement from healthcare professionals.
Conclusion
Our findings suggest that patients and healthcare professionals perceive patient-held medication lists to have a wide variety of benefits. Interventions are needed to raise awareness of the potential role of these lists in enhancing patient safety. Such interventions should empower patients and carers to identify a method that suits them best from a range of options and avoid a ‘one size fits all’ approach.
Community-based pharmacy practice is evolving from a focus on product preparation and dispensing to becoming a health care destination within the four walls of the traditional community-based pharmacy. Furthermore, community-based pharmacy practice is expanding beyond the four walls of the traditional community-based pharmacy to provide care to patients where they need it. Pharmacists involved in this transition are community-based pharmacist practitioners who are primarily involved in leading and advancing team-based patient care services in communities to improve the patient health. This paper will review community-based pharmacy practice innovations and the role of the community-based pharmacist practitioner in the United States.
Data sources:
Not applicable.
Summary:
Since at least the time of Hippocrates, health care providers have recognized their responsibility to protect patients from potential harm resulting from the care they provide. In pharmacy, such harm typically results from a violation of any of the "5 rights" of safe medication use. However, a memorable adage stops short of providing operational guidance to improve medication safety. Specific actionable recommendations are needed to identify changes that, if implemented, would significantly improve the safety of medication delivery and use.
Conclusion:
Most threats to medication safety result from weaknesses or failures in one or more of the key system elements identified by the Institute for Safe Medication Practices. Pharmacists should be advocates for implementing targeted recommendations to strengthen their practice systems and improve medication safety.
Background and purpose
Polypharmacy is becoming increasingly common owing to the ageing population, which can pose problems for patients and society. We investigated the trends in polypharmacy and underlying drug groups among adults in the Netherlands from 1999 to 2014 stratified by age, and compared these with findings from the United States (US).
Methods
We conducted a repeated cross-sectional study using the Dutch IADB.nl prescription database. All patients aged 20 years and older in the period 1999 to 2014 were included. Polypharmacy was defined as the dispensing of five or more chronic drugs at the pharmacological subgroup level. Chi-square tests were applied to calculate the p-value for trends. Changes in prevalences were compared between the Netherlands and the US.
Results
The prevalence of polypharmacy increased from 3.1% to 8.0% (p-value for trend <0.001) over 15 years, and increased in all age groups. The highest rates were observed in patients aged ≥65 years, but the relative increase over time was higher in the younger age groups. Overall, large increases were observed for angiotensin-II inhibitors, statins and proton-pump inhibitors. The relative increase in polypharmacy was larger in the Netherlands than in the US (ratio of polypharmacy prevalence 2.4 versus 1.8). The Netherlands showed larger relative increases for angiotensin-II inhibitors, statins, proton-pump inhibitors, biguanides and smaller relative increases for antidepressants, benzodiazepines and insulins.
Conclusions
Polypharmacy more than doubled from 1999 to 2014, and this increase was not limited to the elderly. The relative increase was larger in the Netherlands compared to the US, which was partly due to larger increases in several guideline-recommended preventive drugs.
The pharmacist may play a relevant role in primary and secondary prevention of cardiovascular diseases, mainly through patient education and counselling, drug safety management, medication review, monitoring and reconciliation, detection and control of specific cardiovascular risk factors (eg, blood pressure, blood glucose, serum lipids) and clinical outcomes. Systematic reviews of randomised controlled and observational studies have documented an improved control of hypertension, dyslipidaemia or diabetes, smoking cessation and reduced hospitalisation in patients with heart failure, following a pharmacist’s intervention. Limited proof for effectiveness is available for humanistic (patient satisfaction, adherence and knowledge) and economic outcomes. A multidisciplinary approach, including medical input plus a pharmacist, specialist nurse or both, and a greater involvement of community rather than hospital pharmacists, seems to represent the most efficient and modern healthcare delivery model. However, further well-designed research is demanded in order to quantitatively and qualitatively evaluate the impact of pharmacist’s interventions on cardiovascular disease and to identify specific areas of impact of collaborative practice. Such research should particularly focus on the demonstration of a sensitivity to community pharmacist’s intervention. Since pharmacy services are easily accessible and widely distributed in the community setting, a maximum benefit should be expected from interventions provided in this context.
Background
Despite numerous evidences for the positive effect of community pharmacists on health care, interprofessional collaboration of pharmacists and general practitioners is very often limited. Though highly trained, pharmacists remain an underutilised resource in primary health care in most western countries. This qualitative study aims at investigating pharmacists’ and general practitioners’ views on barriers to interprofessional collaboration in the German health care system. MethodsA total of 13 narrative in-depth interviews, and two focus group discussions with 12 pharmacists and general practitioners in Mecklenburg-Western Pomerania, a predominantly rural region of North-Eastern Germany, were conducted. The interviews aimed at exploring general practitioners’ and pharmacists’ attitudes, views and experiences of interprofessional collaboration. At a second stage, two focus group discussions were performed. Fieldwork was carried out by a multi-professional team. All interviews and focus group discussions were audio taped and transcribed verbatim. The constant comparative method of analysis from grounded theory was applied to the data. ResultsThere are three main findings: First, mutual trust and appreciation appear to be important factors influencing the quality of interprofessional collaboration. Second, in light of negative personal experiences, pharmacists call for a predefined, clear and straightforward way to communicate with physicians. Third, given the increasing challenge to treat a rising number of elderly patients with chronic conditions, general practitioners desire competent support of experienced pharmacists. Conclusions
On the ground of methodological triangulation the findings of this study go beyond previous investigations and are able to provide specific recommendations for future interprofessional collaboration. First, interventions and initiatives should focus on increasing trust, e.g. by implementing multi-professional local quality circles. Second, governments and health authorities in most countries have been and still are reluctant in advancing political initiatives that bring together physicians and pharmacists. Proactive lobbying and empowerment of pharmacists are extremely important in this context. In addition, future physician and pharmaceutical training curricula should focus on comprehensive pharmacist-physician interaction at early stages within both professional educations and careers. Developing and fostering a culture of continued professional exchange and appreciation is one major challenge of future policy and research.
Older people are often prescribed multiple medicines and have a high prevalence of polypharmacy. Polypharmacy is associated with an increased risk of inappropriate use of medicines and drug-related problems. As experts in pharmacotherapy, pharmacists are well placed to review complex medication regimens and identify causes of drug-related problems and recommend solutions to prevent or resolve them. Involvement in medication review services represents a major philosophical shift and paradigm change in the way pharmacists practice, in that the focus is shifted away from the dispensing of prescription medicines to the provision of a professional service for a patient, in collaboration with their general practitioner (GP). In Australia, there are two established medication review programs: Home Medicines Review (HMR) and Residential Medication Management Review (RMMR). The objectives of this article were to describe the process of government-funded medication review services in Australia and to evaluate the contribution of pharmacists to HMR and RMMR, using evidence-based measures, such as the Drug Burden Index (DBI) and the Medication Appropriateness Index (MAI). This review found that there is good evidence to support the role of pharmacists in delivering medication review services across different settings. Although the positive impact of such services has been demonstrated using a variety of validated measures (DBI, MAI), there remains a need to also evaluate actual clinical outcomes and/or patient-reported outcomes.
The majority of older patients present with complex health needs that often require to be addressed by more than one discipline. Hence, the involvement of physicians, nurses, physiotherapists, occupational therapists, pharmacists and other disciplines, adopting a patient-centred interprofessional approach, is an essential component of successful care. A growing phenomenon in education is interprofessional education (IPE), in which various health professionals learn with, from and about another in order to improve collaboration and the quality of care. This article presents a geriatric medicine literature review on IPE, covering several studies that have examined such education, describing different types of intervention and the involvement of various health professionals. There was no clear evidence that could be drawn from the available literature about best practice and intervention, due to the differences in interventions and the lack of replication studies. In this article, we have also reviewed the theories on which IPE is based and its suitability for application to the discipline of geriatric medicine (e.g. regarding curriculum design, clinical practice, and the optimisation of collaboration between team members). Present evidence supports the assumption that IPE-related general principles are applicable to education in geriatric medicine.
