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Urionagüena A, Piquer-Martinez C, Benrimoj SI, Calvo B, Garcia-Cardenas V, Martinez-Martinez F, Gastelurrutia MA. Community pharmacy & primary care integration: qualitative study on stakeholders' opinions and interventions. J Pharm Policy Pract 2024; 17:2395551. [PMID: 39253620 PMCID: PMC11382723 DOI: 10.1080/20523211.2024.2395551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/18/2024] [Indexed: 09/11/2024] Open
Abstract
Background Health systems worldwide are under pressure. Integration seems a possible solution to improve healthcare systems efficiency. This research aims to gather stakeholders' opinions on integrating community pharmacy and the primary healthcare system and secondly to explore and prioritise interventions for an initial integration plan. Method Using a constructivist qualitative research approach, a two-phase qualitative study was conducted in the Basque Country, Spain. Thematic analysis using NVivo® was undertaken on data gathered during focus groups and semi-structured interviews (phase 1). During phase 2, a nominal group prioritised potential integration interventions identified in phase 1. Results The study amalgamated findings from four focus groups and nine interviews, revealing six themes. Stakeholders had a diverse understanding of integration, associating the term mainly with collaboration, communication or cooperation. Community pharmacies were positively perceived; however, their commercial and privately owned nature was of concern. Remuneration methods for pharmacists were controversial, with a suggested shift to service-based remuneration. Information availability and barriers such as interprofessional communication gaps were highlighted. The nominal group prioritised, according to importance and feasibility, bidirectional communication development, coordination in using interprofessional protocols and community pharmacist participation in primary healthcare centre meetings as interventions for integrating community pharmacies and primary healthcare centres. Conclusion Based on the opinions of stakeholders, three interventions are proposed to initiate the integration process of community pharmacy and primary care. The implementation of these interventions will need to be negotiated with the relevant authorities and evaluated.
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Affiliation(s)
- Amaia Urionagüena
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | | | - Shalom Isaac Benrimoj
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain
| | - Begoña Calvo
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - Victoria Garcia-Cardenas
- Pharmacy and Pharmaceutical Technology Department, Social and Legal Pharmacy Section, Faculty of Pharmacy, University of Granada, Granada, Spain
| | | | - Miguel Angel Gastelurrutia
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain
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Fuga H, Yamaoka E, Ishida N, Shitanda K, Hashimoto M, Matushita R. The relationship between psychological burden and providing assistance with taking medication among caregivers of patients with dementia: a cross-sectional study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2024; 32:377-383. [PMID: 38954838 DOI: 10.1093/ijpp/riae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/17/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVES Previous studies have examined the psychological burden of caregivers of patients with dementia. However, although many caregivers struggle to assist patients with dementia with medication management, the relationship between assisting such patients with taking their medicines and the caregiver psychological burden is understudied. Therefore, this study identified the association between caregivers' psychological burden and assisting patients with dementia with taking medication. METHODS A cross-sectional survey was conducted among caregivers of patients with dementia in Japan. The survey questionnaire included questions that assessed the symptoms of patients with dementia, their status of taking medication through medication assistance from caregivers, and caregivers' psychological burden using the Kessler Psychological Distress Scale and the Japanese version of the Perceived Stress Scale. KEY FINDINGS A total of 57 caregivers participated in the study. Higher Kessler Psychological Distress Scale scores were significantly associated with unsuccessful assistance with taking regular medication (β = 0.35, 95% confidence interval [CI]: 2.23-12.0, P < .05), depressive symptoms (β = 0.26, 95% CI: 0.10-8.53, P < .05), and irritability (β = 0.38, 95% CI: 2.71-11.5, P < .05). Likewise, higher scores on the Japanese version of the Perceived Stress Scale were significantly associated with irritability (β = 0.37, 95% CI: 1.87-12.5, P < .05) among patients with dementia. CONCLUSION The findings suggest that caregiver psychological burden is associated with unsuccessful assistance with taking regular medication for patients with dementia.
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Affiliation(s)
- Habuchi Fuga
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Ishikawa 920-1192, Japan
| | - Erika Yamaoka
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Ishikawa 920-1192, Japan
| | - Natsuko Ishida
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Ishikawa 920-1192, Japan
| | - Koji Shitanda
- The TEMARI GROUP, Spatel Co., Ltd., Kanazawa, Ishikawa, Japan
| | | | - Ryo Matushita
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Kanazawa, Ishikawa 920-1192, Japan
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Mellot M, Jawal L, Morel T, Fournier JP, Tubach F, Cadwallader JS, Christiaens A, Zerah L. Barriers and Enablers for Deprescribing Glucose-Lowering Treatment in Older Adults: A Systematic Review. J Am Med Dir Assoc 2024; 25:439-447.e18. [PMID: 38237904 DOI: 10.1016/j.jamda.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Overtreatment with glucose-lowering treatment (GLT) is frequent and a source of high morbidity and mortality in older adults with type 2 diabetes mellitus (T2DM). This study aimed to identify and synthesize barriers and enablers for deprescribing GLT in older adults (≥65 years) with T2DM. DESIGN Systematic review of qualitative and mixed-methods studies. SETTING AND PARTICIPANTS Older adults with T2DM, any participants [patients, health care providers (HCPs), caregivers], any settings. METHODS Two researchers (and a referred third researcher at all stages) independently screened original articles reporting qualitative and mixed-methods studies exploring barriers and enablers for deprescribing GLT in older adults published during 2010-2023, identified from MEDLINE, Embase, CINAHL, and gray literature. Quality of the included studies was assessed with the Mixed-Methods Appraisal Tool. Verbatim statements on barriers and enablers were extracted, and determinants of behaviors were identified with the Theoretical Domains Framework (TDF) version 2, and related intervention functions (targets for future interventions) were proposed according to the Behavior Change Wheel (BCW). RESULTS We identified only 4 studies from 2 countries (United States and the Netherlands), all recently published (2019-2023), that primarily reported barriers to GLT deprescribing from interviews or focus groups of patients or HCPs practicing outpatient medicine. Knowledge, fear, poor communication, inertia, and trust with HCPs were the main determinants of behaviors that influenced deprescribing, and education, training, persuasion and environmental restructuring were the main intervention functions for proposing future interventions. Studies did not cover financial aspects, physician characteristics, or caregiver and family viewpoints. CONCLUSIONS AND IMPLICATIONS The use of a behavioral theory and a validated implementation framework provided a comprehensive approach to identifying barriers and enablers for deprescribing GLT in older adults (≥65 years) with T2DM. The behavioral determinants identified may be useful in tailoring interventions to improve the implementation of GLT deprescribing in older adults in ambulatory settings.
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Affiliation(s)
- Marion Mellot
- Département de gériatrie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Pitié Salpêtrière, Paris, France
| | - Lina Jawal
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Thomas Morel
- Département de Médecine Générale, Faculté de Médecine, Nantes Université, Nantes, France
| | - Jean-Pascal Fournier
- Département de Médecine Générale, Faculté de Médecine, Nantes Université, Nantes, France; Université Tours-Nantes, INSERM, UMR U1246 SPHERE "Methods in Patient-Centered Outcomes and Health Research", Tours, France
| | - Florence Tubach
- Département de Santé Publique, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Pitié Salpêtrière, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Jean-Sébastien Cadwallader
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France; Département de Médecine Générale, Sorbonne Université, Paris, France
| | - Antoine Christiaens
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France; Fonds de la Recherche Scientifique (FNRS), Brussels, Belgium; Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium
| | - Lorène Zerah
- Département de gériatrie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Pitié Salpêtrière, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France.
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Bergsholm YKR, Feiring M, Charnock C, Krogstad T, Holm LB. Positioning of community pharmacists in interactions with general practitioners and patients regarding prescribing and using antibiotics. J Interprof Care 2023; 37:886-895. [PMID: 37161732 DOI: 10.1080/13561820.2023.2203698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 01/12/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023]
Abstract
Interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs) is important for ensuring antibiotics are used correctly and combating antibiotic resistance. The study's main objective was to investigate how CPs, GPs and patients, respectively, position CPs in their interactions with patients on antibiotic-related matters in Norwegian pharmacies. Seven focus-group interviews were performed. Data were analyzed using systematic text condensation. Positioning theory was used to identify positions assigned to CPs by themselves, by GPs and by patients. CPs position themselves as helpful, accessible drug specialists responsible for advising on antibiotic use, but also consider themselves dependent on GP-supplied information to do so. GPs position CPs as helpful, responsible businesspeople who, however, lack clinical experience and are overzealous gatekeepers. Patients position CPs as helpful people who supply information in "everyday language" and as the GP's extended arm. Patients utter they are best served when GPs and CPs collaborate. This discrepancy is a barrier to optimal service to patients in general, and to proper antibiotic use in particular.
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Affiliation(s)
| | - Marte Feiring
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Colin Charnock
- Department of Life Sciences and health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Tonje Krogstad
- Department of Life Sciences and health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Lene Berge Holm
- Department of Life Sciences and health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Centre for Connected Care, Oslo University Hospital, Oslo, Norway
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Wrześniewska-Wal I, Pinkas J, Ostrowski J, Jankowski M. Pharmacists' Perceptions of Physician-Pharmacist Collaboration-A 2022 Cross-Sectional Survey in Poland. Healthcare (Basel) 2023; 11:2444. [PMID: 37685477 PMCID: PMC10486938 DOI: 10.3390/healthcare11172444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Patient-centered care requires close collaboration among multiple healthcare professionals, including physician-pharmacist collaboration (especially as a part of pharmaceutical care). This study aimed to assess pharmacists' perceptions of physician-pharmacist collaboration as well as to identify factors associated with the willingness to provide pharmaceutical care services in Poland. This questionnaire-based survey was carried out in 2022 among community pharmacists from one of the largest franchise chain pharmacy networks in Poland. Completed questionnaires were received from 635 community pharmacists (response rate of 47.9%). Almost all the pharmacists agreed with the statement that there is a need for physician-pharmacist collaboration (98.2%), and 94.8% declared that pharmacists can help physicians in patient care and pharmacotherapy. Most pharmacists (80%) believed that physicians were not aware of the competencies of pharmacists resulting from Polish law. Patient education (89.9%), detection of polypharmacy (88%), and detection of interactions between drugs and dietary supplements (85.7%) were the most common tasks in the field of pharmaceutical care that can be provided by a pharmacist. Females were more likely (p < 0.05) to declare the need for physician-pharmacist collaboration. Age and location of the pharmacy were the most important factors (p < 0.05) associated with pharmacists' attitudes toward physician-pharmacist collaboration.
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Affiliation(s)
- Iwona Wrześniewska-Wal
- School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland
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Pitman V, Hemphill JC, Cao V. Interprofessional Team Improves Hypertension in African American Men. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2023.104600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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Bawab N, Moullin J, Jotterand S, Rossier C, Schneider MP, Perraudin C. Building Interprofessional Collaborative Practices Through a Support Program for Patients With Type 2 Diabetes in Primary Care. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:77-86. [PMID: 36877813 PMCID: PMC10219666 DOI: 10.1097/ceh.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/20/2022] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The building of interprofessional collaborative practices throughout the implementation process of a patient support program (Siscare) in primary care for patients with type 2 diabetes was assessed. Siscare included regular patient-pharmacist motivational-based interviews; medication adherence, patient-reported, and clinical outcomes monitoring; and physician-pharmacist interactions. METHOD This investigation was a prospective, multicenter, observational, mixed-methods cohort study. Interprofessionality was operationalized through four progressive levels of interrelationship practices between the health care professionals. The target number of patients per pharmacy was 10 among 20 pharmacies. RESULTS The project started with the recognition of Siscare by stakeholders, the creation of an interprofessional steering committee, and the adoption of Siscare by 41 pharmacies among 47 pharmacies in April 2016. Nineteen pharmacies presented Siscare at 43 meetings attended by 115 physicians. Twenty-seven pharmacies included 212 patients; however, no physician prescribed Siscare. Collaboration primarily occurred through the unidirectional transmission of information from the pharmacist to the physician (level 1: 70% of pharmacists transmitted interview reports to physicians), bidirectional exchange of information sometimes occurred (level 2: 42% received physician responses), and concerted measures of treatment objectives took place occasionally (level 3). Twenty-nine of 33 physicians surveyed were in favor of this collaboration. DISCUSSION Despite multiple implementation strategies, physician resistance and lack of motivation to participate exists, but Siscare was well received by pharmacists, patients, and physicians. Barriers to collaborative practice (financial and IT) need to be further explored. Interprofessional collaboration is a clear need to improve type 2 diabetes adherence and outcomes.
