Pharmacist-physician co-operation at a regional level

The Effect of Pharmacotherapy Audit Meetings on Early New Drug Prescribing by General Practitioners

Background:

New drugs are cornerstones of clinical practice. However, when included in practice in an erratic fashion, there is valid concern about uncertain risk–benefit for patients and increased healthcare expenditures. In several countries, general practitioners (GPs) and pharmacists work closely together to ensure proper use of new drugs in clinical practice.

Objective:

To estimate the effect of pharmacotherapy audit meetings (PTAMs) between GPs and community pharmacists on prescribing of newly marketed drugs by GPs.

Methods:

We conducted an observational study of new drug prescribing in a cohort of 103 GPs, working in 59 practices, from 1999 until 2003. The main outcome measures were the decisions to start therapy with a new drug or with an existing older drug from the same therapeutic category within the first 6 months after market introduction. Multilevel modeling was used for analyses.

Results:

Overall, in 6.1% of the decisions to start drug therapy, GPs chose the drug that was most recently introduced into the market. The GPs attending lowquality PTAMs made 1861 decisions to start therapy; in 112 (6.0%) of those decisions, a new drug was preferred over an older alternative. GPs participating in high-quality PTAMs preferred a new drug in only 3.4% of the 3138 decisions made. Compared with GPs participating in PTAMs on the highest quality level (level 4), GPS attending level 1 or level 2 PTAMs were more than twice as likely to start therapy with new drugs than with older drugs (OR 2.24; 95% CI 1.04 to 4.81 vs OR 2.31; 95% CI 1.30 to 4.09, respectively).

Conclusions:

PTAMs may be an effective way to control early prescribing of new drugs in general practice. For PTAMs to be effective, it is vital that GPs and pharmacists set common goals on how to optimize pharmacotherapy. This concordance should be reflected in PTAMs that result in concrete decisions with auditing of GP prescribing behavior. Pharmacists should play an active role in organizing PTAMs to increase their influence on drug prescribing.

Which Pharmacists Contribute to High-Level Pharmacotherapy Audit Meetings with General Practitioners?

Background:

In the Netherlands, community pharmacists and general practitioners (GPs) collaborate in pharmacotherapy audit meetings (PTAMs) to optimize pharmacotherapy.

Objective:

To identify associations between the quality level of PTAMs and characteristics of pharmacists.

Methods:

We used a cross-sectional questionnaire design in a Dutch general practice and community pharmacy setting to estimate the contribution of pharmacists to the quality level of PTAMs. The questionnaire was sent to 123 community pharmacies working closely with 104 GP practices. The outcome variable was the quality level of PTAMs. The questionnaire provided information on 4 topics that were used as independent variables: characteristics of the PTAMs, provision of pharmacotherapy activities, characteristics of the pharmacists, and characteristics of the pharmacies.

Results:

In total, 109 (88.6%) pharmacists completed the questionnaire, with 103 participating in 62 different PTAMs. Seventeen pharmacists participated in level 1 PTAMs (lowest level), 57 in level 2, 21 in level 3, and 8 in PTAMs at the highest level. The multinomial logistic regression identified only one significant association: pharmacists who participated in the highest quality level reported that they undertake initiatives in PTAMs (OR 2.98; 95% CI 1.07 to 8.26) more frequently compared with pharmacists participating on the lowest level.

Conclusions:

In light of existing evidence, the role of pharmacists in PTAMs seems to be important. Pharmacists should create a distinct profile of their expertise, allowing them to professionalize PTAMs by undertaking more initiatives. PTAMs offer pharmacists a great opportunity to become integral members of the prescribing process.

Exploring community pharmacists' perceptions of their professional relationships with physicians, in Canada and the Netherlands

Objective

To explore community pharmacists' levels of interaction with, and perceptions of, physicians in primary care in Canada and the Netherlands

Method

Interviews with community pharmacists

Setting

Thirty-six community pharmacies in Vancouver, Canada, and 36 in the Nijmegen and Arnhem areas of the Netherlands

Key findings

Dutch pharmacists were more likely to have “face-to-face contacts with the physician in the pharmacy setting” (P=0.008) and structured professional meetings with physicians (P<0.001). Canadian pharmacists were more likely to agree that “interaction with physicians is mainly limited to phone/fax” (P<0.001) and “the concept of pharmaceutical care is difficult to implement” (P=0.006). Qualitative analysis revealed that in both countries pharmacists had concerns about the attitudes of physicians and issues concerning territoriality. There were also many constructive comments and these enabled consideration of actions to enhance patient care

Conclusion

The findings of the study suggest four areas which could contribute to improved patient care: (1) Increasing levels of professional interaction; (2) developing a mutual understanding of roles; (3) participating in joint initiatives to benefit patients through the extended role of pharmacists; (4) conducting structured meetings between professionals with an emphasis on the care of individual patients

Changing relationships: attitudes and opinions of general practitioners and pharmacists regarding the role of the community pharmacist

BACKGROUND

Relationship between general practitioners and pharmacists.