Since 2008, French healthcare reform encourages community pharmacists (CP) to develop collaborative care with other health care providers through new cognitive pharmacy services.
This review is aimed to identify theoretical models that have been developed to understand the physician-CP collaboration (PCPC) and to identify the associated determinants.
English-written abstracts research was conducted on Pubmed/Medline, PsycINFO, Sociological Abstracts, and CINAHL from January 1990 to June 2013. Keywords were based on common terminology of inter-professional relations and community pharmacy.
Of the 1545 single articles identified, the final review was conducted on 16 articles. Four specific models of collaboration centered on PCPC were identified: (i) the Collaborative Working Relationship Model (CWR), (ii) the Conceptual model of GPCP collaboration, (iii) the CP Attitudes towards Collaboration with GPs Model (ATC-P), (iv) the GP Attitudes towards collaboration with CPs (ATC-GP). The analysis of these four PCPC models shows that their respective factors might cover the same concepts, especially for relational and interactional determinants. These key elements are: trust, interdependence, perceptions and expectations about the other HCP, skills, interest for collaborative practice, role definition and communication.
A meta-model for PCPC has been postulated. It can be used for qualitative exploration of PCPC, in a context of implementation of collaborative practice including CPs, in the primary care.
Copyright © 2015 Elsevier Inc. All rights reserved.
Australian community pharmacies offer a range of professional pharmacy services (PPS) which include Home Medicines Review (HMR) and the Diabetes Medication Assistance Service (DMAS). The extent of interaction and collaboration between general practitioners (GPs) and pharmacists in the context of these services is unknown. Therefore, the aim of this study was to investigate (1) the nature and extent of interactions between GPs and community pharmacists and; (2) the factors that influence these interactions in the context of PPS. Individual semi-structured face-to-face and telephone interviews were conducted with a purposive sample of 15 GPs and 15 pharmacists in rural and metropolitan areas of New South Wales, Australia. The results indicated that involvement in PPS resulted in a perceived increase in the level of interactions between the pharmacist and GP. Factors found which may influence collaborative behaviour in PPS include interactional, practitioner and environmental determinants. These factors are in line with what has previously been reported however, facilitators of collaboration in the primary care, PPS context included additional environmental factors such as the presence of rules and protocols, interprofessional continuing education and the availability of adequate remuneration. Attention to these environmental factors as well as the more established interactional and practitioner determinants will improve collaboration in PPS.
Background:
Collaborative working relationships (CWRs) between community pharmacists and physicians may foster the provision of medication therapy management services, disease state management, and other patient care activities; however, pharmacists have expressed difficulty in developing such relationships. Additional work is needed to understand the specific pharmacist-physician exchanges that effectively contribute to the development of CWR. Data from successful pairs of community pharmacists and physicians may provide further insights into these exchange variables and expand research on models of professional collaboration.
Objective:
To describe the professional exchanges that occurred between community pharmacists and physicians engaged in successful CWRs, using a published conceptual model and tool for quantifying the extent of collaboration.
Methods:
A national pool of experts in community pharmacy practice identified community pharmacists engaged in CWRs with physicians. Five pairs of community pharmacists and physician colleagues participated in individual semistructured interviews, and 4 of these pairs completed the Pharmacist-Physician Collaborative Index (PPCI). Main outcome measures include quantitative (ie, scores on the PPCI) and qualitative information about professional exchanges within 3 domains found previously to influence relationship development: relationship initiation, trustworthiness, and role specification.
Results:
On the PPCI, participants scored similarly on trustworthiness; however, physicians scored higher on relationship initiation and role specification. The qualitative interviews revealed that when initiating relationships, it was important for many pharmacists to establish open communication through face-to-face visits with physicians. Furthermore, physicians were able to recognize in these pharmacists a commitment for improved patient care. Trustworthiness was established by pharmacists making consistent contributions to care that improved patient outcomes over time. Open discussions regarding professional roles and an acknowledgment of professional norms (ie, physicians as decision makers) were essential.
Conclusions:
The findings support and extend the literature on pharmacist-physician CWRs by examining the exchange domains of relationship initiation, trustworthiness, and role specification qualitatively and quantitatively among pairs of practitioners. Relationships appeared to develop in a manner consistent with a published model for CWRs, including the pharmacist as relationship initiator, the importance of communication during early stages of the relationship, and an emphasis on high-quality pharmacist contributions.
Patient involvement is essential to maintain accurate and updated medication lists, provide quality care, and decrease potential errors. The purpose of this study was to determine the acceptance of medication lists maintained by patients and if their use affected perceptions of patient and physician responsibility and patients' knowledge of their medical care.
A foldable, wallet-sized medication list card was distributed to a convenience sample of 104 patients>or=40 years of age at an outpatient residency site. They were also given a survey of demographic variables and the Patient Medication Scale, which measures their perceptions of patient responsibility, physician responsibility, and patients' knowledge of their medical care. They were contacted by phone 4 to 11 months later to ascertain if they were using the medication card and the Patient Medication Scale was readministered.
Forty-two of 66 patients contacted after the intervention consented to a full interview. Thirty-eight percent (25 of 66) reported using the card. The patients using the card showed increased scores in perceived patient knowledge and patient responsibility, with no change in their perceptions of physician responsibility. Among the 41 respondents not using the card, approximately half indicated interest in using the card in the future or were using a card of their own.
A significant percentage of patients were willing to use the medication list card. Use of the card also seemed to increase their sense of responsibility and perceived knowledge of their medical care.
Objective:
To describe older adult patients' and care partners' knowledge broker roles during emergency department (ED) visits.
Background:
Older adult patients are vulnerable to communication and coordination challenges during an ED visit, which can be exacerbated by the time and resource constrained ED environment. Yet, as a constant throughout the patient journey, patients and care partners can act as an information conduit, or knowledge broker, between fragmented care systems to attain high-quality, safe care.
Methods:
Participants included 14 older adult patients (≥ 65 years old) and their care partners (e.g., spouse, adult child) who presented to the ED after having experienced a fall. Human factors researchers collected observation data from patients, care partners and clinician interactions during the patient's ED visit. We used an inductive content analysis to determine the role of patients and care partners as knowledge brokers.
Results:
We found that patients and care partners act as knowledge brokers by providing information about diagnostic testing, medications, the patient's health history, and care accommodations at the disposition location. Patients and care partners filled the role of knowledge broker proactively (i.e. offer information) and reactively (i.e. are asked to provide information by clinicians or staff), within-ED work system and across work systems (e.g., between the ED and hospital), and in anticipation of future knowledge brokering.
Conclusion:
Patients and care partners, acting as knowledge brokers, often fill gaps in communication and participate in care coordination that assists in mitigating health care fragmentation.
Importance:
Assessing the scope of acute medication harms to patients should include both therapeutic and nontherapeutic medication use.
Objective:
To describe the characteristics of emergency department (ED) visits for acute harms from both therapeutic and nontherapeutic medication use in the US.
Design, setting, and participants:
Active, nationally representative, public health surveillance based on patient visits to 60 EDs in the US participating in the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance Project from 2017 through 2019.
Exposures:
Medications implicated in ED visits, with visits attributed to medication harms (adverse events) based on the clinicians' diagnoses and supporting data documented in the medical record.
Main outcomes and measures:
Nationally weighted estimates of ED visits and subsequent hospitalizations for medication harms.