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Affiliation(s)
- Noura Bawab
- Bawab: Research fellow, Center for Primary Care and Public Health (Unisanté), Department of ambulatory care, University of Lausanne, Lausanne, Switzerland; and Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland; and School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland. Moullin: Senior Research Fellow, Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Australia. Jotterand : General practitioner, Médcins de famille et de l'enfance Suisse, Zürich, Switzerland; and Sispha SA, Ofac, Lausanne, Switzerland. Rossier: Pharmacist, Sispha SA, Ofac, Lausanne, Switzerland. Schneider: Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland, and Medication adherence and Interprofessionality lab, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland. Perraudin: Health economist, Center for Primary Care and Public Health (Unisanté), Department of ambulatory care, University of Lausanne, Lausanne, Switzerland; and Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland; and School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
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Berger J. Quelques outils pour mettre en œuvre la déprescription. ACTUALITES PHARMACEUTIQUES 2023. [DOI: 10.1016/j.actpha.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
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Percival M, McMurray A, Freeman C, Cottrell N. A collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: Patient and general practitioner perceptions. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100236. [PMID: 36923064 PMCID: PMC10009526 DOI: 10.1016/j.rcsop.2023.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/01/2023] [Accepted: 02/11/2023] [Indexed: 02/19/2023] Open
Abstract
A collaborative pharmacist prescribing model for patients with chronic disease(s) attending Australian general practices: patient and general practitioner perceptions. Background Pharmacists working in general practice settings are slowly emerging in Australia, with comprehensive medication reviews forming a large part of their role in optimising pharmaceutical care. In Australia, pharmacists are entirely reliant on general practitioners (GPs) accepting and implementing their recommendations to manage drug related problems (DRPs). The next step is a model where the pharmacist takes on responsibility for implementing some of their recommendations. Aim To investigate patient and general practitioner perceptions of a collaborative model of care where the pharmacist has increased responsibility in assisting the general practitioner manage patients with chronic conditions. Method Semi-structured, phone and face-to-face interviews were conducted with a purposive sample of patients and GPs respectively. Data were transcribed by a professional transcription service, collated using NVivo 12 Plus and analysed using Braun and Clarke's thematic analysis. Provisional codes were generated and clustered into categories, from which themes were identified. Results Eighteen interviews were conducted (12 patients, 6 GPs). Four themes were identified from the patient interview data: pharmacist attributes; acknowledgement of the impact of the pharmacist, understanding of the GP-pharmacist collaborative model; relationships with and attitudes towards medicines and health care providers. Four themes were identified from the general practitioner interview data: pharmacist attributes; relationships with pharmacists; impressions on collaboration; impressions of the pharmacist's recommendations. Patients' and GPs' perceptions of the collaborative model of care overall were positive, acknowledging the advantages of a patient-centred, interdisciplinary approach and the potential benefits to patients. Conclusion The GP-pharmacist collaborative model was viewed favourably by patients and GPs, with some GPs articulating the value in the pharmacist's increased responsibility as they implemented some recommendations to manage DRPs.
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Affiliation(s)
- Matthew Percival
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia.,Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, QLD 4215, Australia
| | - Anne McMurray
- School of Nursing and Midwifery, Griffith University - Gold Coast Campus, Parklands Dr, Southport, Gold Coast, QLD 4222, Australia.,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, QLD 4556, Australia
| | - Christopher Freeman
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Neil Cottrell
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
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Rakvaag H, Kjome RLS, Elisabeth Søreide G. Power dynamics and interprofessional collaboration: How do community pharmacists position general practitioners, and how do general practitioners position themselves? J Interprof Care 2023:1-8. [PMID: 36597594 DOI: 10.1080/13561820.2022.2148637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 01/05/2023]
Abstract
Power differentials and medical dominance can negatively affect collaboration between physicians and pharmacists. Norway is recognized as having a relatively egalitarian work sector, which could affect power differentials. In this qualitative study, we used positioning theory as a framework to explore the aspect of power dynamics between Norwegian general practitioners (GPs) and community pharmacists. We used the concepts of reflexive and interactive positioning to identify how GPs positioned themselves and how they were positioned by pharmacists in six focus groups. Data were analyzed using systematic text condensation. We found positioning theory to be a useful lens through which to study power dynamics in relation to collaboration between community pharmacists and GPs. Our findings imply that the presence of medical dominance poses challenges even in an egalitarian Norwegian setting. However, although both GPs and pharmacists draw on a 'medical dominance' storyline, we have also identified how both pharmacists and GPs draw on alternative and promising storylines of collaboration between the two professions.
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Affiliation(s)
- Hilde Rakvaag
- Department of Global Public Health and Primary care/Centre for Pharmacy, University of Bergen, Bergen, Norway
| | - Reidun Lisbet Skeide Kjome
- Department of Global Public Health and Primary care/Centre for Pharmacy, University of Bergen, Bergen, Norway
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Grimes TC, Guinan EM. Interprofessional education focused on medication safety: a systematic review. J Interprof Care 2023; 37:131-149. [PMID: 35050843 DOI: 10.1080/13561820.2021.2015301] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Safe medication use necessitates interprofessional working, with calls to enhance interprofessional education (IPE) focusing on medication safety (MS) in healthcare professional (HCP) curricula. Little is known about the design, delivery or evaluation of such activities. This systematic literature review describes MS-focused IPE activities in pre-qualification HCP programmes. MedLine, EMBASE, CINAHL and ERIC were searched, relevant studies identified and data extracted. The McGill Mixed Methods Appraisal Tool was employed. The 3P (presage-process-product) theory structured deductive analysis. Thirty-one studies were included, reporting on 30 activities, mostly undertaken in North America or United Kingdom. Presage/Design: Most reported activities involved pharmacy, nursing, medical or physician assistant students learning with one or more other HCP group. Few studies matched student groups' skills or experiences. Few studies reported theoretical underpinnings. Process/Delivery: Multiple pedagogical approaches were employed, mostly social construction, and low- and high-fidelity simulation-based learning. Few studies reported learning outcomes or summative assessment, more reported formative assessment. Product/evaluation: Outcomes measured were learners' opinions, satisfaction or attitudes toward interprofessional working and findings were generally positive. Few studies reported on student development or outcomes specific to medication safety. Lack of integration of qualitative/quantitative components of mixed methods studies and limited outcome measurements' validity or reliability weakened study quality. MS-focused IPE for pre-qualification HCPs is well received by students. Design of future activities could be enhanced by employing theory and ensuring matching of students' and groups' skills, professional identity and learner attributes to enhance learning in an interprofessional setting. Future delivery should embed MS-focused IPE into the standard curricula to optimize constructive alignment, learner engagement, quality and drive development. The required skillset in pre-qualification HCP programmes to facilitate future safe medication practice, together with the associated learning outcomes and assessment approaches, should be defined. The quality of scholarly studies examining these activities needs improvement.
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Affiliation(s)
- T C Grimes
- School of Pharmacy and Pharmaceutical Sciences, Panoz Institute, Trinity College Dublin, Dublin 2, Ireland
| | - E M Guinan
- School of Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
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Sudeshika T, Naunton M, Peterson GM, Deeks LS, Guénette L, Sharma R, Freeman C, Niyonsenga T, Kosari S. Interprofessional Collaboration and Team Effectiveness of Pharmacists in General Practice: A Cross-National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:394. [PMID: 36612716 PMCID: PMC9819811 DOI: 10.3390/ijerph20010394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/17/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
As team-based care continues to evolve, pharmacists have been included in general practice teams in many countries, to varying extents, to improve medication use and patient safety. However, evidence on interprofessional collaboration and team effectiveness of pharmacists in general practice is sparse. This study aimed to compare the extent of interprofessional collaboration and team effectiveness of general practice pharmacists in Australia with international sites (Canada and the UK), and identify the factors associated with interprofessional collaboration and team effectiveness. General practice pharmacists from Australia, Canada, and the UK were identified through professional organisations and networks, and invited to participate in an online survey, adapted from existing validated tools. The survey explored interprofessional collaboration through four sub-domains (professional interactions, relationship initiation, trust and role clarity, and commitment to collaboration) and team effectiveness of general practice pharmacists. Of the 101 respondents (26 from Australia, 44 from Canada and 31 from the UK), 79% were female and 78% were aged below 50 years. Interprofessional collaboration and team effectiveness appeared to be high and similar between countries. Total scores for collaboration of pharmacists were 86.1 ± 7.4 in Australia, 88.5 ± 7.5 in the UK, and 89.1 ± 7.3 in Canada (mean ± SD, where higher scores represent more advanced collaboration), while the team effectiveness scores of the pharmacists were 88.6 ± 14.6 in Canada, 91.8 ± 14.6 in Australia and 97.5 ± 14.0 in the UK. Pharmacists who had worked in general practice for a longer time showed advanced interprofessional collaboration while those who worked exclusively in general practice had higher scores for team effectiveness. Overall, general practice pharmacists in the three countries were highly collaborative with general practitioners. Long-term employment and longer work hours could enhance interprofessional collaboration and team effectiveness in general practice pharmacists by improving trust and working relationships over time.
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Affiliation(s)
- Thilini Sudeshika
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | - Mark Naunton
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia
| | - Gregory M. Peterson
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7005, Australia
| | - Louise S. Deeks
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia
| | - Line Guénette
- Faculty of Pharmacy, Laval University, Quebec, QC GIV 0A6, Canada
| | - Ravi Sharma
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia
- Bedfordshire Hospitals NHS Foundation Trust, Luton LU4 0DZ, UK
| | - Christopher Freeman
- School of Pharmacy, Faculty of Health and Behavioural Sciences, University of Queensland, Woolloongabba, QLD 4102, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
- Metro North Hospital and Health Service, Herston, QLD 4006, Australia
| | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia
| | - Sam Kosari
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia
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White A, Fulda KG, Blythe R, Chui MA, Reeve E, Young R, Espinoza A, Hendrix N, Xiao Y. Defining and enhancing collaboration between community pharmacists and primary care providers to improve medication safety. Expert Opin Drug Saf 2022; 21:1357-1364. [PMID: 36377503 PMCID: PMC9850835 DOI: 10.1080/14740338.2022.2147923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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 follows: 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 and 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.
