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Lee KMK, Page A, Kim S, Al-Diery T, Koeper I, Singh I, Hawthorne D, Johnson J. Perceptions and expectations of health professionals regarding hospital pharmacy services and the roles of hospital pharmacists: A qualitative systematic review and meta-synthesis. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 10:100264. [PMID: 37193372 PMCID: PMC10182321 DOI: 10.1016/j.rcsop.2023.100264] [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: 03/09/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/18/2023] Open
Abstract
Background Pharmacists have become increasingly integrated within the interprofessional hospital team as their scope of practice expanded in recent decades. However, limited research has explored how the roles of hospital pharmacists are perceived by other health professionals. Aim/Objectives To identify what is known about the perceptions of hospital pharmacists' roles and hospital pharmacy services held by non-pharmacist health professionals. Methods A systematic literature search was conducted in August 2022 in MEDLINE, Embase, and CINAHL to identify peer-reviewed articles published between 2011 and 2022. Title/abstract and full-text screening, by two independent reviewers, identified eligible articles. Inclusion criteria included qualitative studies in hospital settings that reported perceptions regarding the roles of hospital pharmacists held by non-pharmacist health professionals. Data were extracted using a standardised extraction tool. Collated qualitative data underwent inductive thematic analysis by two independent investigators to identify codes, which were reconciled and merged into over-arching themes through a consensus process. Findings were assessed to measure confidence using the GRADE-CERQual criteria. Results The search resulted in 14,718 hits. After removing duplicates, 10,551 studies underwent title/abstract screening. Of these, 515 underwent full-text review, and 36 were included for analysis. Most studies included perceptions held by medical or nursing staff. Hospital pharmacists were perceived as valuable, competent and supportive. At an organisational level, the roles of hospital pharmacists were perceived to benefit hospital workflow and improve patient safety. Roles contributing to all four domains of the World Health Organization's Strategic Framework of the Global Patient Safety Challenge were recognised. Highly-valued roles include medication reviews, provision of drug information, and education for health professionals. Conclusion This review describes the roles hospital pharmacists performed within the interprofessional team, as reported by non-pharmacist health professionals internationally. Multidisciplinary perceptions and expectations of these roles may guide the prioritisation and optimisation of hospital pharmacy services.
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Affiliation(s)
- Kyung Min Kirsten Lee
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- Corresponding author.
| | - Amy Page
- WA Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
| | - Sangseo Kim
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | | | - Ivanka Koeper
- SA Pharmacy, Central Adelaide Local Health Network, SA Health, Adelaide, Australia
| | - Isabella Singh
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Deborah Hawthorne
- WA Centre for Health & Ageing, School of Allied Health, University of Western Australia, Perth, Australia
| | - Jacinta Johnson
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
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Papotti B, Marchi C, Adorni MP, Potì F. Drug-drug interactions in polypharmacy patients: The impact of renal impairment. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2021; 2:100020. [PMID: 34909655 PMCID: PMC8663981 DOI: 10.1016/j.crphar.2021.100020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/18/2022] Open
Abstract
Chronic kidney disease (CKD) is a long-term condition characterized by a gradual loss of kidney functions, usually accompanied by other comorbidities including cardiovascular diseases (hypertension, heart failure and stroke) and diabetes mellitus. Therefore, multiple pharmacological prescriptions are very common in these patients. Epidemiological and clinical observations have shown that polypharmacy may increase the probability of adverse drug reactions (ADRs), possibly through a higher risk of drug-drug interactions (DDIs). Renal impairment may further worsen this scenario by affecting the physiological and biochemical pathways underlying pharmacokinetics and ultimately modifying the pharmacodynamic responses. It has been estimated that the prevalence of DDIs in CKD patients ranged between 56.9% and 89.1%, accounting for a significant increase in healthcare costs, length and frequency of hospitalization, with a detrimental impact on health and quality of life of these patients. Despite these recognized high-risk conditions, scientific literature released on this topic is still limited. Basing on the most commonly prescribed therapies in patients with CKD, the present short review summarizes the current state of knowledge of the putative DDIs occurring in CKD patients undergoing polytherapy. The most relevant underlying mechanisms and their clinical significance are also debated.