Results:
Based on 96 925 cases (mean patient age, 49 years; 55% female), there were an estimated 6.1 (95% CI, 4.8-7.5) ED visits for medication harms per 1000 population annually and 38.6% (95% CI, 35.2%-41.9%) resulted in hospitalization. Population rates of ED visits for medication harms were higher for patients aged 65 years or older than for those younger than 65 years (12.1 vs 5.0 [95% CI, 7.4-16.8 vs 4.1-5.8] per 1000 population). Overall, an estimated 69.1% (95% CI, 63.6%-74.7%) of ED visits for medication harms involved therapeutic medication use, but among patients younger than 45 years, an estimated 52.5% (95% CI, 48.1%-56.8%) of visits for medication harms involved nontherapeutic use. The proportions of ED visits for medication harms involving therapeutic use were lowest for barbiturates (6.3%), benzodiazepines (11.1%), nonopioid analgesics (15.7%), and antihistamines (21.8%). By age group, the most frequent medication types and intents of use associated with ED visits for medication harms were therapeutic use of anticoagulants (4.5 [95% CI, 2.3-6.7] per 1000 population) and diabetes agents (1.8 [95% CI, 1.3-2.3] per 1000 population) for patients aged 65 years and older; therapeutic use of diabetes agents (0.8 [95% CI, 0.5-1.0] per 1000 population) for patients aged 45 to 64 years; nontherapeutic use of benzodiazepines (1.0 [95% CI, 0.7-1.3] per 1000 population) for patients aged 25 to 44 years; and unsupervised medication exposures (2.2 [95% CI, 1.8-2.7] per 1000 population) and therapeutic use of antibiotics (1.4 [95% CI, 1.0-1.8] per 1000 population) for children younger than 5 years.
Conclusions and relevance:
According to data from 60 nationally representative US emergency departments, visits attributed to medication harms in 2017-2019 were frequent, with variation in products and intent of use by age.
Background
Many UK GP practices now employ a practice pharmacist, but little is known about how GPs and pharmacists work together to optimise medications for complex patients with multimorbidity.
Aim
To explore GP and pharmacist perspectives on collaborative working within the context of optimising medications for patients with multimorbidity.
Design and setting
A qualitative analysis of semi-structured interviews with GPs and pharmacists working in the West of England, Northern England, and Scotland.
Method
Thirteen GPs and 10 pharmacists were sampled from practices enrolled in the 3D trial (a complex intervention for people with multimorbidity). Participants’ views on collaborative working were explored with interviews that were audiorecorded, transcribed, and analysed thematically. Saturation of data was achieved with no new insights arising from later interviews.
Results
GPs from surgeries that employed a pharmacist tended to value their expertise more than GPs who had not worked with one. Three key themes were identified: resources and competing priorities; responsibility; and professional boundaries. GPs valued pharmacist recommendations that were perceived to improve patient safety, as opposed to those that were technical and unlikely to benefit the patient. Pharmacists who were not known to GPs felt undervalued and wanted feedback from the GPs about their recommendations, particularly those that were not actioned.
Conclusion
A good working relationship between the GP and pharmacist, where each profession understood the other’s skills and expertise, was key. The importance of face-to-face meetings and feedback should be considered in future studies of interdisciplinary interventions, and by GP practices that employ pharmacists and other allied health professionals.
Background:
Deprescribing, the planned and supervised process of stopping or reducing doses of medications, can reduce the use of harmful or unnecessary medications. However, deprescribing is challenging for patients and prescribers to implement. Community pharmacists have the potential to contribute to deprescribing, but whether they are well positioned to do so effectively remains unclear.
Objectives:
To explore community pharmacists' involvement with deprescribing, and identify strategies for enhancing this involvement.
Methods:
We conducted qualitative telephone interviews with 17 community pharmacists in Ontario, Canada. The Behaviour Change Wheel's COM-B model was used to inform the development of the interview guide. Four investigators coded three transcripts independently to develop the codebook. One investigator coded the remainder and generated themes relating to the first study objective using inductive thematic analysis. Two phases of analysis were then used to satisfy the second study objective: the first without the explicit use of theory, and the second using the Behaviour Change Wheel as a theoretical framework.
Results:
Pharmacists' involvement in deprescribing was affected by: 1) their understanding of which medications should be stopped and by whom, 2) their access to patient information, and 3) competing clinical and business/technical demands of their daily activities. Findings support recommendations for optimizing community pharmacists' involvement in deprescribing by focusing on specific steps within deprescribing, expanding pharmacists' understanding of how to integrate deprescribing into their practices, and defining their deprescribing role with multi-stakeholder engagement.
Conclusions:
This study is the first to connect community pharmacists' real-world deprescribing challenges with theory-informed recommendations for enhancing their contributions to deprescribing. This study also explored the role of theory in pragmatically-oriented qualitative work by analyzing data without the explicit use of theory as the first step to analysis. Findings inform recommendations for enhancing community pharmacists' contributions to deprescribing.
Background:
Electronic prescribing (e-prescribing) technology was introduced as an alternative to handwritten prescriptions allowing health care professionals to send prescriptions directly to pharmacies. While the technology has many advantages, such as improving pharmacy workflow and reducing medication errors, some limitations have been realized.
Objective:
The objective of this study was to examine the frequency, type, and contributing factors of e-prescribing quality-related incidents reported to two national error-reporting databases in the United States.
Methods:
This was a retrospective analysis of voluntarily reports of e-prescribing quality-related incidents. A quantitative and qualitative analysis was conducted of incidents reported between 2011 and 2015 to the Pharmacy Quality Commitment (PQC) and the Pharmacy Provider e-prescribing Experience Reporting Portal (PEER) databases. For the qualitative analysis, events were combined from the PQC and PEER portal and a 10% random sample of events were analyzed.
Results:
A total of 589 events were reported to the PEER Portal. Of these, problems with patient directions were the most frequent incident type (n = 210) of which 10% (n = 21) reached the patient. Quantity selection (n = 158) and drug selection (n = 96) were the next most frequently reported events, 20% of which reached the patient. The PQC system received 550 reports. The most frequent event type reported to this system was incorrect directions (23.3%, n = 128) followed by incorrect prescriber (17%), incorrect drug (15%), and incorrect strength (12%). The most common theme in the qualitative analysis was a perceived increased likelihood of patient receiving incorrect drug therapy due to e-prescribing. Another theme identified included confusion and frustration of pharmacy personnel as result of e-prescription quality-related events.
Conclusion:
The use of qualitative and quantitative incident data revealed that patient directions and quantity selection were the most common quality issues with e-prescribing. In turn, this may increase the likelihood of patients receiving incorrect drug therapy.
Patient safety is becoming increasingly recognised as a top priority for action that requires a collective and coordinated response. The leading cause of harm or injury in health care systems is medication errors. As medicines experts, the pharmacy workforce plays a key role in minimising medication errors and mitigating the global challenge of patient safety. Pharmacists' involvement in ensuring patient safety is crucial. Pharmacists are charged with the responsibility to ensure that when a patient receives and uses a medicine, it will not cause harm or death. The International Pharmaceutical Federation (FIP) recognises the critical role the pharmacy plays in realising global, regional and national patient safety goals; and works with its partners, stakeholders and members around the world to advocate for the role of pharmacy in achieving this global patient safety agenda and to envision a world of safe access to medicines and care.
Effective interprofessional collaboration is critical for sustaining high quality care in the context of the increasing burden on primary healthcare services. Despite this, there is limited understanding of the factors contributing to effective collaboration between general practitioners and community pharmacists. The aim of this systematic review was to identify the factors that impact on interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs). Keywords and synonyms were combined and applied to four databases (EMBASE, CINAHL, SCOPUS, and MEDLINE) to identify articles published between January 2000 to April 2017. Relevant journals and reference lists were also hand‐searched. A total of 37 articles met the eligibility criteria. Factors that posed a challenge to effective interprofessional collaboration were the perceived imbalance in hierarchy and power between the professions and a lack of understanding of each other's skills and knowledge. Experience of collaboration with the other party led to greater understanding of each other's capabilities and potential role in co‐delivering patient care. The physical environment was also identified as important, with co‐location and other resources to facilitate clear and regular communication identified as important facilitators of interprofessional collaboration. The review findings highlight a range of approaches that may positively influence interprofessional collaboration between GPs and CPS such as co‐location, co‐education to understand the professional capabilities of each group, and utilising compatible technologies to facilitate communication between the two professions.