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Affiliation(s)
- Annesha White
- Department of Pharmacotherapy, University of North Texas Health Science Center College of Pharmacy, Fort Worth, TX, USA
| | - Kimberly G. Fulda
- University of North Texas Health Science Center, Department of Family Medicine and Osteopathic Manipulative Medicine, North Texas Primary Care Practice-Based Research Network (NorTex), Texas College of Osteopathic Medicine, Fort Worth, TX, USA
| | - Rachel Blythe
- Department of Pharmacotherapy, University of North Texas Health Science Center College of Pharmacy, Fort Worth, TX, USA
| | - Michelle A. Chui
- Social and Administrative Sciences Division, University of Wisconsin – Madison School of Pharmacy, Madison, WI, USA
| | - Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Science, University of South Australia, Adelaide, Australia,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Richard Young
- JPS Hospital, Department of Family Medicine, Residency Program, Fort Worth, TX, USA
| | - Anna Espinoza
- University of North Texas Health Science Center, Department of Family Medicine and Osteopathic Manipulative Medicine, North Texas Primary Care Practice-Based Research Network (NorTex), Texas College of Osteopathic Medicine, Fort Worth, TX, USA
| | - Noah Hendrix
- University of Texas at Arlington, Arlington, TX, USA
| | - Yan Xiao
- University of Texas at Arlington, Arlington, TX, USA
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Sirimsi MM, De Loof H, Van den Broeck K, De Vliegher K, Pype P, Remmen R, Van Bogaert P. Scoping review to identify strategies and interventions improving interprofessional collaboration and integration in primary care. BMJ Open 2022; 12:e062111. [PMID: 36302577 PMCID: PMC9621161 DOI: 10.1136/bmjopen-2022-062111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/05/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify strategies and interventions used to improve interprofessional collaboration and integration (IPCI) in primary care. DESIGN Scoping review DATA SOURCES: Specific Medical Subject Headings terms were used, and a search strategy was developed for PubMed and afterwards adapted to Medline, Eric and Web of Science. STUDY SELECTION In the first stage of the selection, two researchers screened the article abstracts to select eligible papers. When decisions conflicted, three other researchers joined the decision-making process. The same strategy was used with full-text screening. Articles were included if they: (1) were in English, (2) described an intervention to improve IPCI in primary care involving at least two different healthcare disciplines, (3) originated from a high-income country, (4) were peer-reviewed and (5) were published between 2001 and 2020. DATA EXTRACTION AND SYNTHESIS From each paper, eligible data were extracted, and the selected papers were analysed inductively. Studying the main focus of the papers, researchers searched for common patterns in answering the research question and exposing research gaps. The identified themes were discussed and adjusted until a consensus was reached among all authors. RESULTS The literature search yielded a total of 1816 papers. After removing duplicates, screening titles and abstracts, and performing full-text readings, 34 papers were incorporated in this scoping review. The identified strategies and interventions were inductively categorised under five main themes: (1) Acceptance and team readiness towards collaboration, (2) acting as a team and not as an individual; (3) communication strategies and shared decision making, (4) coordination in primary care and (5) integration of caregivers and their skills and competences. CONCLUSIONS We identified a mix of strategies and interventions that can function as 'building blocks', for the development of a generic intervention to improve collaboration in different types of primary care settings and organisations.
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Affiliation(s)
- Muhammed Mustafa Sirimsi
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Centre of Research and Innovations in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hans De Loof
- Laboratory of Physiopharmacology, Faculty of pharmaceutic sciences, University of Antwerp, Antwerp, Belgium
| | - Kris Van den Broeck
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Peter Pype
- Center for family medicine, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium
| | - Roy Remmen
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Van Bogaert
- Centre for research and innovation in care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Jebara T, McIntosh T, Stewart F, Osprey A, Bruce R, Cunningham S. Designated prescribing practitioners: a theory-based cross-sectional study of stakeholders' views on implementation of a novel pharmacy regulator mandated preceptorship model. Int J Clin Pharm 2022; 44:1195-1204. [PMID: 35951218 DOI: 10.1007/s11096-022-01467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/02/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Scottish Government is increasing independent prescribers (IP) in community pharmacy (CP). A new preceptorship model using IPs as Designated Prescribing Practitioners (DPPs) has been introduced. AIM To investigate stakeholder views of implementation of a novel regulator mandated IP course preceptorship model. METHOD A theory-based online pre-piloted survey of stakeholders including e.g. directors of pharmacy, prescribing, education leads, policy & strategy leads and CPs. Questionnaire development used Consolidated Framework for Implementation Research (CFIR) and a DPP Competency Framework. Data were analysed descriptively and presented with mapping to CFIR constructs. RESULTS Of ninety-nine responses 82.5% (80/97) responded 'yes' to '..abilities in reporting concerns..' and 53.1% (51/96) indicating 'no' to '..anticipated issues with clinical and diagnostic skills'. CFIR related facilitators included agreement that; there was tension for change with 84 (85%) indicating '….urgent need to implement role …', that incentives are likely to help (6566%) and small pilots would help (8588%). Barriers were evident related to 'unsure' responses about sufficiency of; DPP capacity (39/97, 40.2%), time (48/96, 50%) and support and resources (4445%) to undertake the role. Concerns were expressed with 81 (83%) in agreement or unsure that leadership commitment may be lacking and 48 (48.9%) were 'unsure' about availability of good training for the DPP role. CONCLUSION There was DPP role positivity but expressed barriers and facilitators at policy, organisational and individual practitioner levels needing further consideration. Further research is warranted on uptake and embedding of the role.
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Affiliation(s)
- Tesnime Jebara
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Trudi McIntosh
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | | | | | - Rachel Bruce
- NHS Education for Scotland, Glasgow, UK.,NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Scott Cunningham
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK.
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Sanchez-Molina AI, Benrimoj SI, Ferri-Garcia R, Martinez-Martinez F, Gastelurrutia MA, Garcia-Cardenas V. Development and validation of a tool to measure collaborative practice between community pharmacists and physicians from the perspective of community pharmacists: the professional collaborative practice tool. BMC Health Serv Res 2022; 22:649. [PMID: 35568892 PMCID: PMC9107731 DOI: 10.1186/s12913-022-08027-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Collaborative practice between community pharmacists and physicians is becoming increasingly common. Although tools and models to explore collaborative practice between both health care professionals have been developed, very few have been validated for their use in clinical practice. The objective of this study was to develop and validate a tool for measuring collaborative practice between community pharmacists and physicians from the perspective of community pharmacists. METHODS The DeVellis method was used to develop and validate the Professional Collaborative Practice Tool. A pool of 40 items with Likert frequency scales was generated based on previous literature and expert opinion. This study was undertaken in Spain. A sample of community pharmacists providing medication reviews with follow-up and a random sample of pharmacists providing usual care were invited to participate. Exploratory and confirmatory factor analysis was used to assess the tool's reliability and content validity. RESULTS Three hundred thirty-six pharmacists were invited with an overall response rate of 84.8%. The initial 40 items selected were reduced to 14 items. Exploratory Factor Analysis provided a 3-factor solution explaining 62% of the variance. Confirmatory Factor Analysis confirmed the three factors "Activation for collaborative professional practice," the "Integration in collaborative professional practice," and the "Professional acceptance in collaborative professional practice." The tool demonstrated an adequate fit (X2/df = 1.657, GFI = 0.889 and RMSEA = 0.069) and good internal consistency (Cronbach's alpha = 0.924). CONCLUSIONS The Professional Collaborative Practice Tool has shown good internal reliability and criterion validity. The tool could be used to measure the perceived level of collaborative practice between community pharmacists and physicians and monitor changes over time. Its applicability and transferability to other settings should be evaluated.
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Affiliation(s)
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain
| | - Ramon Ferri-Garcia
- Department of Statistics and Operations Research, University of Granada, Granada, Spain
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Corre TL, Fournier JP. Rôle des pharmaciens d'officine dans les protocoles des maisons de santé pluriprofessionnelles en 2020: étude descriptive transversale multi-méthodes. ANNALES PHARMACEUTIQUES FRANÇAISES 2022; 80:988-994. [DOI: 10.1016/j.pharma.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
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Kari H, Kortejärvi H, Laaksonen R. Developing an interprofessional people-centred care model for home-living older people with multimorbidities in a primary care health centre: A community-based study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100114. [PMID: 35478508 PMCID: PMC9030719 DOI: 10.1016/j.rcsop.2022.100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/20/2022] [Accepted: 02/01/2022] [Indexed: 12/17/2022] Open
Abstract
Background The ageing population with multiple conditions and complex health needs has forced healthcare systems to rethink the optimal way of delivering services. Instead of trying to manage numerous diseases in a siloed approach, the emphasis should be on people-centred practice, in which healthcare services are tailored to people's needs and provided in partnership with them. Objective The aim was to develop an interprofessional people-centred care model (PCCM), including the contribution of a clinically trained pharmacist for home-living multimorbid older people in primary care. Methods Participatory action research method, including the active involvement of healthcare professionals, was utilised to develop the PCCM in a public health centre in Finland. The data comprised interview transcripts, workshop materials, field notes, surveys, and memos and were analysed using inductive content analysis. Results The PCCM was developed in iterative phases, including planning, acting, observing, and reflecting. The PCCM comprised: 1) A self-management evaluation questionnaire sent before a home visit; 2) A person-centred patient interview at home with a named nurse and a pharmacist; 3) A nurse-led health review and a pharmacist-led clinical medication review; 4) An interprofessional (a GP, a pharmacist and a named nurse) case conference meeting; 5) A care plan, including health and medication plans; and 6) Health support and empowerment interventions. The PCCM shifted working practices in the health centre from parallel and consultative practice towards interprofessional people-centred practice and more holistic care. The patient's active involvement in their own care was encouraged. Healthcare professionals appreciated the advantages of the new skill-mix, including the clinically trained pharmacist. Building trust among healthcare professionals and between the professionals and the patients was essential. Conclusion The successfully developed PCCM improved holistic and more people-centred care in primary care. Healthcare professionals appreciated the advantages of the skill mix and found that trust was essential for implementing the PCCM.
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Affiliation(s)
- Heini Kari
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E (P.O.Box 56), 00014 Helsinki, Finland
- Corresponding author at: Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, Viikinkaari 5 E (P.O.Box 56), 00014, University of Helsinki, Helsinki, Finland.
| | - Hanna Kortejärvi
- Division of Pharmaceutical Biosciences, Faculty of Pharmacy, Viikinkaari 5 E (P.O.Box 56), 00014, University of Helsinki, Helsinki, Finland
| | - Raisa Laaksonen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E (P.O.Box 56), 00014 Helsinki, Finland
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Gemmechu WD, Eticha EM. Factors influencing the degree of physician-pharmacists collaboration within governmental hospitals of Jigjiga Town, Somali National Regional State, Ethiopia, 2020. BMC Health Serv Res 2021; 21:1269. [PMID: 34819071 PMCID: PMC8611947 DOI: 10.1186/s12913-021-07301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Collaboration is the way to deliver the desired health outcome for the patients or service users in the healthcare. Inter-professional collaboration can improve medication safety, patient outcome and minimize healthcare costs. This study aimed to explore the degree of collaboration and factors influencing collaboration between physicians and pharmacists within the public hospitals of Jigjiga town, Somali National Regional State, Ethiopia, 2020. METHODS A cross-sectional study qualitative was conducted among 149 participants in the two governmental hospitals of the Jigjiga town with a response rate of 79.87%. The collaborative working relationship model and the physician-pharmacist collaborative instrument with three main exchange domains (trustworthiness, role specification, and relationship initiation) and collaborative care items were used. An independent sample t-test was used to compute the differences of the mean scores of physician-pharmacist collaborative instrument domains and collaborative care. Separate multiple regression was employed to assess factors influencing collaborative care for pharmacists and physicians. RESULTS This study showed that pharmacists reported higher mean of collaborative care (10.66 ± 4.75) than physicians (9.17 ± 3.92). The multiple regression indicated that area of practice influence both professionals' collaborative practice. A significant association between collaborative care and the two PPCI domains (trustworthiness and relationship initiation for the physicians; role specification and relationship initiation for pharmacists) was established. CONCLUSIONS The study showed that the collaboration between the physicians and pharmacists was sub-optimal and the exchange variables had a significant influence on their collaboration. RECOMMENDATION Physicians and pharmacists need to exert more efforts to enhance this collaboration. Further qualitative study might be needed to search for factors affecting, barriers and how to develop collaborative practice.