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Affiliation(s)
- Bianca Papotti
- University of Parma, Department of Food and Drug, 43124, Parma, Italy
| | - Cinzia Marchi
- University of Parma, Department of Food and Drug, 43124, Parma, Italy
| | - Maria Pia Adorni
- University of Parma, Department of Medicine and Surgery – Unit of Neurosciences, 43125, Parma, Italy
- Corresponding author. Department of Medicine and Surgery, Unit of Neurosciences, University of Parma, Parma, Italy.
| | - Francesco Potì
- University of Parma, Department of Medicine and Surgery – Unit of Neurosciences, 43125, Parma, Italy
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Factors influencing the implementation of pharmaceutical care in outpatient settings: A systematic review applying the Consolidated Framework for Implementation Research. Res Social Adm Pharm 2021; 18:2579-2592. [PMID: 34158263 DOI: 10.1016/j.sapharm.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/18/2021] [Accepted: 06/13/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pharmaceutical care in outpatient settings is a type of health service that has been shown to contribute to decreasing drug-related morbidity and mortality rates. However, every process of implementing a new service brings about changes and transformations in the work routine, thus posing challenges. OBJECTIVES This systematic review aims to identify barriers to and facilitators for the implementation of pharmaceutical care in outpatient settings by applying the CFIR method, a framework based on the theory of health services, used to analyze and synthesize research data, which can direct strategies for the service to work as planned. METHODS A systematic review was conducted exploring the barriers to and facilitators for the implementation of pharmaceutical care in outpatient settings. The MEDLINE, EMBASE, CINAHL, COCHRANE, and LILACS databases were consulted. RESULTS Eight studies were included: five qualitative ones, two mixed-method ones, and a quantitative one. The most frequent CFIR constructs identified were Patient Needs and Resources (n = 30, 10.75%), Knowledge and Beliefs about the Intervention (n = 31, 11.11%), Networks and Communications (n = 34, 12.19%), and Available Resources (n = 56, 20.07%). The most cited barriers were: insufficient human resources, patients' unawareness of the existence of the pharmaceutical care service, and pharmacists' resistance to changes. Facilitators included: the opportune presentation of the service to the healthcare team; the use of electronic devices for specific guidance; and the assessment of patient satisfaction. CONCLUSIONS This systematic review allowed detecting key guidelines to improve the implementation process, including (1) defining an implementation method and exploring it extensively during the pre-implementation phase, (2) ensuring human and financial resources, (3) determining how the new service will interact with other existing services. More research is needed to understand how these factors can affect the implementation of clinical services.
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Wu SE, Wen MJ, Chen JH, Shen WC, Chang EH. A qualitative study on the development of pharmacist-managed clinics in Taiwan. J Clin Pharm Ther 2021; 46:966-974. [PMID: 33569839 DOI: 10.1111/jcpt.13378] [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: 12/28/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Pharmacist-managed clinics (PMCs) are established to solve drug-related problems and enhance the quality of care of ambulatory patients. Although the benefits of such services have been demonstrated, little is known about PMC operations, especially outside the United States. The aim of this study was to explore how PMCs were established and to discuss implementation issues of PMCs in Taiwan. METHODS A purposive sample of pharmacists, pharmacy administrators and physicians involved with PMCs was recruited from hospitals of varying scales across Taiwan. Semi-structured, individual interviews were conducted to understand the perceptions of the clinical service of PMCs. Interviews were transcribed verbatim and analysed by thematic analysis to find underlying themes. RESULTS A total of 12 pharmacists, 5 pharmacy administrators and 3 physicians from 8 institutions were interviewed. Pharmacists spent 4 to 20 h per week at PMCs, and the practice experiences of PMC ranged from 1 to 6 years. PMCs have been provided in these institutions for 4 to 11 years with an average volume of 28 h and 25 patient visits weekly. Study participants described influential factors in establishing PMCs, including clinical expertise, attitude towards patient care and trust building with collaborating physicians. Operational concerns in implementing PMCs included role clarifications, manpower shortage, inadequate advanced training or certification, regulatory issues and a lack of service promotion. WHAT IS NEW AND CONCLUSION This research broadens the understanding of operating PMC services and reveals key requirements and concerns regarding the care model, which can be useful for other countries. Resolving perceived barriers and collecting other stakeholders' perspectives may reinforce the integration of PMCs into patient care in the future.