Importance
High rates of inappropriate prescribing persist among older adults in many outpatient settings, increasing the risk of adverse drug events and drug-related hospitalizations.
Objective
To compare the effectiveness of a consumer-targeted, pharmacist-led educational intervention vs usual care on discontinuation of inappropriate medication among community-dwelling older adults.
Design, Setting, and Participants
A cluster randomized trial (D-PRESCRIBE [Developing Pharmacist-Led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly]) that recruited community pharmacies in Quebec, Canada, from February 2014 to September 2017, with follow-up until February 2018, and randomly allocated them to intervention or control groups. Patients included were adults aged 65 years and older who were prescribed 1 of 4 Beers Criteria medications (sedative-hypnotics, first-generation antihistamines, glyburide, or nonsteroidal anti-inflammatory drugs), recruited from 69 community pharmacies. Patients were screened and enrolled before randomization.
Interventions
Pharmacists in the intervention group were encouraged to send patients an educational deprescribing brochure in parallel to sending their physicians an evidence-based pharmaceutical opinion to recommend deprescribing. The pharmacists in the control group provided usual care. Randomization occurred at the pharmacy level, with 34 pharmacies randomized to the intervention group (248 patients) and 35 to the control group (241 patients). Patients, physicians, pharmacists, and evaluators were blinded to outcome assessment.
Main Outcomes and Measures
Discontinuation of prescriptions for inappropriate medication at 6 months, ascertained by pharmacy medication renewal profiles.
Results
Among 489 patients (mean age, 75 years; 66% women), 437 (89%) completed the trial (219 [88%] in the intervention group vs 218 [91%] in the control group). At 6 months, 106 of 248 patients (43%) in the intervention group no longer filled prescriptions for inappropriate medication compared with 29 of 241 (12%) in the control group (risk difference, 31% [95% CI, 23% to 38%]). In the intervention vs control group, discontinuation of inappropriate medication occurred among 63 of 146 sedative-hypnotic drug users (43.2%) vs 14 of 155 (9.0%), respectively (risk difference, 34% [95% CI, 25% to 43%]); 19 of 62 glyburide users (30.6%) vs 8 of 58 (13.8%), respectively (risk difference, 17% [95% CI, 2% to 31%]); and 19 of 33 nonsteroidal anti-inflammatory drug users (57.6%) vs 5 of 23 (21.7%), respectively (risk difference, 35% [95% CI, 10% to 55%]) (P for interaction = .09). Analysis of the antihistamine drug class was not possible because of the small sample size (n = 12). No adverse events requiring hospitalization were reported, although 29 of 77 patients (38%) who attempted to taper sedative-hypnotics reported withdrawal symptoms.
Conclusions and Relevance
Among older adults in Quebec, a pharmacist-led educational intervention compared with usual care resulted in greater discontinuation of prescriptions for inappropriate medication after 6 months. The generalizability of these findings to other settings requires further research.
Trial Registration
ClinicalTrials.gov Identifier: NCT02053194
Background:
Effective communication between prescribers of opioids and community pharmacists can contribute to maximizing appropriate pain management and reducing opioid misuse and diversion. While much of the education and training available on reducing opioid misuse and diversion stresses the importance of interprofessional communication between prescribers and pharmacists, few studies have been explored those communication patterns directly.
Objective:
The objectives of this manuscript are to present and explore key emergent themes from a qualitative study around the nature, frequency, and content of communication between primary care physicians (PCPs) and pharmacists focusing on opioids.
Methods:
Interviews were conducted with 48 PCPs and 60 community pharmacists across four states in the U.S.: Washington, Idaho, Kentucky and Arkansas.
Results:
Convergent results from both samples indicated that the content of communication usually centers on questions of dosing, timing of the prescription, and/or evidence of potential misuse/diversion. When communication was focused on relaying information about a patient and/or clarifying questions around the prescription, it appeared positive for both parties. Results also indicated that close physical proximity between PCPs and dispensing pharmacists contributed to more positive and useful communication, especially when the clinics and pharmacies were part of the same healthcare system. Many pharmacists reported hesitancy in "questioning" a physician's judgement, which appeared related to commonly held beliefs of both pharmacists and physicians about the respective roles of each in providing patient care. Pharmacists reported difficulty in reaching PCPs for discussion, while PCPs reported it was easy to reach pharmacists.
Conclusions:
Physician and pharmacist communication around opioids can be mutually beneficial. When prescribers and pharmacists are co-located, higher levels of trust and teamwork are reported, which in turn seems to be related to more open and positive communication. Additional research is needed to identify interventions to increase mutually-valued communication that improves the quality of decision-making around opioids.
Background:
Hospital discharge poses a significant threat to the continuity of medication therapy and frequently results in drug-related problems post-discharge. Therefore, establishing continuity of care by realizing optimal collaboration between hospital and community pharmacists is of utmost importance.
Objective:
To evaluate the collaboration between hospital and community pharmacists on addressing drug-related problems after hospital discharge.
Methods:
A prospective follow-up study was conducted between November 2013-December 2014 in a general hospital and all affiliated community pharmacies. Adult patients, admitted for ≥48 h to the neurology or pulmonology ward were eligible if they used ≥3 chronic prescription drugs and lived in the community pharmacies' service area. The HomeCoMe intervention program was comprised of medication verification and counseling at admission, medication screening by the hospital pharmacist during admission, outpatient pharmacy discharge consultation and support, and a community pharmacist home visit within one week post-discharge.
Results:
The mean age of the 152 included patients was 67.0 ± 12.6 years and 56.6% were female. A total of 745 DRPs (4.9 ± 2.2 DRPs per patient, range: 0-11) were identified with the need for additional "Education or information" (36.1%) and "Compliance" (16.4%) issues as most common DRP-types. This led to a total of 928 recommendations (6.1 ± 3.0 per patient, range: 1-19) to solve the DRP. The majority of DRPs were identified (83.6%, n = 623) and solved (91.6%, n = 682) by the community pharmacist during the home visit. Furthermore, 52.5% (n = 64) of the DRPs identified during hospitalization were solved during the post-discharge home visit.
Conclusions:
Collaboration between hospital and community pharmacists from hospital admission to readmission to primary care is crucial to establish continuity of care. A post-discharge community pharmacist home visit is a valuable addition to in-hospital transitional care to identify and solve drug-related problems.
Background:
Although the current methods of medication therapy management (MTM) delivery have demonstrably improved therapeutic, safety, economic, and humanistic health outcomes, patient- and prescriber-level barriers persist, limiting its reach and effectiveness.
Objective:
To assess telephonic- and community-based clinical pharmacy services in improving health indicators for rural, underserved patients.
Methods:
In 2014, an established MTM provider created a novel, collaborative pilot program with independent retail and community health center pharmacies to provide comprehensive, telephonic MTM services to rural Arizonans. This pilot program used a combined telephonic- and community-based pharmacist approach in the provision of MTM services for rural, underserved Arizona populations. Adults with diabetes mellitus and/or hypertension, seen by a prescriber or who filled prescriptions at a contracted, rural facility in 2014, were eligible to participate. Initial MTM telephonic consultations were conducted, and recommendations were communicated to patients' prescribers and/or pharmacists. Patients received a follow-up telephone call at standard intervals, depending on risk severity.
Results:
A total of 517 patients participated, and 237 medication-related and 1,102 health promotion interventions were completed. Positive trends were observed in fasting blood glucose, postprandial glucose, and diastolic blood pressure. Broad variation in prescriber acceptance of pharmacist recommendations was observed (27%-60%).
