"My pharmacist": Creating and maintaining relationship between physicians and pharmacists in primary care settings

Is it time to stop counting on saturation in pharmacy research? Ideas for a new way forward

The concept of saturation is commonly mentioned in pharmacy research, but there has been recent debate among the applied qualitative research community that challenges the appropriateness of this construct for many qualitative research efforts. This begins by describing the origins of saturation as a grounded theory construct and discusses how saturation is currently being used. Three challenges are discussed related to the use of saturation in pharmacy related to the epistemological, methodological, and practical use of saturation by pharmacy researchers and how they relate to the goals and reporting quality of pharmacy practice research The commentary describes how the concept of information power and established guidance on analysis quality can better justify sample size inform decisions about when to cease further data collection, hopefully increasing the transparency of reporting and supporting rigorous and coherent analyses.

A Goffmanian analysis of impact of unclear professional identity and role negotiation of pharmacists in primary care: A multiple case study

BACKGROUND

Professional identity and its development is a focus of research, education, and practice. But, there is a lack of how professional identity impacts changes in pharmacists' roles in practice, which are particularly prevalent in primary care teams.

OBJECTIVES

This research uses Goffmanian theory, micro-sociologic interactional theory, to describe the outcomes of role negotiation in integrated primary care teams.

METHODS

This is a multiple case study done per Yin, which used interviews and documents to collect data. Interviews used a storytelling format to gather information on the pharmacist's role and negotiation with their team. Four to six interviews were done in each case. Data was analyzed in an iterative manner using the Qualitative approach by Leuven including narrative reports being created for each case.

RESULTS

Five cases were recruited but three cases were completed. In each case, the pharmacist was passive in role negotiation and allowed other actors to decide what tasks were of value. Likely this passivity was due to their professional identities: supportive and "not a physician". These identities led to a focus on the pharmacists' need to develop. This multi-case study demonstrated that pharmacists' professional identity led to passivity being valued and expected. Whether pharmacists self-limited, which has been previously seen, needs to be better defined. But unclear archetypes reduced tasks identified as unique to the pharmacist.

CONCLUSION

Goffmanian theory highlighted a key success for future pharmacist role negotiation, a clear professional identity by both pharmacists and society, including team members. Until that occurs, there is a risk of underuse in primary care team settings.

Development of hospital pharmacy services at transition of care points: a scoping review

BACKGROUND

Several hospital pharmacy services exist, which take place at different interfaces of patient care. Although they are an important tool for improving medication safety, they are not yet sufficiently implemented in hospitals around the world.

OBJECTIVE

This scoping review aims to summarise different hospital pharmacy services at transition of care (TOC) points in order to identify development trends and practice patterns in high-income countries over the past decade.

METHODS

A literature search of four databases (PubMed, PubPharm, Cochrane Library (Ovid) and ScienceDirect) since 2011 was conducted. A detailed search strategy was developed and refined with the help of a research librarian. Title, abstract and full-text selection was carried out by two researchers independently. The study was reported in accordance with the PRISMA-ScR items to ensure quality standard reporting. Only studies originating from developed countries and published in the English language were included. The data obtained were extracted and summarised using a data extraction form developed to meet the research aims of the study.

RESULTS

Of the 5456 search results, 65 studies met the inclusion criteria. These originated from Europe (n=29), North America/Canada (n=28), Australia (n=7) and Asia (n=1). Individual TOC services such as medication reconciliation and medication review on admission and at discharge were the main focus of published literature practice patterns between 2011 and 2016, after which a more holistic TOC service started to emerge that follows patients across all TOC points during their hospital stay. Facilitators and barriers were consistently dependent on resources and infrastructure. Clinical and economic outcomes show a mixed picture.

CONCLUSION

During the past decade pharmaceutical services have developed more holistic TOC services. Large-scale high-quality studies are needed to reliably determine clinical and economic benefit.

Exploring the future adult vaccine landscape-crowded schedules and new dynamics

Amidst the backdrop of the COVID-19 pandemic, vaccine innovation has garnered significant attention, but this field was already on the cusp of a groundbreaking renaissance. Propelling these advancements are scientific and technological breakthroughs, alongside a growing understanding of the societal and economic boons vaccines offer, particularly for non-pediatric populations like adults and the immunocompromised. In a departure from previous decades where vaccine launches could be seamlessly integrated into existing processes, we anticipate potentially than 100 novel, risk-adjusted product launches over the next 10 years in the adult vaccine market, primarily addressing new indications. However, this segment is infamous for its challenges: low uptake, funding shortfalls, and operational hurdles linked to delivery and administration. To unlock the societal benefits of this burgeoning expansion, we need to adopt a fresh perspective to steer through the dynamics sparked by the rapid growth of the global adult vaccine market. This article aims to provide that fresh perspective, offering a detailed analysis of the anticipated number of adult vaccine approvals by category and exploring how our understanding of barriers to adult vaccine uptake might evolve. We incorporated pertinent insights from external stakeholder interviews, spotlighting shifting preferences, perceptions, priorities, and decision-making criteria. Consequently, this article aspires to serve as a pivotal starting point for industry participants, equipping them with the knowledge to skillfully navigate the anticipated surge in both volume and complexity.