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Affiliation(s)
- Shang-En Wu
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy, Taipei City Hospital Songde Branch, Taipei, Taiwan
| | - Meng-Jung Wen
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Jo-Hsin Chen
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wan-Chen Shen
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Elizabeth H Chang
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Research Center for Pharmacoeconomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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van Berlo-van de Laar IRF, Sluiter HE, Riet EV', Taxis K, Jansman FGA. Pharmacist-led medication reviews in pre-dialysis and dialysis patients. Res Social Adm Pharm 2020; 16:1718-1723. [PMID: 32111533 DOI: 10.1016/j.sapharm.2020.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pre-dialysis and dialysis patients are at risk for drug related problems (DRPs) due to a high incidence of comorbidities. Pharmacist-led medication reviews might reduce the number of DRPs. OBJECTIVES The aim of this study was to evaluate pharmacist-led medication reviews in pre-dialysis and dialysis patients by determining the number and type of DRPs, nephrologist acceptance of pharmacist interventions and time investment. METHODS From September 2017 until December 2018, pharmacist-led medication reviews were performed on pre-dialysis and dialysis patients. DRPs (medication discrepancies, prescribing issues related to drug and dose selection, drug use problems) were identified using the pharmacists' expert opinion and the STOPP/START criteria. Number and type of accepted pharmacist interventions, sustainability of interventions after at least 1 month and time investment were determined. Practical barriers in the process were appraised. RESULTS One-hundred twenty five patients were reviewed: 37 pre-dialysis and 88 dialysis patients. In 100 (80%) patients 277 medication discrepancies were identified of which 224 (81%) were accepted by the nephrologist. Pharmacists suggested 422 interventions concerning drug or dose selection for 115 patients; 106 interventions were accepted by the nephrologist, which resulted in 60 patients having medication changed. Ninety percent of those changes remained implemented on follow-up after at least 1 month. In 46 (37%) patients, the clinical pharmacist detected DRPs concerning the drug use process and performed patient counseling. The average time investment was 85 min per patient for the clinical pharmacist and 15 min for the nephrologist. Besides time investment, unclear responsibility for medication management due to multiple prescribers was an important barrier in the process and the main reason for nephrologists to reject pharmacist interventions. CONCLUSION Pharmacist-led medication reviews in pre-dialysis and dialysis patients led to medication changes in half of the patients. However, efficiency should be improved before adopting pharmacist-led medication reviews into clinical practice.
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Affiliation(s)
| | - Henk E Sluiter
- Department of Internal Medicine, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, the Netherlands.
| | - Esther van 't Riet
- Department of Research and Innovation, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, the Netherlands.
| | - Katja Taxis
- Unit of PharmacoTherapy, Epidemiology &-Economics, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands.
| | - Frank G A Jansman
- Department of Clinical Pharmacy, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, the Netherlands; Unit of PharmacoTherapy, Epidemiology &-Economics, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands.
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Parker K, Wong J. Is polypharmacy an increasing burden in chronic kidney disease? The German experience. Clin Kidney J 2019; 12:659-662. [PMID: 31584570 PMCID: PMC6768297 DOI: 10.1093/ckj/sfz072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Indexed: 02/07/2023] Open
Abstract
This is a commentary article describing the key findings of the German chronic kidney disease (GCKD) study and how these relate to current practice. With the GCKD study showing high levels of polypharmacy, this article discusses ways to ensure that polypharmacy is appropriate and the difficulties faced within a chronic kidney disease population. Suggestions of ways to minimize medication burden in renal patients provide some practical advice for clinicians.