Conclusions:
Study results provide initial evidence to support the efficacy of collaborative efforts in the provision of MTM services for improving health indicators and safety measures while potentially reducing health care disparities. While the results are encouraging, future research is warranted in more diverse populations and settings.
Disclosures:
This work was supported in part by funding from the Centers for Disease Control and Prevention via a multiyear, interagency grant from the Arizona Department of Health Services. The findings and conclusions presented in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention nor the Arizona Department of Health Services. Study concept and design were contributed by M. Johnson, Jastrzab, Hall-Lipsy, Martin, and Warholak. M. Johnson took the lead in data collection, along with K. Johnson, Martin, Jastrzab, and Hall-Lipsy. Data interpretation was performed by Jastrzab, Warholak, and Taylor. The manuscript was written by K. Johnson, M. Johnson, and Jastrzab, along with the other authors, and revised by M. Johnson, Tate, and Taylor, along with Jastrzab, K. Johnson, and Hall-Lipsy. The data from this manuscript were previously presented in poster and podium format by Jastrzab and Johnson at the American Public Health Annual Meeting; Chicago, Illinois; October 31-November 4, 2015.
Objectives:
Many pharmacists are actively enhancing their role in the delivery of health care by offering a variety of pharmacist-led clinical services. The delivery of these services within community pharmacies can contribute to overcoming the cost and accessibility challenges currently facing U.S. health care, especially when pharmacist-physician collaborative efforts are utilized. The study purpose was to identify general and family practice physicians' awareness of pharmacists' delivery of clinical services, uncover their perceived barriers to collaboration with community pharmacists, and collect their input on how to overcome such barriers in order to better understand how pharmacist-led clinical services can be integrated, improved and more widely utilized as a healthcare delivery mechanism.
Methods:
Semi-structured interviews were performed at the physicians' place of practice to assess (1) family practice and internal medicine physicians' knowledge of pharmacists' education, clinical training, and role in the healthcare team; (2) their perceptions and barriers towards pharmacist-delivered clinical services and physician-pharmacist collaboration; and (3) their recommendations to improve physician-pharmacist collaboration. The data were analysed qualitatively to identify and categorize themes.
Key findings:
Thirteen physicians were interviewed. While nearly all physicians were aware of pharmacists' level of education, most were not aware of the level of clinical training pharmacists receive. Only half of the physicians were able to provide a definition or example of collaborative practice agreements, although most recognized value and benefit when the definition and examples were provided to them. The commonly perceived barriers for collaboration were concern over loss of communication, hesitancy to relinquish control and lack of confidence in pharmacists' clinical judgement.
Conclusion:
The study results emphasize the need to develop strategies to improve collaborative relationships between physicians and pharmacists. To encourage collaboration, pharmacists must take a proactive approach to increasing awareness of their clinical knowledge and training, the benefits and value of collaborative practice and the opportunities for it.
Background While collaboration between community pharmacists (CPs) and general practitioners (GPs) is essential to provide comprehensive patient care, their communication often is scarce and hampered by multiple barriers. Objective We aimed to assess both professions’ perceptions of interprofessional communication with regard to content and methods of communication as a basis to subsequently develop best-practice recommendations for information exchange. Setting Ambulatory care setting in Germany. Method CPs and GPs shared their experience in focus groups and in-depth interviews which were conducted using a semi-structured interview guideline. Transcribed recordings were assessed using qualitative content analysis according to Mayring. Main outcome measure Specification of existing barriers, CPs’/GPs’ general perceptions of interprofessional communication and similarities and differences regarding prioritization of specific information items and how to best communicate with each other. Results Four focus groups and fourteen interviews were conducted. Seven internal (e.g. professions were not personally known to one another) and nine external barriers (e.g. mutual accessibility) were identified. Ten organizational, eight medication-related, and four patient-related information items were identified requiring interprofessional communication. Their relevance varied between the professions, e.g. CPs rated organizational issues higher than GPs. Both professions indicated communication via phone to be the most frequently used method of communication. Conclusion CPs and GPs opinions often differ. However, communication between CPs and GPs is perceived as crucial suggesting that a future concept has to offer standardized recommendations, while leaving CPs and GPs room to adjust it to their individual needs.
Deprescribing can be defined as the process of withdrawal or dose reduction of medications which are considered inappropriate in an individual. The aim of this narrative review is to provide an overview of "deprescribing"; firstly discussing the potential benefits and harms followed by the barriers to and enablers of deprescribing. We also provide practical recommendations to recognise opportunities and strategies for deprescribing in practice. Studies focused on minimizing polypharmacy indicate that deprescribing may be associated with potential benefits including resolution of adverse drug reactions, improved quality of life and medication adherence and a reduction in drug costs. While the data on the benefits is inconsistent, deprescribing appears to be safe. There are, however, potential harms including return of medical conditions or symptoms and adverse drug withdrawal reactions which emphasise the need for the process to be supervised and monitored by a health care professional. Taking action on deprescribing can be facilitated by knowledge of potential barriers, implementing a deprescribing process (utilising developed tools and resources) and identifying opportunities for deprescribing through engaging with patients and caregivers and other health care professionals and considering deprescribing in a variety of populations. Important areas for future research include the suitability of deprescribing of certain medications in specific populations, how to implement deprescribing processes into clinical care in a feasible and cost effective manner and how to engage consumers throughout the process to achieve positive health and quality of life outcomes.
Importance
The Patient Protection and Affordable Care Act of 2010 brought attention to adverse drug events in national patient safety efforts. Updated, detailed, nationally representative data describing adverse drug events can help focus these efforts.
Objective
To describe the characteristics of emergency department (ED) visits for adverse drug events in the United States in 2013-2014 and describe changes in ED visits for adverse drug events since 2005-2006.
Design, Setting, and Participants
Active, nationally representative, public health surveillance in 58 EDs located in the United States and participating in the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project.
Exposures
Drugs implicated in ED visits.
Main Outcomes and Measures
National weighted estimates of ED visits and subsequent hospitalizations for adverse drug events.
Results
Based on data from 42 585 cases, an estimated 4.0 (95% CI, 3.1-5.0) ED visits for adverse drug events occurred per 1000 individuals annually in 2013 and 2014 and 27.3% (95% CI, 22.2%-32.4%) of ED visits for adverse drug events resulted in hospitalization. An estimated 34.5% (95% CI, 30.3%-38.8%) of ED visits for adverse drug events occurred among adults aged 65 years or older in 2013-2014 compared with an estimated 25.6% (95% CI, 21.1%-30.0%) in 2005-2006; older adults experienced the highest hospitalization rates (43.6%; 95% CI, 36.6%-50.5%). Anticoagulants, antibiotics, and diabetes agents were implicated in an estimated 46.9% (95% CI, 44.2%-49.7%) of ED visits for adverse drug events, which included clinically significant adverse events, such as hemorrhage (anticoagulants), moderate to severe allergic reactions (antibiotics), and hypoglycemia with moderate to severe neurological effects (diabetes agents). Since 2005-2006, the proportions of ED visits for adverse drug events from anticoagulants and diabetes agents have increased, whereas the proportion from antibiotics has decreased. Among children aged 5 years or younger, antibiotics were the most common drug class implicated (56.4%; 95% CI, 51.8%-61.0%). Among children and adolescents aged 6 to 19 years, antibiotics also were the most common drug class implicated (31.8%; 95% CI, 28.7%-34.9%) in ED visits for adverse drug events, followed by antipsychotics (4.5%; 95% CI, 3.3%-5.6%). Among older adults (aged ≥65 years), 3 drug classes (anticoagulants, diabetes agents, and opioid analgesics) were implicated in an estimated 59.9% (95% CI, 56.8%-62.9%) of ED visits for adverse drug events; 4 anticoagulants (warfarin, rivaroxaban, dabigatran, and enoxaparin) and 5 diabetes agents (insulin and 4 oral agents) were among the 15 most common drugs implicated. Medications to always avoid in older adults according to Beers criteria were implicated in 1.8% (95% CI, 1.5%-2.1%) of ED visits for adverse drug events.