AIM

To explore similarities and differences in opinions between general practitioners and pharmacists about the pharmacist's role. To identify factors which determine the attitude of the general practitioner towards the role of the pharmacist as a care provider.

DESIGN

Cross-sectional questionnaire survey.

SETTING

The Netherlands, 2001.

PARTICIPANTS

926 non-dispensing general practitioners, 93 dispensing general practitioners and 328 community pharmacists.

METHODS

Statements about the pharmacist's position in primary care were formulated. The attitude towards the pharmacist's care-providing function was determined by adding the scores to the statements. Data were collected on age, gender, professional experience, trainership, type and size of practice, electronic communication, urbanisation level, part-time work, work pressure, postgraduate training, pharmacotherapy audit meetings (PTAMs), the mutual relationship and the desired role of the pharmacist in pharmacotherapy.

RESULTS

No significant differences in opinions were found between pharmacists and non-dispending general practitioners with respect to a number of the pharmacist's signalling tasks. Eighty-six percent (CI 83-89) of non-dispensing general practitioners and eighty-two percent (CI 76-87) of pharmacists shared the opinion that pharmacists need to provide the general practitioner with feedback on prescription figures. Furthermore, 85% (CI 82-88) of the non-dispensing general practitioners and 80% (CI 75-86) of the pharmacists believed that pharmacists should suggest items for the PTAM agenda, based on prescription patterns they notice in their pharmacy. The attitude of general practitioners towards the care-providing function of the community pharmacist correlates significantly with the relationship between general practitioners and pharmacists (P < 0.001). There is also a significant difference (P < 0.001) in the attitude score between dispensing and non-dispensing general practitioners: dispensing general practitioners scored lower on the attitude scale.

CONCLUSION

Pharmacists and general practitioners largely agree on the pharmacotherapeutic signalling role that a pharmacist should fulfill. A good relationship benefits the attitude of general practitioners towards the pharmacist's care-providing function.

Patient oriented activities in Dutch community pharmacy: diffusion of innovations

OBJECTIVES

To explore the implementation of patient oriented activities, the perception of an innovation aimed at implementation of patient education and the preconditions for implementation of this innovation among Dutch pharmacists.

METHOD

A survey, based on Roger's theory of diffusion of innovations, was carried out among a random sample (n = 300) of Dutch managing pharmacists.

MAIN OUTCOME MEASURES

Reported activities regarding patient education, medication surveillance and drug therapy meetings, as well as perception of the innovation and its perceived compatibility with pharmacy practice.

RESULTS

The response rate was 49.3%. Hundred (84.7%) respondents reported to provide extra written and verbal information with first prescription medication. Medication surveillance (100% check by computer, and check of the lists by the pharmacist) was reported by 43 (36.4%), and complete participation in drug therapy meetings was reported by 57 (48.3%) respondents. Observability (or results to others) of the new strategy was perceived as important by 90 (77.6%), compatibility (perceived consistency with existing values, past experiences and needs of potential adopters) by 87 (76.4%) and trialability (degree to which an innovation may be experimented with) by 81 (69.8%) respondents. Relative advantages (perception of the innovation as being better) and complexity (relatively difficult to understand and use) of the innovation were perceived as important by less respondents. The preconditions that were met by most pharmacists were 'financial resources' (n = 70; 59.8%), 'enough workspace' (n = 61; 53.1%) and 'enough time' (n = 58; 50%). Fifty-eight (49.2%) respondents intend to adopt the innovation, but this intention would be higher when more time and money and technicians are available, as well as less situations that are experienced as barriers (rush hours, lack of support, illness of employees).

CONCLUSION

Based on the definitions used, we conclude that the implementation of medication surveillance and drug therapy meetings is relatively low compared to patient education. The development of an implementation tool is justified, but should deal with the experienced preconditions, barriers and needs of pharmacists. Combined, comprehensive pharmacy interventions promise to be a good way to change pharmacy practice.