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Affiliation(s)
- Workineh Diriba Gemmechu
- College of Medicine and Health Science, School of Medicine, Jigjiga University, Jigjiga, Ethiopia
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20
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Zielińska-Tomczak Ł, Cerbin-Koczorowska M, Przymuszała P, Gałązka N, Marciniak R. Pharmacists' Perspectives on Interprofessional Collaboration with Physicians in Poland: A Quantitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9686. [PMID: 34574606 PMCID: PMC8470388 DOI: 10.3390/ijerph18189686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022]
Abstract
Over the years, many studies have emphasized the pharmacist's importance as part of the patient care team. Still, the interprofessional collaboration between physicians and pharmacists in their everyday work seems rare. Therefore, this study aimed to investigate the types of contact between them, possible mutual collaboration, and barriers to implementation. This study was conducted from April to August 2020. The study group included licensed pharmacists working in community pharmacies in Poland (n = 207). The results show that, according to the respondents, physician-pharmacist contact mainly concerns formal aspects, such as correcting prescription errors. They occasionally communicate for other matters, such as consultation regarding drug availability and drug dosage. However, when asked to divide responsibilities between them and physicians, pharmacists indicate areas that should involve interprofessional collaboration, e.g., monitoring adverse drug reactions, analysis of multi-drug therapy, and checking the regularity of taking medications. They indicated the lack of specific collaboration rules, limited willingness to establish relationships and low mutual respect and trust among existing barriers. It is worth considering the possibility of overcoming these barriers provided by interprofessional education in order to develop communication skills and build relationships based on respect.
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Affiliation(s)
- Łucja Zielińska-Tomczak
- Department of Medical Education, Poznan University of Medical Sciences, 7 Rokietnicka St., 60-806 Poznan, Poland; (M.C.-K.); (P.P.); (R.M.)
| | - Magdalena Cerbin-Koczorowska
- Department of Medical Education, Poznan University of Medical Sciences, 7 Rokietnicka St., 60-806 Poznan, Poland; (M.C.-K.); (P.P.); (R.M.)
| | - Piotr Przymuszała
- Department of Medical Education, Poznan University of Medical Sciences, 7 Rokietnicka St., 60-806 Poznan, Poland; (M.C.-K.); (P.P.); (R.M.)
| | - Natalia Gałązka
- Students’ Scientific Club of Medical Education, Department of Medical Education, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
| | - Ryszard Marciniak
- Department of Medical Education, Poznan University of Medical Sciences, 7 Rokietnicka St., 60-806 Poznan, Poland; (M.C.-K.); (P.P.); (R.M.)
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Adeoye-Olatunde OA, Lake LM, Strohmier CA, Gourley AK, Ray AR, Zillich AJ, Snyder ME. Positive deviants for medication therapy management: A mixed-methods comparative case study of community pharmacy practices. Res Social Adm Pharm 2021; 17:1407-1419. [PMID: 33214124 PMCID: PMC8079557 DOI: 10.1016/j.sapharm.2020.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND To optimize medication use in older adults, the Centers for Medicare & Medicaid Services (CMS) launched Medication Therapy Management (MTM) services as part of Medicare Part D policy; however, strategies for achieving high quality MTM outcomes are not well understood. OBJECTIVE The objective of this study was to generate hypotheses for strategies contributing to community pharmacies' high performance on policy-relevant MTM quality measures. METHODS This mixed-methods comparative case study was guided by the Positive Deviance approach and Chronic Care Model. The study population consisted of pharmacy staff employed by a Midwestern division of a national supermarket-community pharmacy chain. Data consisted of demographics and qualitative data from semi-structured interviews. Qualitative and quantitative data were analyzed deductively and inductively or using descriptive statistics, respectively. MTM quality measures used to evaluate participant pharmacies' MTM performance mirrored select 2017 Medicare Part D Plans' Star Rating measures. RESULTS Thirteen of 18 selected case pharmacies (72.2%) participated in this study, of which 5 were categorized as high performers, 4 moderate performers, and 4 low performers. Eleven pharmacists, 11 technicians, and 3 student interns participated in interviews. Eight strategies were hypothesized as contributing to MTM performance: Strong pharmacy staff-provider relationships and trust, Inability to address patients' social determinants of health (negatively contributing), Technician involvement in MTM, Providing comprehensive medication reviews in person vs. phone alone, Placing high priority on MTM, Using available clinical information systems to identify eligible patients, Technicians using clinical information systems to collect/document information for pharmacists, Faxing prescribers adherence medication therapy problems (MTPs) and calling on indication MTPs. CONCLUSIONS Eight strategies were hypothesized as contributing to community pharmacies' performance on MTM quality measures. Findings from this work can inform MTM practice and Medicare Part D MTM policy changes to positively influence patient outcomes. Future research should test hypotheses in a larger representative sample of pharmacies.
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Affiliation(s)
- Omolola A Adeoye-Olatunde
- Department of Pharmacy Practice, Purdue University College of Pharmacy, 640 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
| | - Leslie M Lake
- Kroger Health Central Division, 5960 Castleway West Dr Indianapolis, IN, 46250, USA.
| | - Celena A Strohmier
- Kroger Health Central Division, 5960 Castleway West Dr Indianapolis, IN, 46250, USA; Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN, 47907, USA.
| | - Amanda K Gourley
- Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN, 47907, USA; CVS Target Channel District 4, 3601 N Barr St Muncie, IN 47303, USA.
| | - Ashli R Ray
- Union Hospital, 1606 N 7th St, Terre Haute, IN, 47804, USA.
| | - Alan J Zillich
- Department of Pharmacy Practice, Purdue University College of Pharmacy, 640 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
| | - Margie E Snyder
- Department of Pharmacy Practice, Purdue University College of Pharmacy, 640 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
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Rosli MR, Neoh CF, Wu DB, Hassan NW, Mahmud M, Rahimi A, Karuppannan M. Evaluation of home medication review for patients with type 2 diabetes mellitus by community pharmacists: a randomised controlled trial. Pharm Pract (Granada) 2021; 19:2397. [PMID: 34621450 PMCID: PMC8455124 DOI: 10.18549/pharmpract.2021.3.2397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/05/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Successful diabetes treatment requires commitment and understanding of disease management by the patients. OBJECTIVE This trial aimed to evaluate the programme effectiveness of home medication review by community pharmacists (HMR-CP) in optimising diabetes care and reducing medication wastage. METHODS A randomised controlled trial was conducted on 166 patients with Type 2 Diabetes Mellitus (T2DM) who were randomly assigned to the intervention or control groups. The intervention group received HMR-CP at 0-month, 3-month, and 6-month. The primary outcome was haemoglobin A1c (HbA1c) while clinical outcomes, anthropometric data, and humanistic outcomes were the secondary outcomes. For the intervention group, drug-related problems (DRP) were classified according to the Pharmaceutical Care Network Europe Foundation (PCNE). Medication adherence was determined based on the Pill Counting Adherence Ratio (PCAR). The cost of medication wastage was calculated based on the total missed dose by the T2DM patients multiplied by the cost of medication. General linear model and generalised estimating equations were used to compare data across the different time-points within and between the groups, respectively. RESULTS No significant difference was observed in the demographic and anthropometric data at baseline between the two groups except for fasting blood glucose (FBG). There was a significant reduction in the HbA1c (-0.91%) and FBG (-1.62mmol/L) over the study period (p<0.05). A similar observation was noted in diastolic blood pressure (DBP) and total cholesterol (TC) but not in high-density lipoprotein (HDL), and anthropometric parameters. Both utility value and Michigan Diabetes Knowledge Test (MDKT) scores increased significantly over time. As for the intervention group, significant changes in PCAR (p<0.001) and the number of DRP (p<0.001) were noted. CONCLUSIONS HMR-CP significantly improved the glycaemic control, QoL, medication adherence, and knowledge of T2DM patients as well as reduced the number of DRP and cost of medication wastage. However, the impact of HMR-CP on certain clinical and anthropometric parameters remains inconclusive and further investigation is warranted.
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Affiliation(s)
- M Rozaini Rosli
- BPharm, MBA. PhD. Faculty of Pharmacy, University of Technology MARA (UiTM). Selangor (Malaysia).
| | - Chin F Neoh
- PhD. Senior Lecturer. Faculty of Pharmacy, University of Technology MARA (UiTM). Selangor (Malaysia).
| | - David B Wu
- PhD. Director. Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-Being Cluster, Global Asia in the 21st Century Platform, Monash University Malaysia, Sunway Town, Selangor (Malaysia).
| | - Nazariah W Hassan
- M.D. Family medicine specialist, Pasir Mas City Health Clinic. Kelantan (Malaysia).
| | - Mahani Mahmud
- M.D. Senior Medical Officer at Pasir Mas City Health Clinic, Hospital Street, Pasir Mas, Kelantan, Malaysia.
| | - Afifah Rahimi
- BPharm. Senior Pharmacist at Pasir Mas City Health Clinic, Hospital Street, Pasir Mas, Kelantan, Malaysia.
| | - Mahmathi Karuppannan
- PhD. Senior Lecturer, Faculty of Pharmacy, University of Technology MARA (UiTM). Selangor (Malaysia).
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An Overview of Reviews on Interprofessional Collaboration in Primary Care: Barriers and Facilitators. Int J Integr Care 2021; 21:32. [PMID: 34220396 PMCID: PMC8231480 DOI: 10.5334/ijic.5589] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Interprofessional collaboration (IPC) is becoming more widespread in primary care due to the increasing complex needs of patients. However, its implementation can be challenging. We aimed to identify barriers and facilitators of IPC in primary care settings. Methods: An overview of reviews was carried out. Nine databases were searched, and two independent reviewers took part in review selection, data extraction and quality assessment. A thematic synthesis was carried out to highlight the main barriers and facilitators, according to the type of IPC and their level of intervention (system, organizational, inter-individual and individual). Results: Twenty-nine reviews were included, classified according to six types of IPC: IPC in primary care (large scope) (n = 11), primary care physician (PCP)-nurse in primary care (n = 2), PCP-specialty care provider (n = 3), PCP-pharmacist (n = 2), PCP-mental health care provider (n = 6), and intersectoral collaboration (n = 5). Most barriers and facilitators were reported at the organizational and inter-individual levels. Main barriers referred to lack of time and training, lack of clear roles, fears relating to professional identity and poor communication. Principal facilitators included tools to improve communication, co-location and recognition of other professionals’ skills and contribution. Conclusions: The range of barriers and facilitators highlighted in this overview goes beyond specific local contexts and can prove useful for the development of tools or guidelines for successful implementation of IPC in primary care.
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Damiaens A, Fraeyman J, Fakroune S, Hutsebaut C, Roussel S, Van Dyck L, Van Hal G, Van den Broucke S, Foulon V. General Practitioners and Community Pharmacists' Collaboration in Primary Care: Small Steps for a Major Change. Int J Integr Care 2021; 21:10. [PMID: 33976599 PMCID: PMC8064283 DOI: 10.5334/ijic.5612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Amber Damiaens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Jessica Fraeyman
- Association of Community Health Centers, Vooruitgangstraat 333 box 10, B-1030 Brussels
- Department of Epidemiology and Social Medicine, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk
| | - Sarah Fakroune
- Psychological Sciences Research Institute, UCLouvain, Place Cardinal Mercier 10, B-1348, Louvain-La-Neuve, Belgium
| | - Caroline Hutsebaut
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Sandrine Roussel
- Psychological Sciences Research Institute, UCLouvain, Place Cardinal Mercier 10, B-1348, Louvain-La-Neuve, Belgium
| | - Lieve Van Dyck
- Department of Epidemiology and Social Medicine, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk
| | - Guido Van Hal
- Department of Epidemiology and Social Medicine, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, UCLouvain, Place Cardinal Mercier 10, B-1348, Louvain-La-Neuve, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
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Evaluation of General Practice Pharmacists: Study Protocol to Assess Interprofessional Collaboration and Team Effectiveness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030966. [PMID: 33499259 PMCID: PMC7908139 DOI: 10.3390/ijerph18030966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022]
Abstract
The inclusion of pharmacists into general practices has expanded in Australia. However, there is a paucity of research examining interprofessional collaboration and team effectiveness after including a pharmacist into the general practice team in primary or community care. This is a protocol for a cross-national comparative mixed-methods study to (i) investigate interprofessional collaboration and team effectiveness within the general practice team after employing pharmacists in general practices in the Australian Capital Territory (ACT) and (ii) to compare interprofessional collaboration and team effectiveness of pharmacists in general practice across Australia with international sites. The first objective will be addressed through a multiphase sequential explanatory mixed-method design, using surveys and semi-structured interviews. The study will recruit general practice pharmacists, general practitioners, and other health professionals from eight general practices in the ACT. Quantitative and qualitative results will be merged during interpretation to provide complementary perspectives of interprofessional collaboration. Secondly, a quantitative descriptive design will compare findings on interprofessional collaboration (professional interactions, relationship initiation, exchange characteristics, and commitment to collaboration) and team effectiveness of general practice pharmacists in Australia with international sites from Canada and the United Kingdom. The results of the study will be used to provide recommendations on how to best implement the role of general practice pharmacists across Australia.