Conclusions and Relevance
The prevalence of emergency department visits for adverse drug events in the United States was estimated to be 4 per 1000 individuals in 2013 and 2014. The most common drug classes implicated were anticoagulants, antibiotics, diabetes agents, and opioid analgesics.
Background:
Electronic prescribing (ERx) is the ability for prescriber to send a digital prescription directly to a pharmacist through a dedicated secure network. A number of federally funded incentives such as the health information technology for economic and clinical health (HITECH) and Meaningful Use standards have led to ERx implementation. ERx is an integral part of primary care practice and today most community pharmacies are enabled to accept e-prescriptions. Little is known about the experience of rural pharmacists, primary care providers and patients regarding e-prescribing. This paper reports on the results of ERx from their perspectives. The findings are a portion of a larger qualitative descriptive study focused on the meaning of Meaningful Use in remote rural communities. One remote rural community in the Pacific Northwest was used for this research endeavor.
Objectives:
Explore understandings of e-prescribing from both pharmacist and primary care provider perspective. Explore patients' understandings and experiences of e-prescribing.
Methods:
The conceptual model for this research was the Ecological Transactional Model. This model informed the research design, interview questions and analysis. A qualitative descriptive methodology - focused ethnography was used for this study. Six key informant interviews, 14 patient interviews and 15 hours of participant observation provided the data. Data analysis occurred collectively between a social pharmacy researcher, a primary care nurse practitioner-researcher and pharmacy graduate students. The research qualitatively identified contextual understandings and dimensions of ERx in this setting.
Results:
Based on a focused ethnographic methodology, contextual understandings of rurality and role identity, both pharmacist and primary care provider, were explored. Perspectives on ERx of patients, clinic manager and RN staff were also elicited. Three dimensions of ERx were identified - technological, structural and communication.
Discussion:
The structural, technological and communication dimensions are essential in understanding e-prescribing across settings and addressing digital divides in our health care system. Implications for interprofessional pharmacy education were addressed. Understanding the rural context and the need for role adaptability has implications for health care policy. Additional research is needed on the role of the rural pharmacist and how best to interact with primary care providers and patients.
To explore barriers and facilitators to recovery from e-prescribing errors in community pharmacies and to explore practical solutions for work system redesign to ensure successful recovery from errors.
Cross-sectional qualitative design using direct observations, interviews, and focus groups.
Five community pharmacies in Wisconsin.
13 pharmacists and 14 pharmacy technicians.
Observational field notes and transcribed interviews and focus groups were subjected to thematic analysis guided by the Systems Engineering Initiative for Patient Safety (SEIPS) work system and patient safety model.
Barriers and facilitators to recovering from e-prescription errors in community pharmacies.
Organizational factors, such as communication, training, teamwork, and staffing levels, play an important role in recovering from e-prescription errors. Other factors that could positively or negatively affect recovery of e-prescription errors include level of experience, knowledge of the pharmacy personnel, availability or usability of tools and technology, interruptions and time pressure when performing tasks, and noise in the physical environment.
The SEIPS model sheds light on key factors that may influence recovery from e-prescribing errors in pharmacies, including the environment, teamwork, communication, technology, tasks, and other organizational variables. To be successful in recovering from e-prescribing errors, pharmacies must provide the appropriate working conditions that support recovery from errors.
Abstract According to the theory of reasoned action (TRA), collaboration is only possible when it is perceived as useful by the participants involved. This paper describes a qualitative study using semi-structured interviews to explore the preceived usefulness of general practitioner (GPs)-community pharmacists (CPs)' collaboration from these professionals' perspectives based in two Spanish regions. Thirty-seven interviews were conducted with GPs and CPs with and without previous experience of collaborating with the other groups of professionals. Analysis of the data indicated that the GPs and CPs considered that collaboration between practitioners and pharmacists to have different forms of usefulness, ranging from positive to negative perceptions of usefulness. Negative and neutral opinions (collaboration generates conflict and/or is not benefitial) could prevent practitioners from initiating collaboration with the other group of professionals, which is explained by the TRA. These perceptions were only found among those participants without experience in collaboration. When collaboration was perceived as advantageous, it could be beneficial on three levels: health system (i.e. provision of integrated care, increased efficiency of the system), GPs and CPs (i.e. increased job satisfaction and patient loyalty) and patients (i.e. improved patient safety). Although GPs and CPs with experience identified benefits using a range of examples, GPs and CPs who had never collaborated also believed that if collaboration was undertaken there would be benefits for the health system, patients and health professionals. These results should be considered when developing strategies to encourage and improve the implementation of collaborative working relationships between GPs and pharmacists in primary care.
Objective
To elicit and describe mutually agreed upon common problems and subsequent solutions resulting from a facilitated face-to-face meeting between pharmacists and physicians.
Design
Descriptive, exploratory, nonexperimental study.
Setting
Wisconsin from October to December 2011.
Participants
Physicians and community pharmacists.
Intervention
Face-to-face semistructured interviews with pharmacists and physicians from the same community, informed by previous individual interviews.
Main outcome measures
Methods to enhance collaboration and barriers to implementing collaboration between pharmacists and physicians.
Results
Physicians and pharmacists generated ideas in which collaboration could improve patient care, including controlled substance monitoring, medication adherence, collaborative practice agreements for point-of-service issues, and a mechanism for urgent communication. Methods on how to collaborate on these issues also were discussed.
Conclusion
Bringing physicians and pharmacists together for a face-to-face interaction that was informed by information gained in previous individual interviews successfully stimulated conversation on ways in which each profession could help the other provide optimal patient care. This interaction appeared to dispel assumptions and build trust. The results of this project may provide pharmacists with the confidence to reach out to their physician colleagues.
Integration of pharmacists into primary care general practice clinics has the potential to improve interdisciplinary teamwork and patient care; however this practice is not widespread.
The aim of this study was to review the effectiveness of clinical pharmacist services delivered in primary care general practice clinics.
A systematic review of English language randomized controlled trials cited in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and International Pharmaceutical Abstracts was conducted. Studies were included if pharmacists had a regular and ongoing relationship with the clinic; delivered an intervention aimed at optimizing prescribing for, and/or medication use by, clinic patients; and were physically present within the clinic for all or part of the intervention, or for communication with staff. The search generated 1484 articles. After removal of duplicates and screening of titles and abstracts against inclusion criteria, 131 articles remained. A total of 38 studies were included in the review and assessed for quality. Seventeen studies had common endpoints (blood pressure, glycosylated hemoglobin, cholesterol and/or Framingham risk score) and were included in meta-analyses.
Twenty-nine of the 38 studies recruited patients with specific medical conditions, most commonly cardiovascular disease (15 studies) and/or diabetes (9 studies). The remaining 9 studies recruited patients at general risk of medication misadventure. Pharmacist interventions usually involved medication review (86.8%), with or without other activities delivered collaboratively with the general practitioner (family physician). Positive effects on primary outcomes related to medication use or clinical outcomes were reported in 19 studies, mixed effects in six studies, and no effect in 13 studies. The results of meta-analyses favored the pharmacist intervention, with significant improvements in blood pressure, glycosylated hemoglobin, cholesterol and Framingham risk score in intervention patients compared to control patients.
Pharmacists co-located in general practice clinics delivered a range of interventions, with favorable results in various areas of chronic disease management and quality use of medicines.