Exploring the training of pharmacists oriented to the demands for clinical pharmacy services: from the perspective of physicians

BACKGROUND

To evaluate physicians' perceptions, experiences and expectations of clinical pharmacists in China from the perspective of physicians' demands, to improve the training of pharmacists.

METHODS

A cross-sectional survey involving physicians (except for primary physicians) was conducted from July to August 2019 in China. Using a field questionnaire, this study gathered data on descriptive information about the respondents and their perceptions, experiences and expectations of clinical pharmacists. Data were analysed descriptively using frequencies, percentages and mean. Several subgroup analyses using Chi-square tests were conducted to identify physicians' demands for clinical pharmacists in China.

RESULTS

A total of 1376 physicians from secondary and tertiary hospitals in China (response rate = 92%) participated. The majority of the respondents were comfortable with clinical pharmacists providing education to patients (59.09%) and detecting and preventing prescription errors (60.17%), but they appeared uncomfortable when asked about clinical pharmacists suggesting the use of prescription medications to patients (15.71%). Most respondents agreed that clinical pharmacists are a reliable source of general drug information (81.84%) instead of clinical drug information (79.58%). The majority of the respondents expected clinical pharmacists to be knowledgeable drug therapy experts (95.56%) and to educate their patients about the safe and appropriate use of medications (95.56%).

CONCLUSION

Physicians' perceptions and experiences were positively associated with the frequency of their interaction with clinical pharmacists. They had high expectations of clinical pharmacists as knowledgeable drug therapy experts. Corresponding policies and measures are needed to improve the education and training system of clinical pharmacists in China.

Family physicians collaborating for health system integration: a scoping review

BACKGROUND

In Canada, Ontario Health Teams (OHTs) are a new model for integrated healthcare. Core to OHTs are family physicians (FPs) and their ability to collaborate with other FPs and healthcare providers. Whereas the factors for intra-organizational collaboration have been well-studied, inter-organizational collaboration between FPs and other healthcare organizations as an integrated care network, are less understood. This paper aims to explore the structural factors, processes, and theoretical frameworks that support FPs' collaboration for integrated healthcare.

METHODS

A scoping review was undertaken based on Joanna Briggs Institute (JBI) methodology for scoping review and using the Preferred Reporting Items for Systematic Review and Meta-Analysis for Scoping Review (PRISMA_ScR) checklist. A search for academic and relevant grey literature published between 2000-2021 was conducted across databases (MEDLINE, EMBASE, EBSCOhost).Thematic analysis was used to identify the key findings of the selected studies.

RESULTS

Thirty-two studies were included as eligible for this review. Three structural components were identified as critical to FPs' successful participation in inter-organizational partnerships: (1) shared vision/values, (2) leadership by FPs, and (3) defined decision-making procedures. Also, three processes were identified: (1) effective communication, (2) a collective sense of motivation for change, and (3) relationships built on trust. Three theoretical frameworks provided insight into collaborative initiatives: (1) Social Identity Approach, (2) framework of interprofessional collaboration, and (3) competing values framework.

CONCLUSION

FPs hold unique positions in healthcare and this review is the first to synthesize the best evidence for building collaborations between FPs and other healthcare sectors. These findings will inform collaboration strategies for healthcare integration, including with OHTs.

Systematic literature review of pharmacists in general practice in supporting the implementation of shared care agreements in primary care

BACKGROUND

Rising demand for healthcare continues to impact all sectors of the health service. As a result of the growing ageing population and the burden of chronic disease, healthcare has become more complex, and the need for more efficient management of specialist medication across the healthcare interface is of paramount importance. With the rising number of pharmacists working in primary care in clinical roles, is this a role that pharmacists could support to ensure the successful execution of shared care agreement (SCA) in primary care for these patients?

AIM OF THE REVIEW

Systematic review to identify activities and assess the interventions provided by pharmacists in primary care on SCA provision and how it affects health-related quality of life (HRQoL) for patients.

METHOD

Primary studies in English which tested the intervention or obtained views of stakeholders related to pharmacist input to shared care agreement within primary care were included. The following electronic databases were systematically searched from the date of inception to November 2021: AMED®, CINAHL®, Cochrane Database of Systematic Reviews (CDSR), EMBASE®, EMCARE®, Google Scholar, HMIC®, MEDLINE®, PsycINFO®, Scopus and Web of Science®. Grey literature sources were also searched. The search was adapted according to the respective database-specific search tools. It was searched using a combination of Medical Subject Heading terms (MeSH), free-text search terms and Boolean operators.