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Hashmi F, Hassali MA, Saleem F, Saeed H, Islam M, Malik UR, Atif N, Babar ZUD. Perspectives of community pharmacists in Pakistan about practice change and implementation of extended pharmacy services: a mixed method study. Int J Clin Pharm 2021; 43:1090-1100. [PMID: 33411180 DOI: 10.1007/s11096-020-01221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Background Community pharmacists' role in the primary health care, patient-centered services, beyond traditional dispensing services is well established in the developed world. However, this role is not fully established in low-middle-income countries including Pakistan. Objective To explore community pharmacists' perspectives and preparedness about practice change and associated facilitators and barriers to extended services. Setting A study was conducted involving community pharmacists of Lahore, Pakistan. Method Two phased studies were conducted using mixed-method sequential design. The first phase involved qualitative semi-structured face-to-face interviews with the community pharmacists, while the second phase constituted a questionnaire-based cross-sectional study. Main outcome measure Pharmacists' perspectives about extended pharmacy services, facilitators, barriers and preparedness for the practice change. Results For the first phase, pharmacists were purposively sampled and the saturation yielded a final sample size of fifteen pharmacists (N = 15). The thematic content analysis yielded four distinct themes; (1) current practices and familiarity with extended pharmacy services (2) practice gap between Pakistan and the developed countries (3) facilitators and the preparedness, and (4) barriers towards its implementation and provision. The second part was a questionnaire-based cross-sectional phase, where a total of 348 community pharmacists were approached, while only 242 responded, yielding a response rate of 69.5%. The triangulation of qualitative and quantitative data identified several barriers such as; shortage of pharmacists, lack of knowledge and skills, poor collaboration with general practitioners, failure of customers to pay for extended services. Facilitators and preparedness for the provision of extended pharmacy services were; access to patient notes, follow-up, separate counselling areas, accreditation of specific services and sufficient resources. Conclusion This study's findings call for the implementation and enforcement of Punjab Drug Sale Rules 2007 to facilitate the practice change and provision of comprehensive pharmacy services in Punjab, Pakistan. There is a need for additional laws to define community pharmacists' roles, uniform job description, training, new funding model, separate area, and accreditation of extended pharmacy services in Pakistan.
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Affiliation(s)
- Furqan Hashmi
- University College of Pharmacy, University of the Punjab Allama Iqbal Campus, Lahore, Pakistan.
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Pulau Penang, Malaysia
| | - Fahad Saleem
- Faculty of Pharmacy, University of Balochistan, Sariab Road, Quetta, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, University of the Punjab Allama Iqbal Campus, Lahore, Pakistan
| | - Muhammad Islam
- University College of Pharmacy, University of the Punjab Allama Iqbal Campus, Lahore, Pakistan
| | | | - Naveel Atif
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK
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Divergent and Convergent Attitudes and Views of General Practitioners and Community Pharmacists to Collaboratively Implement Antimicrobial Stewardship Programs in Australia: A Nationwide Study. Antibiotics (Basel) 2021; 10:antibiotics10010047. [PMID: 33466476 PMCID: PMC7824809 DOI: 10.3390/antibiotics10010047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 11/23/2022] Open
Abstract
Setting up an interprofessional team for antimicrobial stewardship (AMS) to improve the quality and safety of antimicrobial use in primary care is essential but challenging. This study aimed to investigate the convergent and divergent attitudes and views of general practitioners (GPs) and community pharmacists (CPs) about AMS implementation and their perceived challenges of collaboration to design a GP–pharmacist collaborative AMS (GPPAS) model. Nationwide surveys of GPs and CPs across Australia were conducted January-October 2019. Chi square statistics and a theoretical framework were used for comparative analyses of quantitative and qualitative data, respectively. In total, 999 participants responded to the surveys with 15.4% (n = 386) response rates for GPs and 30.7% (n = 613) for CPs. GPs and CPs were aware about AMS however their interprofessional perceptions varied to the benefits of AMS programs. CPs indicated that they would need AMS training; significantly higher than GPs (GP vs. CP; 46.4% vs. 76.5%; p < 0.0001). GPs’ use of the Therapeutic Guideline Antibiotic was much higher than CPs (83.2% vs. 45.5%; p < 0.0001). No interprofessional difference was found in the very-limited use of patient information leaflets (p < 0.1162) and point-of-care tests (p < 0.7848). While CPs were more willing (p < 0.0001) to collaborate with GPs, both groups were convergent in views that policies that support GP–CP collaboration are needed to implement GPPAS strategies. GP–pharmacist collaborative group meetings (54.9% vs. 82.5%) and antimicrobial audit (46.1% vs. 86.5%) models were inter-professionally supported to optimise antimicrobial therapy, but an attitudinal divergence was significant (p < 0.001). The challenges towards GP–CP collaboration in AMS were identified by both at personal, logistical and organisational environment level. There are opportunities for GP–CP collaboration to improve AMS in Australian primary care. However, strengthening GP–pharmacy collaborative system structure and practice agreements is a priority to improve interprofessional trust, competencies, and communications for AMS and to establish a GPPAS model in future.
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Marques TC, Silva RDOS, Dos Santos Júnior GA, de Jesus Júnior FC, Silvestre CC, Rocha KSS, da Rocha CE, Brito GDC, de Lyra-Jr DP. Evaluation of process indicators of a medication review service between pharmacists and physicians. J Eval Clin Pract 2020; 26:1448-1456. [PMID: 31883204 DOI: 10.1111/jep.13332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Literature have showed inconclusive or contradictory results regarding medication review services effectiveness in optimizing process indicators. Thus, this study aimed to evaluate the process indicators of a medication review service between pharmacists and physicians. METHOD This quasi-experimental study was conducted between March 2013 and February 2014 with patients who were receiving care in a medication review service in a teaching hospital in northeastern Brazil. The main process indicators were number of pharmaceutical consultations; identification and resolution of drug-related problems (DRP) and pharmaceutical interventions that were classified according to type and degree of acceptance. Descriptive statistics were used to report data. The statistical significance of the association between variables was evaluated using the Mantel-Haenszel chi-square test. The 95% confidence interval was considered, and differences were deemed statistically significant if P ≤ .05. RESULTS A total of 146 patients attended the medication review service. The number of consultations per patient ranged from one to five (2.1 ± 1.1). The service identified 366 DRP, most of which were indication (67.5%). Patients who had four to five pharmaceutical consultations were 1.14 times more likely to have their DRP identified (χ2 = 33.83, P < .0001). Of the DRP identified, 183 (42.33%) were resolved. Patients who had between one and two pharmaceutical consultations were 1.22 times more likely not to have their DRP resolved compared with the group with more than three consultations (χ2 = 3.44, P < .05). Of the 173 pharmaceutical interventions made to the medical students and physicians, the majority (98.7%) was accepted. CONCLUSION The collaborative medication review service optimized the process indicators. Drug-related problems identification and resolution required more than three pharmaceutical consultations. Most of the pharmaceutical interventions were accepted by prescribers. Thus, collaborative medication review services may be fundamental to the construction of more effective and safe health systems.
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Affiliation(s)
- Tatiane C Marques
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Rafaella de Oliveira Santos Silva
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Genival A Dos Santos Júnior
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Francisco C de Jesus Júnior
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Carina C Silvestre
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Kérilin S S Rocha
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Chiara E da Rocha
- Department of Pharmacy, Federal University of Sergipe, Lagarto, Brazil
| | | | - Divaldo P de Lyra-Jr
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
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García-Agua Soler N, Gómez-Bermúdez E, Baixauli-Fernández VJ, Bellver-Beltrán S, Velasco-Martínez J, García Ruiz AJ, Jódar-Sánchez F. Medicines use review service in community pharmacies in Spain: REVISA project. Int J Clin Pharm 2020; 43:524-531. [PMID: 32996076 PMCID: PMC8214585 DOI: 10.1007/s11096-020-01158-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/17/2020] [Indexed: 11/26/2022]
Abstract
Background Community pharmacy services play an important role in controlling some factors related to medicine use and patients can benefit from these services to improve the adherence and knowledge of their medications, besides to reduce medicine-related problems. Objective The aim of the REVISA project is to carry out a study on preliminary implementation of the medicines use review service in Spanish community pharmacies. Setting Sixty-four community pharmacies from all regions of Spain. Method A preliminary implementation, cross-sectional multicentre study was conducted using a convenience sample of voluntary community pharmacies. A structured interview enabled to pharmacists to obtain a better understanding of patient's medicines use. Main outcome measure Medicines use review-related time and cost, satisfaction and willingness to pay. Results A total of 495 patients were enrolled. The mean age of the patients was 66.1 years, with the majority females (56.4%) and a mean consumption of 5.7 medicines. A total of 2811 medicines were evaluated and 550 referral recommendations were made (29.8% to Primary Care). The mean time employed by the pharmacists in the medicines use review service was 52.8 min (medicines use review-related cost of €17.27). Most patients expressed a high level of satisfaction with this service (98.5%) and a willingness to pay for it (84%). Conclusion Medicines use review service in community pharmacies in Spain can be delivered, that it appears to be acceptable to patients and that most patients said they would be willing to pay for it. This service may offer an opportunity to promote inter-professional collaboration between pharmacists and general practitioners.
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Affiliation(s)
- Nuria García-Agua Soler
- Chair of Health Economics and Rational Use of Drugs, Department of Pharmacology. University of Málaga, Boulevard Louis Pasteur, 32, 29071, Málaga, Spain.
- Pharmacoeconomics: Clinical and Economic Evaluation of Pharmaceutical Drugs and Palliative Care, Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain.
- Illustrious in the Official College of Pharmacists of Málaga, Málaga, Spain.
- Subcommittee Medicines Use Review, Spanish Society of Family and Community Pharmacy (SEFAC-Sociedad Española de Farmacia Familiar y Comunitaria), Madrid, Spain.
| | - Eugenia Gómez-Bermúdez
- Subcommittee Medicines Use Review, Spanish Society of Family and Community Pharmacy (SEFAC-Sociedad Española de Farmacia Familiar y Comunitaria), Madrid, Spain
| | - Vicente J Baixauli-Fernández
- Subcommittee Medicines Use Review, Spanish Society of Family and Community Pharmacy (SEFAC-Sociedad Española de Farmacia Familiar y Comunitaria), Madrid, Spain
| | - Sara Bellver-Beltrán
- Subcommittee Medicines Use Review, Spanish Society of Family and Community Pharmacy (SEFAC-Sociedad Española de Farmacia Familiar y Comunitaria), Madrid, Spain
| | - Javier Velasco-Martínez
- Subcommittee Medicines Use Review, Spanish Society of Family and Community Pharmacy (SEFAC-Sociedad Española de Farmacia Familiar y Comunitaria), Madrid, Spain
| | - Antonio J García Ruiz
- Chair of Health Economics and Rational Use of Drugs, Department of Pharmacology. University of Málaga, Boulevard Louis Pasteur, 32, 29071, Málaga, Spain
- Pharmacoeconomics: Clinical and Economic Evaluation of Pharmaceutical Drugs and Palliative Care, Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain
| | - Francisco Jódar-Sánchez
- Group in Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine of Seville, IBiS/Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
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Rakvaag H, SØreide GE, Meland E, Kjome RL. Complementing or conflicting? How pharmacists and physicians position the community pharmacist. Pharm Pract (Granada) 2020; 18:2078. [PMID: 33029263 PMCID: PMC7523557 DOI: 10.18549/pharmpract.2020.3.2078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/06/2020] [Indexed: 01/09/2023] Open
Abstract
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.