As defined by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, medication therapy management programs (MTMPs) must be designed to decrease adverse drug events and improve patient outcomes by promoting appropriate medication use. WellPoint Inc. contracted with the pharmacist-run University of Arizona College of Pharmacy Medication Management Center (UA MMC) to provide a pilot telephone-based MTMP to approximately 5,000 high-risk beneficiaries from among its nearly 2 million Medicare prescription drug plan (PDP) beneficiaries. Eligibility for the program was determined by a minimum of 2 of 6 chronic diseases (dyslipidemia, cardiovascular disease, depression, diabetes mellitus, congestive heart failure, and chronic obstructive pulmonary disease; at least 1 of the latter 2 diseases must be present), at least 3 Part-D covered medications, and greater than $4,000 per year in predicted drug spending. In addition to these criteria, WellPoint Inc. used the Johns Hopkins adjusted clinical groups (ACG) predictive model to identify the high-risk beneficiaries to be enrolled in the program. Medication therapy reviews were conducted for these patients. If any medication-related problems (MRPs) were identified, the patient's prescribers were contacted via a fax communication with recommendation(s) to resolve these MRPs. The UA MMC fax interventions were categorized as cost saving, guideline adherence, or safety concerns.
To (a) determine prescriber responses to pharmacist-initiated recommendations in an MTMP for the 3 intervention categories, (b) compare prescriber responses between intervention categories, and (c) compare prescriber response by prescriber type (primary care physician [PCP] vs. specialist) within each intervention category.
A retrospective analysis of pharmacist-initiated interventions from August through December 2008 was performed using data collected from the UA MMC database. Data were collected on intervention category (cost saving, guideline adherence, or safety concerns), and responses of prescribers were recorded as either approval or decline (no response was considered decline). Prescriber specialty was identified from searching records of state medical boards. Logistic regression analyses with the robust variance option to adjust for correlation within prescribers were conducted to compare prescriber approval rates between and within intervention categories. Significance was assessed at alpha 0.05.
Of 4,967 Medicare Part D beneficiaries determined to be MTMP-eligible, 4,277 beneficiaries (86.1%) were available for assessment (400 declined, 186 disenrolled, and 104 were deceased). Pharmacists initiated 1,548 valid medication recommendations (i.e., recommendations were excluded for deceased patients, incorrect prescribers, and where prescriber specialty was not identified). These recommendations for 1,174 beneficiaries (27.5% of those available) were faxed to prescribers requesting approval. Mean (SD) age for beneficiaries having recommendations was 72.9 (9.4) years, and the majority (57.6%) was female. By category of recommendation, 58.3% (n=902) were guideline adherence, 33.3% (n=515) were cost saving, and 8.5% (n=131) were safety concerns. Prescriber approval rates were 47.2% overall (n =731/1,548), 41.4% (n=373/902) for guideline adherence, 58.3% (n=300/515) for cost savings, and 44.3% (n=58/131) for safety concerns; 817 recommendations were not approved by prescribers (n= 255 [16.5%] denials and 562 no response [36.3%]). Prescriber approval was significantly higher for cost-saving interventions compared with guideline adherence interventions (odds ratio [OR]=1.98, 95% CI=1.56-2.51, P< 0.001) and compared with safety interventions (OR=1.76, 95% CI=1.19, 2.59, P=0.004); there was no significant difference in the prescriber approval rates for the interventions for safety versus guideline adherence. The overall approval rate was higher for PCPs (49.8%, n=525/1,054) versus specialists (41.7%, n=206/494; OR=1.39, 95% CI=1.08-1.78, P=0.011) and for the category for guideline adherence interventions (44.0% for PCPs vs. 35.9% for specialists; OR =1.40, 95% CI=1.01-1.95, P=0.044), but not for the other 2 intervention categories.
Prescriber approval rates for pharmacist recommendations for drug therapy changes for MTMP beneficiaries were approximately 47% overall and higher for recommendations that involved cost savings compared with recommendations for safety concerns or guideline adherence. Compared with specialists, PCPs had higher approval rates for pharmacist recommendations overall and for the intervention category guideline adherence.
To estimate the incidence of adverse drug events (ADEs) associated with health care visits among U.S. adults across all ambulatory settings.
We analyzed data from two nationally representative probability sample surveys: the National Ambulatory Medical Care Survey and the National Hospital and Ambulatory Medical Care Survey. From 2005 to 2007, the presence of an ADE was specifically defined, requested, and recorded in these surveys.
Secondary data analysis.
An estimated 13.5 million ADE-related visits occurred between 2005 and 2007 (0.5 percent of all visits), the large majority (72 percent) occurring in outpatient practice settings, and the remaining in emergency departments. Older patients (age ≥65 years) had the highest age-specific ADE rate, 3.8 ADEs per 10,000 persons per year. In adjusted analyses of outpatient visits, there was an increased odds of an ADE-related visit with increased medication burden (odds ratio [OR] for six to eight medications compared with no medications, OR 3.83 [2.20, 6.65]), and increased odds of ADEs associated with primary care visits compared with specialty visits (OR 2.22 [1.70, 2.89]).
Approximately 4.5 million ambulatory visits related to ADEs occur each year, the majority of these in outpatient office practices. A greater focus on ADE prevention and detection is warranted among patients receiving multiple medications in primary care practices.
Empirical evidence suggests that pharmacist-physician collaboration can improve patients' clinical outcomes; however, such collaboration occurs relatively infrequently in the community setting. There has been little research on physicians' perspectives of such collaboration.
To ascertain Ontario family physician readiness to collaborate with community pharmacists on drug therapy management.
The survey instrument was based on the transtheoretical model of behavior change. It enquired about 3 physician behaviors that represented low-, mid-, and high-level collaboration with pharmacists. The survey was distributed by fax or mail to a random sample of 848 Ontario family physicians and general practitioners, stratified by practice location (urban/rural).
The response rate was 36%. Most respondents reported conversing with community pharmacists about a patient's drug therapy management 5 or fewer times per week. Eighty-four percent reported that they regularly took community pharmacists' phone calls, whereas 78% reported that they sometimes sought pharmacists' recommendations regarding their patients' drug therapy. Twenty-eight percent reported that they sometimes referred their patients to community pharmacists for medication reviews, with 44% unaware of such a service. There were no differences in physician readiness to engage in any of the 3 collaborative behaviors in urban versus rural settings. More accurate patient medication lists were perceived as the main advantage (pro) of collaborating with community pharmacists and pharmacists' lack of patient information as the main disadvantage (con). Collectively, perceived pros of collaboration were positive predictors of physician readiness to collaborate on all 3 behaviors, whereas perceived cons were negative predictors for the low- and mid-level behaviors. Female physicians were more likely than males to seek pharmacists' recommendations, whereas more experienced physicians were more likely to refer patients to pharmacists for medication reviews.
Overall, Ontario physicians were more engaged in the low- and mid-level collaboration with community pharmacists with respect to drug therapy management. The strongest predictor of physician readiness to collaborate was perceived advantages of collaboration.
Collaboration between pharmacists and physicians in ambulatory care clinics has been shown to improve patient outcomes. Although collaborative working relationships (CWRs) between community pharmacists and physicians have been studied, the beliefs and attitudes of physicians toward collaborating with pharmacists in this setting have yet to be described. The Theory of Reasoned Action provides a model for studying collaborative behavior. Beliefs were defined in terms of the value and expected outcomes associated with collaborating with community pharmacists.
The purpose of this study was to describe the beliefs, attitudes, and intentions of office-based physicians toward collaborating with community pharmacists to help patients manage their medications.
A cross-sectional study of Michigan office-based physicians was conducted. A total of 1109 internists, pulmonologists, endocrinologists, and cardiologists were surveyed. CWR measures, beliefs, attitudes, and intentions to collaborate were measured using a mailed survey. Regression analysis identified beliefs relevant to intentions to collaborate.