RESULTS

A total of 5244 titles/abstracts were screened after duplicates were removed, and 64 full articles were assessed for eligibility. On examination of full text, no studies met the inclusion criteria for this review.

CONCLUSION

This review highlights the need for further research to evaluate how pharmacists in general practice can support the safe and effective integration of specialist medication in primary care with the use of SCA.

SYSTEMATIC REVIEW REGISTRATION

NIHR PROSPERO No: 2020 CRD42020165363 .

Awareness, Familiarity, and Pharmacist Trust: A Structural Equation Model Analysis

Background: Trust in health care professionals is critical in the health care system and is needed for a patient to seek care, reveal sensitive information, and follow a specified treatment plan, among other things. Objective: To better understand trust in community pharmacists, this research develops a model of how patient awareness of the different community pharmacy roles (role awareness) and pharmacist familiarity influences pharmacist trust. Methods: A survey of pharmacy patients in Nova Scotia, Canada, occurred in November and December 2019, with quota sampling used to achieve representativeness by age, gender, and household income. A total of 640 usable surveys were obtained. Consistent partial least squares was deployed to test and refine the model. Results: Overall, the final model highlights that both role awareness and pharmacist familiarity influence patient assessments of pharmacist trust and explains 38.7% of its variance. Pharmacist familiarity has a stronger influence than role awareness on pharmacist trust. Results of the consistent partial least squares multigroup analysis found no statistically significant differences in the model based on patient gender. Conclusion: This research provides a means to capture interpersonal trust in community pharmacists and identifies 2 key determinants of such trust. This research also provides guidance on how to assess pharmacist trust, the value of patients knowing their pharmacist, and the value of patient awareness of the roles of the various professionals behind the counter. Such knowledge will help pharmacy managers, associations, and regulatory authorities develop evidence-informed plans to assess, rebuild, and sustain trust.

Impact of an ambulatory care pharmacist on provider relative value units in a rural clinic

Introduction

Collaborative team-based care models have been shown to improve the quality of care provided to patients and may increase productivity along with patient access to care. Productivity is often tracked via work relative value units (wRVU). The primary objective of this project was to evaluate how a collaborative practice model affects tracked productivity.

Methods

Data regarding wRVU were retrospectively extracted from the electronic medical record from a single center. De-identified data points included total number of patients seen and level of service billed for the visit. Visits were grouped as collaborative (physician-pharmacist) or independent (physician alone). Relative value unit totals were calculated separately for individual physicians and pharmacy visits and also combined for collaborative team wRVU totals. Wilcoxon and descriptive statistics were used for analysis. All statistical analyses were performed using SAS v 9.4 (Cary, NC).

Results

A total of 624 patient visits were reviewed. Total number of patients seen by physicians working in collaboration was on average 19.25 per day versus 12.9 per day for those working independently. When evaluating only the average per encounter wRVU for each provider removing collaborative patients, the three providers who worked in the collaborative model averaged 1.45, 1.48, and 1.55 wRVU per patient respectively, compared to those who worked singularly (1.37 and 1.30). This was found to be statistically significant in the unadjusted mixed model (P = 0.0476), but not maintained once adjusted.

Conclusion

Physicians working in collaboration with a pharmacist were able to bill at a higher level on average suggesting more productivity.

The ethical challenges in pharmacy practice in community Pharmacies: A qualitative study

Background

Pharmacists as a group of health care professionals, face different types of ethical challenges in their everyday routine that may impede pharmaceutical care.

Objectives

In this study, we aimed at evaluation and recognition of the ethical challenges of pharmacy practice in community pharmacies.

Methods

This exploratory study was conducted as a qualitative study consisting of open-ended in-depth interviews and focus group discussions followed by content analysis. The study participants were chosen from pharmacists with PharmD degree who had at least 4 years work experience and were the founders or technical managers of community pharmacies, either as governmental or private. Interviews continued until data saturation and transcribed verbatim. The content analysis was done by Graneheim and Lundman method. The codes were generated, and categorized. After assessment and final modifications, the results of the study were discussed and confirmed in a focus group discussion conducted by 7 experts who teach medical ethics and/or pharmacy ethics.

Results

Overall, 40 pharmacists were interviewed (mean age 46 ± 11.3 years). The extracted ethical challenges of pharmacy practice were categorized into 3 main themes, 11 subthemes and 102 codes. The themes were achieved as challenges related to professionalism and professional practice, challenges related to professional communications and challenges related to regulations and policies.

Conclusion

Taken together, it seems that most of the challenges of pharmacy practice are related to professionalism and professional commitment; however, the regulations and policies provide serious obstacles for pharmacy practice and pharmaceutical care. More efforts towards teaching professionalism and modification of regulations and policies are recommended.