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Affiliation(s)
- Kathrine Parker
- Department of Pharmacy, Manchester University NHS Foundation Trust, Manchester, UK
| | - Joanne Wong
- Department of Pharmacy, Manchester University NHS Foundation Trust, Manchester, UK
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Ghimire S, Banks C, Jose MD, Castelino RL, Zaidi STR. Medication adherence assessment practices in dialysis settings: A survey of renal nurses’ perceptions. J Clin Nurs 2018; 28:528-537. [DOI: 10.1111/jocn.14642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/05/2018] [Accepted: 08/02/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Saurav Ghimire
- Unit for Medication Outcomes Research and Education (UMORE) Pharmacy School of Medicine Faculty of Health University of Tasmania Hobart Tas. Australia
| | - Colin Banks
- Department of Nephrology Royal Hobart Hospital Hobart Tas. Australia
| | - Matthew D. Jose
- Department of Nephrology Royal Hobart Hospital Hobart Tas. Australia
- School of Medicine Faculty of Health University of Tasmania Hobart Tas. Australia
| | | | - Syed Tabish R. Zaidi
- Unit for Medication Outcomes Research and Education (UMORE) Pharmacy School of Medicine Faculty of Health University of Tasmania Hobart Tas. Australia
- School of Healthcare University of Leeds Leeds UK
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Quintana-Bárcena P, Lalonde L, Lauzier S. Beliefs influencing community pharmacists' interventions with chronic kidney disease patients: A theory-based qualitative study. Res Social Adm Pharm 2018; 15:145-153. [PMID: 29709530 DOI: 10.1016/j.sapharm.2018.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 03/14/2018] [Accepted: 04/05/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Drug-related problems (DRPs) are highly prevalent in chronic kidney disease (CKD) patients. Community pharmacists are ideally positioned to manage these DRPs. However, little is known about the factors influencing their interventions with CKD patients. OBJECTIVES Using the theory of planned behavior (TPB), this qualitative study sought to: (1) explore the behavioral beliefs (perceived advantages and disadvantages), normative beliefs (perceived expectations of significant others) and control beliefs (perceived barriers and facilitators) influencing community pharmacists' interventions related to identifying and managing DRPs in CKD; and (2) compare these beliefs among three DRPs prevalent in CKD patients. METHODS Community pharmacists in Quebec, Canada participated in face-to-face individual semi-structured interviews. The topic guide was based on the TPB. Three vignettes were presented to stimulate community pharmacists' thoughts about their interventions regarding: (1) the use of an inappropriate over-the-counter laxative; (2) prescriptions of anti-inflammatory medications; and (3) non-adherence to antihypertensive medication. Integral transcripts of audio recordings were analyzed using thematic analysis. The findings on each of the three DRPs were systematically compared. RESULTS Fifteen community pharmacists participated in the study. All expressed a positive attitude toward DRP management, mentioning advantages such as gaining the patient's loyalty as a client and avoiding CKD complications. Participants mentioned that patients and physicians generally approve their interventions, but the dynamics of these relationships may vary depending on the DRP. Common barriers in the management of the three DRPs were the pharmacists' limited time and heavy workloads. The pharmacists felt that the main disadvantage is that these interventions interrupt the workflow in the pharmacy. CONCLUSION Community pharmacists hold positive views of their interventions in CKD. However, enhancing community pharmacists' involvement in CKD care may require measures to facilitate pharmacists' proactivity, inter-professional collaboration and a work organization adapted to clinical activities.
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Affiliation(s)
| | - Lyne Lalonde
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Université de Montréal, Centre Intégré de Santé et de Services Sociaux de Laval, Quebec, Canada
| | - Sophie Lauzier
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada; CHU de Quebec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Quebec City, Quebec, Canada.
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Ghimire S, Banks C, Jose MD, Castelino RL, Zaidi STR. Renal pharmacists’ perceptions and current practices of assessing medication adherence in dialysis patients. Int J Clin Pharm 2017; 40:26-35. [DOI: 10.1007/s11096-017-0574-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
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Rural health systems' perceptions of referral to community pharmacists during transitions of care. J Am Pharm Assoc (2003) 2016; 56:562-567.e2. [DOI: 10.1016/j.japh.2016.04.562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 03/10/2016] [Accepted: 04/17/2016] [Indexed: 10/21/2022]
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Barriers to the implementation of advanced clinical pharmacy services at Portuguese hospitals. Int J Clin Pharm 2014; 36:1031-8. [DOI: 10.1007/s11096-014-9991-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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Salgado TM, Moles R, Benrimoj SI, Fernandez-Llimos F. Renal nurses' views of the potential role of pharmacists in outpatient dialysis centres: a qualitative study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2014; 22:300-3. [PMID: 24754627 DOI: 10.1111/ijpp.12082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 09/19/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to explore the differences in the views of Australian and Portuguese renal nurses on the provision of clinical pharmacy services in outpatient dialysis centres. METHODS Semi-structured interviews were conducted with Australian and Portuguese renal nurses. The interviews were recorded and thematically content-analysed. KEY FINDINGS Three main themes were identified: nurses' opinions towards pharmacists' current role; nurses' opinions towards pharmacists' future role; and future clinical pharmacy services to be provided. While Australian nurses appeared to be aware of pharmacists' competencies and viewed a role for pharmacists within the team, Portuguese nurses showed low expectations of pharmacists and regarded them as external to the team. CONCLUSIONS Previous or lack of exposure to pharmacists' clinical skills and the existence of health policies that promote interprofessional collaboration appear to influence nurses' views.
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Affiliation(s)
- Teresa M Salgado
- Research Institute for Medicines and Pharmaceutical Sciences (iMed.UL), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
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