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Affiliation(s)
- Hilde Rakvaag
- MPharm. Department of Global Public Health and Primary Care, Centre for Pharmacy, University of Bergen. Bergen (Norway).
| | - Gunn E SØreide
- Dr.Phil. Associate Professor. Department of Education, University of Bergen. Bergen (Norway).
| | - Eivind Meland
- MD, PhD. Emeritus Professor. Department of Global Public Health and Primary Care, University of Bergen. Bergen (Norway).
| | - Reidun L Kjome
- MPharm, PhD. Associate Professor. Department of Global Public Health and Primary Care, Centre for Pharmacy, University of Bergen. Bergen (Norway).
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The Emerging Role of Community Pharmacists in Remote Patient Monitoring Services. PHARMACY 2020; 8:pharmacy8030166. [PMID: 32899995 PMCID: PMC7557406 DOI: 10.3390/pharmacy8030166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
Abstract
Remote physiologic monitoring (RPM) services involve the transmission of patient-collected physiologic data to the healthcare team. These data are then analyzed to determine what changes may be needed to enhance patient care. While pharmacists may not be recognized as billing providers through some payers, there are opportunities for pharmacist collaboration with providers to enhance patient access to RPM services. Community pharmacist services are traditionally tied to a product, but pharmacists are skilled in medication management, disease state evaluation, and patient counseling, which are skills that can contribute to an elevated RPM program.
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Gerlach N, Michiels-Corsten M, Viniol A, Schleef T, Junius-Walker U, Krause O, Donner-Banzhoff N. Professional roles of general practitioners, community pharmacists and specialist providers in collaborative medication deprescribing - a qualitative study. BMC FAMILY PRACTICE 2020; 21:183. [PMID: 32887551 PMCID: PMC7487755 DOI: 10.1186/s12875-020-01255-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/27/2020] [Indexed: 12/02/2022]
Abstract
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.
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Affiliation(s)
- Navina Gerlach
- Department of General Practice, University of Marburg, Karl-von-Frisch-Straße 4, D-35043, Marburg, Germany.
| | - Matthias Michiels-Corsten
- Department of General Practice, University of Marburg, Karl-von-Frisch-Straße 4, D-35043, Marburg, Germany
| | - Annika Viniol
- Department of General Practice, University of Marburg, Karl-von-Frisch-Straße 4, D-35043, Marburg, Germany
| | - Tanja Schleef
- Hannover Medical School, Institute of General Practice, Carl-Neuberg-Straße 1, D-30625, Hannover, Germany
| | - Ulrike Junius-Walker
- Hannover Medical School, Institute of General Practice, Carl-Neuberg-Straße 1, D-30625, Hannover, Germany
| | - Olaf Krause
- Hannover Medical School, Institute of General Practice, Carl-Neuberg-Straße 1, D-30625, Hannover, Germany
| | - Norbert Donner-Banzhoff
- Department of General Practice, University of Marburg, Karl-von-Frisch-Straße 4, D-35043, Marburg, Germany
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Experiences of medical dominance in pharmacist-doctor interactions - An elephant in the room? Res Social Adm Pharm 2019; 16:1177-1182. [PMID: 31862212 DOI: 10.1016/j.sapharm.2019.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/24/2019] [Accepted: 12/14/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The development of new roles by pharmacists supports the delivery of healthcare services but potentially also encroaches into other healthcare professions' domains of practice. Some novel pharmacy services are only reluctantly accepted by the medical profession and are surrounded by a discourse which expresses medical dominance, with pharmacists facing resistance to their closer involvement in patient care. OBJECTIVE To investigate whether and how pharmacists may experience medical dominance in their practice. METHODS For this qualitative study, pharmacists working in primary care settings were introduced to concepts of sociology in healthcare and medical dominance, then asked to reflect on personal experiences of potential medical dominance, and their emotional and behavioural response. The reflective texts were thematically analysed using a framework based on theories of medical dominance, self-regulation and the influence of emotions on cognition to interpret themes. RESULTS Twenty-five pharmacists provided detailed reflective accounts. Most worked in a community pharmacy when they experienced medical dominance in interactions with doctors. They described how doctors demarcated territory, evaded scrutiny or disparaged pharmacists' professional expertise. Pharmacists perceived limited options in negotiating these experiences and often employed patients in resolving issues which were left unaddressed. They felt frustrated, undervalued and angry after their experiences and described apprehensiveness in future interactions with doctors. CONCLUSION Although experiences of medical dominance by pharmacists working in primary care seem to be an infrequent though regular occurrence pharmacists do not seem to be well prepared to counter or negotiate around it. Perceived and actual dominance in interprofessional interactions with doctors are stressors which may affect pharmacists' ability to problem-solve, their role effectiveness and satisfaction.
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Clinical Pharmacy Activities Documented (ClinPhADoc): Development, Reliability and Acceptability of a Documentation Tool for Community Pharmacists. PHARMACY 2019; 7:pharmacy7040162. [PMID: 31810295 PMCID: PMC6958443 DOI: 10.3390/pharmacy7040162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 11/16/2022] Open
Abstract
Documentation of community pharmacists’ clinical activities, such as the identification and management of drug-related problems (DRPs), is recommended. However, documentation is not systematic in Swiss community pharmacies, and relevant information about DRPs, such as consequences or involved partners, is frequently missing. This study aims to evaluate the interrater and test-retest reliability, appropriateness and acceptability of the Clinical Pharmacy Activities Documented (ClinPhADoc) tool. Ten community pharmacists participated in the study. Interrater reliability coefficients were computed using 24 standardized cases. One month later, test-retest reliability was assessed using 10 standardized cases. To assess the appropriateness, pharmacists were asked to document clinical activities in their own practice using ClinPhADoc. Acceptability was assessed by an online satisfaction survey. Kappa coefficients showing a moderate level of agreement (>0.40) were observed for interrater and test-retest reliability. Pharmacists were able to document 131 clinical activities. The good level of acceptability and brief documentation time (fewer than seven minutes) indicate that ClinPhADoc is well-suited to the community pharmacy setting. To optimize the tool, pharmacists proposed developing an electronic version. These results support the reliability and acceptance of the ClinPhADoc tool.
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Hohmeier KC, Garst A, Adkins L, Yu X, Desselle SP, Cost M. The Optimizing Care Model: A novel community pharmacy approach to enhance patient care delivery by leveraging the technician workforce through technician product verification. J Am Pharm Assoc (2003) 2019; 59:880-885. [DOI: 10.1016/j.japh.2019.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/12/2019] [Accepted: 07/16/2019] [Indexed: 11/17/2022]
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Ventricelli DJ, Mathis SM, Foster KN, Pack RP, Tudiver F, Hagemeier NE. Communication Experiences of DATA-Waivered Physicians with Community Pharmacists: A Qualitative Study. Subst Use Misuse 2019; 55:349-357. [PMID: 31591924 PMCID: PMC7002186 DOI: 10.1080/10826084.2019.1670210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Patients engaged in evidence-based opioid use disorder (OUD) treatment can obtain prescriptions for buprenorphine containing products from specially trained physicians that are subsequently dispensed by community pharmacists. Despite the involvement of physicians and community pharmacists in buprenorphine prescribing and dispensing, respectively, our understanding of their interactions in this context is limited. Objective: To qualitatively describe the communication and collaborative experiences between Drug Addiction Treatment Act 2000 (DATA)-waivered physicians and community pharmacists from the perspective of the physician. Methods: Ten key informant interviews were conducted with DATA-waivered physicians practicing in Northeast Tennessee. A semi-structured interview guide was used to explore communication and collaborative experiences between the physicians and community pharmacists. Interviews were audio recorded and transcribed verbatim. A coding frame was developed using concepts from the scientific literature and emerging codes from physician interviews. Interviews were coded using NVivo 11, with the data subsequently organized and evaluated for themes. Results: Four themes were identified: (1) mechanics of communication; (2) role specification and expectations; (3) education and understanding; and (4) climate of clinical practice. Physician-pharmacist communication primarily occurred indirectly through patients or staff and perceived challenges to collaboration included; lack of trust, stigma, and fear of regulatory oversight. Physicians also indicated the two professionals may lack clear roles and responsibilities as well as common expectations for treatment plans. Conclusions: Communication between DATA-waivered physicians and community pharmacists is influenced by multiple factors. Further research is warranted to improve physician-community pharmacist collaboration (PCPC) in the context of OUD pharmacotherapy and addiction treatment.
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Affiliation(s)
- Daniel J. Ventricelli
- Department of Pharmacy Practice and Administration,
Philadelphia College of Pharmacy, University of the Sciences, 600 S. 43rd Street,
Philadelphia, PA 19104-4495, USA
| | - Stephanie M. Mathis
- Center for Prescription Drug Abuse Prevention and
Treatment, East Tennessee State University, College of Public Health 104 Lamb Hall,
P.O. Box 70623 Johnson City, TN 37614, USA
| | - Kelly N. Foster
- Department of Sociology & Anthropology, East Tennessee
State University, 223 Rogers-Stout Hall P.O. Box 70644 Johnson City, TN 37614-1702
USA
| | - Robert P. Pack
- Department of Community and Behavioral Health, East
Tennessee State University College of Public Health 104 Lamb Hall, P.O. Box 70623
Johnson City, TN 37614, USA
| | - Fred Tudiver
- Department of Family Medicine, East Tennessee State
University Quillen College of Medicine, P.O. Box 70300 Johnson City, TN 37614
USA
| | - Nicholas E. Hagemeier
- Department of Pharmacy Practice, East Tennessee State
University Gatton College of Pharmacy, P.O. Box 70657, Johnson City, TN 37614,
USA
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Bollen A, Harrison R, Aslani P, van Haastregt JCM. Factors influencing interprofessional collaboration between community pharmacists and general practitioners-A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e189-e212. [PMID: 30569475 DOI: 10.1111/hsc.12705] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Annelies Bollen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Reema Harrison
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Parisa Aslani
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
- Faculty of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Jolanda C M van Haastregt
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands
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Dähne A, Costa D, Krass I, Ritter CA. General practitioner-pharmacist collaboration in Germany: an explanatory model. Int J Clin Pharm 2019; 41:939-949. [PMID: 31140161 DOI: 10.1007/s11096-019-00851-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
Background In Germany, no validated measure and model of pharmacist-physician collaboration existed. Objectives To provide evidence for the factor structure of the previously validated Frequency of Inter-professional Collaboration Instrument and the Attitudes Toward Collaboration Instrument in measuring attitudes toward and frequency of collaboration from the general practitioner's perspective in the context of primary care in Germany; to develop an explanatory model which illustrates factors influencing collaboration. Setting The study was conducted in the primary health care sector in Mecklenburg-Western Pomerania, Germany with a cohort of general practitioners. Method The two measures were translated into German and the survey was administered to 1438 practitioners. Exploratory factor analysis was used to assess the structure of the instruments. Structural equation modelling was used to determine how demographic variables and attitudes influence collaborative behaviour. Main outcome measure Outcome measure comprised frequency of and attitudes toward collaboration among German general practitioners and an explanatory model of practitioner-pharmacist collaboration. Results A response rate of 35.9% was achieved. Exploratory factor analysis revealed one factor for the instrument measuring attitudes and two factors for frequency. The factors were interpreted as 'Communication and Collaboration' and 'Pharmacist medication management'. The significant demographic predictors of collaboration were age, population of the surgery's location, distance to the pharmacy, specialty. Conclusion The results provide evidence for the factor structure of both measures in measuring attitudes toward and frequency of collaboration. A model of collaboration in which behaviour and extent of collaboration are directly influenced by individual and context characteristics is supported.