There were 332 usable surveys returned (30% response rate). Overall, physicians' beliefs and attitudes toward collaborating with community pharmacists were moderately strong. Physicians' beliefs that collaborating with a community pharmacist would result in improved medication adherence was the strongest predictor of attitude toward collaboration. The belief that collaboration with a pharmacist would result in improved prescribing was another significant predictor. The results also found attitude toward collaboration significantly predicted intention to collaborate.
Physicians' beliefs and attitudes play an important role in their intentions to collaborate with community pharmacists. The findings suggest a strategy that involves collaboration to improve medication adherence may be most effective.
One approach postulated to improve the provision of health care is effective utilization of team-based care including pharmacists.
The objective of this study was to conduct a comprehensive systematic review with focused meta-analyses to examine the effects of pharmacist-provided direct patient care on therapeutic, safety, and humanistic outcomes.
The following databases were searched from inception to January 2009: NLM PubMed; Ovid/MEDLINE; ABI/INFORM; Health Business Fulltext Elite; Academic Search Complete; International Pharmaceutical Abstracts; PsycINFO; Cochrane Database of Systematic Reviews; National Guideline Clearinghouse; Database of Abstracts of Reviews of Effects; ClinicalTrials.gov; LexisNexis Academic Universe; and Google Scholar. Studies selected included those reporting pharmacist-provided care, comparison groups, and patient-related outcomes. Of these, 56,573 citations were considered. Data were extracted by multidisciplinary study review teams. Variables examined included study characteristics, pharmacists' interventions/services, patient characteristics, and study outcomes. Data for meta-analyses were extracted from randomized controlled trials meeting meta-analysis criteria.
A total of 298 studies were included. Favorable results were found in therapeutic and safety outcomes, and meta-analyses conducted for hemoglobin A1c, LDL cholesterol, blood pressure, and adverse drug events were significant (P < 0.05), favoring pharmacists' direct patient care over comparative services. Results for humanistic outcomes were favorable with variability. Medication adherence, patient knowledge, and quality of life-general health meta-analyses were significant (P < 0.05), favoring pharmacists' direct patient care.
Pharmacist-provided direct patient care has favorable effects across various patient outcomes, health care settings, and disease states. Incorporating pharmacists as health care team members in direct patient care is a viable solution to help improve US health care.
Background:
Poor interprofessional collaboration (IPC) can negatively affect the delivery of health services and patient care. Interventions that address IPC problems have the potential to improve professional practice and healthcare outcomes.
Objectives:
To assess the impact of practice-based interventions designed to change IPC, compared to no intervention or to an alternate intervention, on one or more of the following primary outcomes: patient satisfaction and/or the effectiveness and efficiency of the health care provided. Secondary outcomes include the degree of IPC achieved.
Search strategy:
We searched the Cochrane Effective Practice and Organisation of Care Group Specialised Register (2000-2007), MEDLINE (1950-2007) and CINAHL (1982-2007). We also handsearched the Journal of Interprofessional Care (1999 to 2007) and reference lists of the five included studies.
Selection criteria:
Randomised controlled trials of practice-based IPC interventions that reported changes in objectively-measured or self-reported (by use of a validated instrument) patient/client outcomes and/or health status outcomes and/or healthcare process outcomes and/or measures of IPC.
Data collection and analysis:
At least two of the three reviewers independently assessed the eligibility of each potentially relevant study. One author extracted data from and assessed risk of bias of included studies, consulting with the other authors when necessary. A meta-analysis of study outcomes was not possible given the small number of included studies and their heterogeneity in relation to clinical settings, interventions and outcome measures. Consequently, we summarised the study data and presented the results in a narrative format.
Main results:
Five studies met the inclusion criteria; two studies examined interprofessional rounds, two studies examined interprofessional meetings, and one study examined externally facilitated interprofessional audit. One study on daily interdisciplinary rounds in inpatient medical wards at an acute care hospital showed a positive impact on length of stay and total charges, but another study on daily interdisciplinary rounds in a community hospital telemetry ward found no impact on length of stay. Monthly multidisciplinary team meetings improved prescribing of psychotropic drugs in nursing homes. Videoconferencing compared to audioconferencing multidisciplinary case conferences showed mixed results; there was a decreased number of case conferences per patient and shorter length of treatment, but no differences in occasions of service or the length of the conference. There was also no difference between the groups in the number of communications between health professionals recorded in the notes. Multidisciplinary meetings with an external facilitator, who used strategies to encourage collaborative working, was associated with increased audit activity and reported improvements to care.
Authors' conclusions:
In this updated review, we found five studies (four new studies) that met the inclusion criteria. The review suggests that practice-based IPC interventions can improve healthcare processes and outcomes, but due to the limitations in terms of the small number of studies, sample sizes, problems with conceptualising and measuring collaboration, and heterogeneity of interventions and settings, it is difficult to draw generalisable inferences about the key elements of IPC and its effectiveness. More rigorous, cluster randomised studies with an explicit focus on IPC and its measurement, are needed to provide better evidence of the impact of practice-based IPC interventions on professional practice and healthcare outcomes. These studies should include qualitative methods to provide insight into how the interventions affect collaboration and how improved collaboration contributes to changes in outcomes.
A theoretical model of physician/pharmacist collaborative relationships, driven by 3 groups of relationship characteristics termed participant, context, and exchange, has been developed. There are no studies that have examined the types of characteristics which most influence development of collaborative relationships between physicians and pharmacists.
To test the model and determine which drivers most influence physician/pharmacist collaboration.
Data on the relationship drivers and collaborative practice were collected via a mailed survey of a random sample of 1000 primary care physicians in Iowa. Participant variables include demographics; context drivers refer to the practice environment and professional interactions between physicians and pharmacists. Exchange characteristics describe the nature of social exchange and were elicited using scores from 3 domains (relationship initiation, trustworthiness, role specification) of the Physician/Pharmacist Collaboration Instrument (PPCI). Five additional questions asked about the physician's collaborative practice with a pharmacist. Hierarchical linear regression analysis was performed with collaborative practice as the dependent variable and measures of participant, context, and exchange drivers as independent variables.
Three hundred forty usable surveys (34%) were returned. Almost 70% of the respondents were male and aged 45.8 +/- 9.9 years (mean +/- SD). The majority were family practice physicians (72.1%) in private practice (67.3%). Regression analyses produced an R2 = 0.804 (p < 0.001). Significant predictors in the model were internal medicine physicians, professional interaction with a pharmacist, and the 3 domains of exchange drivers from the PPCI (p < 0.05).
Although participant and context factors influenced physician/pharmacist collaborative relationships, exchange characteristics were the most influential relationship drivers. Role specification, trustworthiness, and relationship initiation were positively associated with physician/pharmacist collaborative practice. Recognition of these drivers may help pharmacists who are developing collaborative working relationships with physicians. But, studies are needed to delineate other factors that may influence physician/pharmacist relationships.
Medication safety officer's handbook
- C Larson
- D Saine
Larson C, Saine D. Medication safety officer's handbook. Bethesda,
MD: American Society of Health-System Pharmacists; 2013.
Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Advances in Patient Safety
- M Rosenstein
Formal Analysis, Methodology, Validation, Visualization, Writing -Original Draft Preparation, Writing -Review and Editing
- R Blythe
R Blythe contributed to: Data Curation, Formal Analysis,
Methodology, Validation, Visualization, Writing -Original Draft Preparation,
Writing -Review and Editing;
Writing -Conceptualization, Data Curation, Methodology, Validation, Writing -Original Draft Preparation, Writing -Review and Editing
- M Chui
- To
M Chui contributed to: Writing -Conceptualization, Data Curation, Methodology, Validation, Writing -Original
Draft Preparation, Writing -Review and Editing;
Patient safety and quality: an evidence-based handbook for nurses
- M O'daniel
- A H Rosenstein
O'Daniel M, Rosenstein AH. Professional communication and team
collaboration. In: Hughes RG, editor. Patient safety and quality: an
evidence-based handbook for nurses. Rockville (MD): AHRQ
Publication; 2008.