Cooperation Between Pharmacists and Physicians - Whether It Was Before and is It Still Ongoing During the Pandemic?

Nowadays, it is very important to put an emphasis on widely understood teamwork. This is of great importance for achieving and maintaining success in all areas, especially in medicine. This kind of unity has many advantages, including unique ideas that are very helpful in a competitive environment, improve performance and knowledge, and create stronger supportive work relationships. Patient’s health can be improved by using comprehensive treatment. This provides an urgent need for multidisciplinary partnership in the medical community. Optimal pharmacological treatment is crucial to achieving treatment goals. To ensure excellent quality of medical care, interprofessional cooperation between physicians and pharmacists and/or other medical professionals is necessary. Their complementary knowledge and experience can lead to improved health outcomes and can also reduce treatment costs. There are also many barriers and difficulties in legal systems that would allow for more effective inter-professional cooperation. The COVID-19 pandemic contributed to emphasizing the role of the pharmacist, increasing powers, and at the same time to teamwork, sometimes forced by the situation. The purpose of this publication is to view the literature on the cooperation of physicians and pharmacists in the provision of medical services for patients. Professional cooperation has been well known in many countries for years, as it is a key medium supporting optimized patient care. Analyzing the challenges and approaches can lead to better and improved health care.

General Practitioners and Community Pharmacists' Collaboration in Primary Care: Small Steps for a Major Change

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.

Prescribers' perspectives on including reason for use information on prescriptions and medication labels: a qualitative thematic analysis

BACKGROUND

The indication for prescribing a particular medication, or its reason for use (RFU) is a crucial piece of information for all those involved in the circle of care. Research has shown that sharing RFU information with physicians, pharmacists and patients improves patient safety and patient adherence, however RFU is rarely added on prescriptions by prescribers or on medication labels for patients to reference.

METHODS

Qualitative interviews were conducted with 20 prescribers in Southern Ontario, Canada, to learn prescribers' current attitudes on the addition of RFU on prescriptions and medication labels. A trained interviewer used a semi-structured interview guide for each interview. The interviews explored how the sharing of RFU information would impact prescribers' workflows and practices. Interviews were recorded, transcribed and thematically coded.

RESULTS

The analysis yielded four main themes: Current Practice, Future Practice, Changing Culture, and Collaboration. Most of the prescribers interviewed do not currently add RFU to prescriptions. Prescribers were open to sharing RFU with colleagues via a regional database but wanted the ability to provide context for the prescribed medication within the system. Many prescribers were wary of the impact of adding RFU on their workflow but felt it could save time by avoiding clarifying questions from pharmacists. Increased interprofessional collaboration, increased patient understanding of prescribed medications, avoiding guesswork when determining indications and decreased misinterpretation regarding RFU were cited by most prescribers as benefits to including RFU information.

CONCLUSIONS

Prescribers were generally open to sharing RFU and clearly identified the benefits to pharmacists and patients if added. Critically, they also identified benefits to their own practices. These results can be used to guide the implementation of future initiatives to promote the sharing of RFU in healthcare teams.

Resident physicians' perceptions of ambulatory care pharmacy

Background:

Physicians’ acceptance of clinical pharmacy services is dependent on exposure to those services, with use increasing as resident physicians progress through their training. Resident physicians train within environments that have a multidisciplinary teaching and clinical care approach, working closely with other healthcare professionals. Ambulatory care pharmacists are increasingly working with resident physicians in clinic settings as part of the multidisciplinary team, and identification of resident physicians’ perceptions may influence future collaboration.

Objective:

The objective of this research is to evaluate the perception of ambulatory care clinical pharmacy services from the perspective of resident physicians.

Methods:

A statewide network of ambulatory care pharmacists was identified and received an electronic questionnaire. Pharmacists working within clinics that serve as training sites for resident physicians then completed and distributed questionnaires to the resident physicians within their clinical site. Items related to demographics and perception of involvement and interactions with clinical pharmacists.

Results:

Forty-five resident physicians responded from four unique clinical sites (response rate = 42%). They agreed or strongly agreed that pharmacists help patients obtain their therapeutic goals (97.8%), are able to educate patients effectively (95.6%), provide high quality care (97.8%), and do a good job helping co-manage patients (91.1%). Previous exposure to pharmacists was limited primarily to the drugstore (48.9%) and hospital (51.1%) settings. Resident physicians in the third year of training and those reporting a friend was a pharmacist, were more likely to have a positive perception of the pharmacist’s role as a resident educator (p=0.048 and p=0.044, respectively).

Conclusions:

Resident physicians with a longer duration of exposure and personal friendship with a pharmacist are more likely to express positive perceptions. Areas for further enhancements in this interprofessional relationship related to perceptions about pharmacist autonomy and patient relationships were identified.