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Affiliation(s)
- Anna Dähne
- Clinical Pharmacy, Institute of Pharmacy, Ernst-Moritz-Arndt-University, Greifswald, Germany.
| | - Daniel Costa
- Pain Management and Research Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ines Krass
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Christoph A Ritter
- Clinical Pharmacy, Institute of Pharmacy, Ernst-Moritz-Arndt-University, Greifswald, Germany
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Pharmacists' perspectives on medication reviews for long-term care residents with advanced dementia: a qualitative study. Int J Clin Pharm 2019; 41:950-962. [PMID: 31123899 DOI: 10.1007/s11096-019-00821-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/28/2019] [Indexed: 10/26/2022]
Abstract
Background Medication reviews by pharmacists have been shown to identify and reduce drug-related problems in long-term care residents. Objective To explore pharmacist perspectives of the Australian Government funded pharmacist-conducted residential medication management review and its role improving the quality and safety of prescribing in long-term care, in particular for those living with advanced dementia. Setting Australian Long-term care pharmacists. Method A qualitative research methodology approach using semi-structured interviews was used, with participants pharmacists with Residential Medication Management Review experience. Interviews were recorded, transcribed and coded utilising a meta-model of Physician-Community Pharmacy Collaboration in medication review. Main outcome measure Pharmacists' perspectives on the Residential Medication Management Review and how to improve the quality of reviews for residents with advanced dementia. Results Fifteen accredited pharmacists participated. The majority believed that the Residential Medication Management Review had the potential to improve the quality and safety of medicines but highlighted systemic issues that worked against collaborative practice. Participants emphasised the importance of three-way collaboration between general practitioners, pharmacists and nursing staff and highlighted key strategies for its optimisation. Conclusion Incorporating avenues for greater communication between team members can improve collaboration between health professionals and ultimately the quality of medication reviews.
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40
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Faruquee CF, Khera AS, Guirguis LM. Family physicians' perceptions of pharmacists prescribing in Alberta. J Interprof Care 2019; 34:87-96. [PMID: 31043099 DOI: 10.1080/13561820.2019.1609432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Canadian pharmacists now have prescribing authority and little is documented about the physicians' perception, experience and relational dynamics evolving around the pharmacists' prescribing practice. The objective of this study was to explore Albertan family physicians' perceptions and experiences of pharmacists' prescribing practice. We used purposeful and maximum variation sampling method and semi-structured face to face or telephone interviews to collect data. From October 2014 to February 2016, we interviewed 12 family physicians in Alberta, having experience with pharmacist prescribing. Interviews were audio recorded and transcribed verbatim for analysis using an interpretive description method, guided by "Relational Coordination" theory. NVivo software was used to manage the data. Three key beliefs (i.e., renewal versus initiate new prescription, community versus team pharmacists, and "I am responsible") about pharmacist prescribing were identified. Trust and communication were prominent themes which shaped participants' collaboration with pharmacist prescribers. Participants were classified as either "collaborative" or "consultative". Participants had greater collaboration with the team pharmacist prescribers compared to community pharmacists due to a higher level of trust and ease of communication. Renewal prescribing by any pharmacist was well accepted but participants showed hesitancy in accepting pharmacist-initiated prescriptions. Our findings provide insight into interprofessional collaboration and communication between physician and pharmacist prescribers.
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Affiliation(s)
- Chowdhury F Faruquee
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Amandeep Sheny Khera
- Faculty of Medicine and Dentistry, Department of Family Medicine, University of Alberta, Alberta, Canada
| | - Lisa M Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
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41
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Mercer K, Neiterman E, Guirguis L, Burns C, Grindrod K. "My pharmacist": Creating and maintaining relationship between physicians and pharmacists in primary care settings. Res Social Adm Pharm 2019; 16:102-107. [PMID: 30956095 DOI: 10.1016/j.sapharm.2019.03.144] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/15/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Pharmacists and physicians are being increasingly encouraged to adopt a collaborative approach to patient care, and delivery of health services. Strong collaboration between pharmacists and physicians is known to improve patient safety, however pharmacists have expressed difficulty in developing interprofessional working relationships. There is not a significant body of knowledge around how relationships influence how and when pharmacists and physicians communicate about patient care. OBJECTIVES This paper examines how pharmacists and primary care physicians communicate with each other, specifically when they have or do not have an established relationship. METHODS Thematic analysis of data from semi-structured interviews with nine primary care physicians and 25 pharmacists, we examined how pharmacists and physicians talk about their roles and responsibilities in primary care and how they build relationships with each other. RESULTS We found that both groups of professionals communicated with each other in relation to the perceived scope of their practice and roles. Three emerging themes emerged in the data focusing on (1) the different ways physicians communicate with pharmacists; (2) insights into barriers discussed by pharmacists; and (3) how relationships shape collaboration and interactions. Pharmacists were also responsible for initiating the relationship as they relied on it more than the physicians. The presence or absence of a personal connection dramatically impacts how comfortable healthcare professionals are with collaboration around care. CONCLUSION The findings support and extend the existing literature on pharmacist-physician collaboration, as it relates to trust, relationship, and role. The importance of strong communication is noted, as is the necessity of improving ways to build relationships to ensure strong interprofessional collaboration.
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Affiliation(s)
- Kathryn Mercer
- School of Pharmacy, University of Waterloo, Ontario, Canada
| | - Elena Neiterman
- School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
| | - Lisa Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Alberta, Canada
| | - Catherine Burns
- Systems Design Engineering, Faculty of Engineering, University of Waterloo, Ontario, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Ontario, Canada.
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Kympers C, Tommelein E, Van Leeuwen E, Boussery K, Petrovic M, Somers A. Detection of potentially inappropriate prescribing in older patients with the GheOP³S-tool: completeness and clinical relevance. Acta Clin Belg 2019; 74:126-136. [PMID: 30698077 DOI: 10.1080/17843286.2019.1568353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The Ghent Older People's Prescriptions community Pharmacy Screening (GheOP3S-) tool was recently developed as an explicit screening method to detect Potentially Inappropriate Prescribing (PIP) in the community pharmacy. We aimed to validate the GheOP3S-tool as an effective screening method for PIP. METHODS All patients admitted to the acute geriatric ward of the Sint-Vincentius hospital (Belgium) were consecutively screened for inclusion (≥70 years,≥5 drugs chronically). PIP prevalence was evaluated by applying the GheOP3S-tool on the complete medication history. For each PIP-item, clinical relevance of the detected item, relevance of proposed alternative and subsequent acceptance by the treating geriatrician and a general practitioner were evaluated. Additionally, contribution to the current admission and preventability was assessed by the geriatrician. The completeness of a PIP-screening with the GheOP3S-tool was evaluated through comparison with the adapted Medication Appropriateness Index (aMAI). RESULTS We detected 250 GheOP3S-items in 57 of 60 included patients (95%) (median: four PIP-items per patient; IQR: 3-5). Both the geriatrician and the general practitioners scored the clinical relevance of the detected items 'serious' or 'significant' in over 70% of cases. Proposed alternative treatment plans were accepted for 79% of the PIP-items (n = 198). The aMAI detected 536 items, of which 145 were also detected by the GheOP3S-tool. A total of 119 PIP-items were additionally detected by the GheOP3S-tool. CONCLUSION The clinical relevance of the PIP-items detected with the GheOP3S-tool is high, likewise the acceptance rate of proposed alternatives.
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Affiliation(s)
- C. Kympers
- Department of Internal medicine, section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - E. Tommelein
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Gent, Belgium
| | - Ellen Van Leeuwen
- Department of Family Medicine and Primary Health Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Heymans Institute of Pharmacology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - K. Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Gent, Belgium
| | - M. Petrovic
- Department of Internal medicine, section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - A. Somers
- Department of Pharmacy, Ghent University Hospital, Gent, Belgium
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43
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Mercer K, Burns C, Guirguis L, Chin J, Dogba MJ, Dolovich L, Guénette L, Jenkins L, Légaré F, McKinnon A, McMurray J, Waked K, Grindrod KA. Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study. JMIR Hum Factors 2018; 5:e24. [PMID: 30274959 PMCID: PMC6231837 DOI: 10.2196/humanfactors.9891] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/23/2018] [Accepted: 06/24/2018] [Indexed: 01/19/2023] Open
Abstract
Background Primary care needs to be patient-centered, integrated, and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, increasing attention has been paid to how and when medication-related decisions should be coordinated across multidisciplinary care teams. Improved knowledge on how integrated electronic health records (EHRs) can support interprofessional shared decision-making for medication therapy management is necessary to continue improving patient care. Objective The objective of our study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of EHRs. Methods This study is part of a broader cross-Canada study between patients and health care providers around how medication-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semistructured interviews with physicians and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data. Results We collected data from 19 pharmacies and 9 medical clinics and identified 6 main themes from 34 health care professionals. First, Interprofessional Shared Decision-Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by EHRs that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician-Pharmacist Relationship, often predicated by colocation. Conclusions We observed limited communication and collaboration between primary care providers and pharmacists when managing medications. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management so that pharmacists and physicians can move beyond task-based work toward a collaborative approach.
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Affiliation(s)
- Kathryn Mercer
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Catherine Burns
- Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, ON, Canada.,Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Lisa Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jessie Chin
- Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | | | - Lisa Dolovich
- Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Line Guénette
- Population Health and Optimal Health Practices, CHU de Québec Research Centre, Université Laval, Ville de Québec, QC, Canada.,Faculté de pharmacie, Université Laval, Ville de Québec, QC, Canada
| | | | - France Légaré
- Faculty of Medicine, Université Laval, Ville de Québec, QC, Canada
| | | | - Josephine McMurray
- Lazaridis School of Business and Economics, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Khrystine Waked
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Kelly A Grindrod
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
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Tommelein E, Mehuys E, Van Tongelen I, Petrovic M, Somers A, Colin P, Demarche S, Van Hees T, Christiaens T, Boussery K. Community pharmacists' evaluation of potentially inappropriate prescribing in older community-dwelling patients with polypharmacy: observational research based on the GheOP³S tool. J Public Health (Oxf) 2018; 39:583-592. [PMID: 27698269 DOI: 10.1093/pubmed/fdw108] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 08/30/2016] [Indexed: 01/08/2023] Open
Abstract
Background In this study, we aimed to (i) determine the prevalence of potentially inappropriate prescribing (PIP) in community-dwelling older polypharmacy patients using the Ghent Older People's Prescriptions community-Pharmacy Screening (GheOP³S) tool, (ii) identify the items that account for the highest proportion of PIP and (iii) identify the patient variables that may influence the occurrence of PIP. Additionally, pharmacist-physician contacts emerging from PIP screening with the GheOP³S tool and feasibility of the GheOP³S tool in daily practice were evaluated. Methods A prospective observational study was carried out between December 2013 and July 2014 in 204 community pharmacies in Belgium. Patients were eligible if they were (i) ≥70 years, (ii) community-dwelling, (iii) using ≥5 chronic drugs, (iv) a regular visitor of the pharmacy and (v) understanding Dutch or French. Community pharmacists used a structured interview to obtain demographic data and medication use and subsequently screened for PIP using the GheOP³S tool. A Poisson regression was used to investigate the association between different covariates and the number of PIP. Results In 987 (97%) of 1016 included patients, 3721 PIP items were detected (median of 3 per patient; inter quartile range: 2-5). Most frequently involved with PIP are drugs for the central nervous system such as hypnosedatives, antipsychotics and antidepressants. Risk factors for a higher PIP prevalence appeared to be a higher number of drugs (30% extra PIPs per 5 extra drugs), female gender (20% extra PIPs), higher body mass index (BMI, 20% extra PIPs per 10-unit increase in BMI) and poorer functional status (30% extra PIPs with 6-point increase). The feasibility of the GheOP³S tool was acceptable although digitalization of the tool would improve implementation. Despite detecting at least one PIP in 987 patients, only 39 physicians were contacted by the community pharmacists to discuss the items. Conclusion A high prevalence of PIP in community-dwelling older polypharmacy patients in Belgium was detected which urges for interventions to reduce PIP.
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Affiliation(s)
- Eline Tommelein
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, B-9000, Belgium
| | - Els Mehuys
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, B-9000, Belgium
| | - Inge Van Tongelen
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, B-9000, Belgium
| | - Mirko Petrovic
- Department of Internal medicine, Faculty of Medicine and Health Sciences, Ghent University, B-9000, Belgium
| | - Annemie Somers
- Department of Pharmacy, Ghent University Hospital, B-9000, Belgium
| | - Pieter Colin
- Laboratory of Medical Biochemistry and Clinical Analysis, Faculty of Pharmaceutical Sciences, Ghent University, B-9000, Belgium
| | - Sophie Demarche
- Department of Clinical Pharmacy, CIRM (Centre for Interdisciplinary Research on Medicines), University of Liège, B-9000, Belgium
| | - Thierry Van Hees
- Department of Clinical Pharmacy, CIRM (Centre for Interdisciplinary Research on Medicines), University of Liège, B-9000, Belgium
| | - Thierry Christiaens
- Faculty of Medicine and Health Sciences, Heymans Institute of Pharmacology, Ghent University, B-9000, Belgium
| | - Koen Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, B-9000, Belgium
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45
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Cardwell K, Hughes CM, Ryan C. Community pharmacists' views of using a screening tool to structure medicines use reviews for older people: findings from qualitative interviews. Int J Clin Pharm 2018; 40:1086-1095. [PMID: 29796962 PMCID: PMC6208598 DOI: 10.1007/s11096-018-0659-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/15/2018] [Indexed: 11/07/2022]
Abstract
Background The Medicines use review (MUR) service, provided by community pharmacists, seeks to optimise patients’ use of medicines. There is limited evidence on the clinical effectiveness of this service. Structuring MURs to include an assessment of prescribing appropriateness, facilitated by a validated prescribing screening tool, has the capacity to enhance this service. Objective To explore community pharmacists’ views on the facilitators and barriers towards the utilisation of a screening tool as a guide to conducting structured MURs. Setting Community Pharmacy, Northern Ireland. Method Using the 14 domain Theoretical Domains Framework (TDF), semi-structured interviews were conducted with community pharmacists. Interviews were digitally recorded, transcribed verbatim and analysed using the Framework method. Main Outcome Measure Pharmacists’ views towards utilisation of a screening tool as a guide to conducting structured MURs. Results Based on the analysis of 15 interviews, 11 TDF domains (‘Knowledge’, ‘Skills’, ‘Social and professional role and identity’, ‘Beliefs about capabilities’, ‘Beliefs about consequences’, ‘Reinforcement’, ‘Goals’, ‘Memory, attention and decision process’, ‘Environmental context and resources’, ‘Social influences’, ‘Behavioural regulation’) were deemed relevant. Facilitators included: knowledge of patients, clinical knowledge, perceived professional role, patients’ clinical outcomes, influence of peers. Barriers included: prioritisation of other clinical activities, inability to access patients’ clinical information, perceived alienation from the primary healthcare team and staffing issues. Conclusions Using the TDF, key facilitators and barriers were identified in the use of a screening tool as a guide to conducting MURs. These findings may assist in further development of MURs as a means to optimise patients’ medicines use.
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Affiliation(s)
- Karen Cardwell
- Department of General Practice, Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Carmel M Hughes
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Cristín Ryan
- School of Pharmacy and Pharmaceutical Science, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
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46
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Díaz de León-Castañeda C, Gutiérrez-Godínez J, Colado-Velázquez JI, Toledano-Jaimes C. Healthcare professionals' perceptions related to the provision of clinical pharmacy services in the public health sector: A case study. Res Social Adm Pharm 2018; 15:321-329. [PMID: 29731375 DOI: 10.1016/j.sapharm.2018.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Mexico, the Modelo Nacional de Farmacia Hospitalaria (MNFH, or National Hospital Pharmacy Model), published in 2009, mainly aims to promote the provision of clinical pharmacy services in private and public hospitals. However, there is little scientific documentation about the quality of these services. OBJECTIVES To explore healthcare professionals' perceptions related to the quality of clinical pharmacy services provision. METHODS A case-study based on a qualitative approach was performed at the pharmaceutical services unit at a public hospital located in Mexico City, which operates under the administrative control of the Ministry of Health. Donabedian's conceptual model was adapted to explore health care professionals' perceptions of the quality of clinical pharmacy services provision. Semi-structured interviews were carried out with pharmacists, physicians and nurses and then transcribed and analyzed via discourse analysis and codification techniques, using the software package Atlas. ti. RESULTS Limitations in pharmaceutical human resources were identified as the main factor affecting coverage and quality in clinical pharmacy services provision. However, the development in pharmacy staff of technical competences and skills for clinical pharmacy service provision were recognized. Significant improvements in the rational use of medicines were associated with clinical pharmacy services provision. CONCLUSIONS The perception analysis performed in this study suggested that it is necessary to increase pharmacy staff in order to improve interprofessional relationships and the quality of clinical pharmacy services provision.
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Affiliation(s)
- Christian Díaz de León-Castañeda
- Consejo Nacional de Ciencia y Tecnología - Infotec, Circuito Tecnopolo Sur 112, Tecnopolo Pocitos, 20313, Aguascalientes, Ags., Mexico.
| | - Jéssica Gutiérrez-Godínez
- Hospital General "Dr. Manuel Gea González", Secretaría de Salud, Calzada de Tlalpan 4800, Tlalpan Centro I, 14080, Tlalpan, Ciudad de México, Mexico.
| | - Juventino Iii Colado-Velázquez
- Departamento de Ciencias de la Salud, Universidad Autónoma de Occidente, Boulevard Lola Beltrán s/n, 4 de Marzo, 80107, Culiacán, Sinaloa, Mexico.
| | - Cairo Toledano-Jaimes
- Facultad de Farmacia, Universidad Autónoma del Estado de Morelos, Avenida Universidad 1001, Chamilpa, 62210, Cuernavaca, Morelos, Mexico.
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Saha SK, Hawes L, Mazza D. Improving antibiotic prescribing by general practitioners: a protocol for a systematic review of interventions involving pharmacists. BMJ Open 2018; 8:e020583. [PMID: 29654036 PMCID: PMC5898351 DOI: 10.1136/bmjopen-2017-020583] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Effective antibiotic options in general practice for patients with infections are declining significantly due to antibiotic over-prescribing and emerging antibiotic resistance. To better improve antibiotic prescribing by general practitioner (GP), pharmacist-GP collaborations have been promoted under antibiotic stewardship programmes. However, there is insufficient information about whether and how pharmacists help GPs to more appropriately prescribe antibiotics. This systematic review aims to determine whether pharmacist-led or pharmacist-involved interventions are effective at improving antibiotic prescribing by GPs. METHODS AND ANALYSIS A systematic review of English language randomised controlled trials (RCTs), cluster RCTs, controlled before-and-after studies and interrupted time series studies cited in MEDLINE, EMBASE, EMCARE, CINAHL Plus, PubMed, PsycINFO, Cochrane Central Register of Controlled Trials and Web of Science databases will be conducted. Studies will be included if a pharmacist is involved as the intervention provider and GPs are the intervention recipients in general practice setting. Data extraction and management will be conducted using Effective Practice and Organisation of Care data abstraction tools and a template for intervention description and replication. The Cochrane and ROBINS-I risk of bias assessment tools will be used to assess the methodological quality of studies. Primary outcome measures include changes (overall, broad spectrum and guidelines concordance) of GP-prescribed antibiotics. Secondary outcomes include quality of antibiotic prescribing, delayed antibiotic use, acceptability and feasibility of interventions. Meta-analysis for combined effect and forest plots, χ2 test and I2 statistics for detailed heterogeneity and sensitivity analysis will be performed if data permit. Grading of Recommendations Assessment, Development and Evaluation and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidance will be used to report findings. ETHICS AND DISSEMINATION No ethics approval is required as no primary, personal or confidential data are being collected in this study. The findings will be disseminated to national and international scientific sessions and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42017078478.
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Affiliation(s)
- Sajal K Saha
- Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Melbourne, Victoria 3168, Australia
| | - Lesley Hawes
- Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Melbourne, Victoria 3168, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Melbourne, Victoria 3168, Australia
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Ryan K, Patel N, Lau WM, Abu-Elmagd H, Stretch G, Pinney H. Pharmacists in general practice: a qualitative interview case study of stakeholders' experiences in a West London GP federation. BMC Health Serv Res 2018; 18:234. [PMID: 29609603 PMCID: PMC5879559 DOI: 10.1186/s12913-018-3056-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background Increased patient demand for healthcare services coupled with a shortage of general practitioners necessitates changes in professional roles and service delivery. In 2016, NHS England began a 3-year- pilot study of pharmacists in general practice, however, this is not an entirely new initiative. There is limited, current, evidence-based, UK research to inform the pilot so studies of pre-existing services must suffice until findings from a formal national evaluation are available. Methods The aim of this exploratory, descriptive interview study was to explore the experiences of stakeholders in eight general practices in the Ealing GP Federation, West London, where pharmacy services have been provided for several years. Forty-seven participants, including pharmacy team members (pre-registration and clinical pharmacists, independent prescribers and pharmacy technicians), general practitioners, patients, practice managers, practice nurses and receptionists took part in semi-structured, audio-recorded qualitative interviews which were transcribed verbatim, coded and analysed thematically to extract the issues raised by participants and the practicalities of providing pharmacy services in general practice. Results Findings are reported under the themes of Complementarity (incorporating roles, skills, education and workloads); Integration (incorporating relationships, trust and communication) and Practicalities (incorporating location and space, access, and costs). Participants reported the need for time to develop and understand the various roles, develop communication processes and build inter-professional trust. Once these were established, however, experiences were positive and included decreased workloads, increased patient safety, improved job satisfaction, improved patient relationships, and enhanced cost savings. Areas for improvement included patients’ awareness of services; pharmacists’ training; and regular, onsite access for practice staff to the pharmacy team. Conclusions Recommendations are made for the development of clear role definitions, identification of training needs, dedication of time for team building, production of educational materials for practice staff members and patients, and provision of on-site, full-time pharmacy services. Future work should focus on evaluation of various models of employing pharmacy teams in general practice; integration of pharmacists and pharmacy technicians into multidisciplinary general practice teams; relationships between local community pharmacy and general practice personnel; and patients’ service and information needs. A formal national evaluation of the pilot scheme is overdue. Electronic supplementary material The online version of this article (10.1186/s12913-018-3056-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kath Ryan
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP, UK.
| | - Nilesh Patel
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP, UK
| | - Wing Man Lau
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP, UK.,School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Hamza Abu-Elmagd
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP, UK
| | - Graham Stretch
- Ealing GP Federation, 179C Bilton Road, Perivale, Greenford, Middlesex, UB6 7HQ, UK
| | - Helen Pinney
- Ealing GP Federation, 179C Bilton Road, Perivale, Greenford, Middlesex, UB6 7HQ, UK
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Hasan S, Stewart K, Chapman CB, Kong DCM. Physicians’ perspectives of pharmacist-physician collaboration in the United Arab Emirates: Findings from an exploratory study. J Interprof Care 2018; 32:566-574. [DOI: 10.1080/13561820.2018.1452726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- S. Hasan
- Department of Clinical Sciences, College of Pharmacy, Ajman University, Ajman, United Arab Emirates
| | - K. Stewart
- Centre for Medicine Use and Safety, Monash University, Parkville, Australia
| | - C. B. Chapman
- Centre for Medicine Use and Safety, Monash University, Parkville, Australia
| | - D. C. M. Kong
- Centre for Medicine Use and Safety, Monash University, Parkville, Australia
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50
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Cardwell K, Smith SM. Clinical pharmacists working within family practice: what is the evidence? Fam Pract 2018; 35:120-121. [PMID: 29420724 DOI: 10.1093/fampra/cmy003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Karen Cardwell
- HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Irel
| | - Susan M Smith
- HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Irel
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