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Vogt CJ, Moecker R, Jacke CO, Haefeli WE, Seidling HM. Exploring the heterogeneity in community pharmacist-led medication review studies - A systematic review. Res Social Adm Pharm 2024; 20:679-688. [PMID: 38811260 DOI: 10.1016/j.sapharm.2024.03.012] [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: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Findings on the effectiveness of medication reviews led by community pharmacists (CPs) are often inconclusive. It has been hypothesized that studies are not sufficiently standardized, and thus, it is difficult to draw conclusions. OBJECTIVE(S) To examine differences in the way CP-led medication review studies are set up. This was accomplished by investigating (1) patient selection criteria, (2) components of the medication review interventions, (3) types of outcomes, and (4) measurement instruments used. METHODS A systematic literature search of randomized controlled trials of CP-led medication reviews was carried out in PubMed and Cochrane Library. Information on patient selection, intervention components, and outcome measurements was extracted, and frequencies were analyzed. Where possible, outcomes were mapped to the Core Outcome Set (COS) for medication review studies. Finally, a network analysis was conducted to explore the influence of individual factors on outcome effects. RESULTS In total, 30 articles (26 studies) were included. Most articles had a drug class-specific or disease-specific patient selection criterion (n = 19). Half of the articles included patients aged ≥60 years (n = 15), and in 40% (n = 12/30) patients taking 4 drugs or more. In 24 of 30 articles, a medication review was comprised with additional interventions, such as distribution of educational material and training or follow-up visits. About 40 different outcomes were extracted. Within specific outcomes, the measurement instruments varied, and COS was rarely represented. CONCLUSION The revealed differences in patient selection, intervention delivery, and outcome assessment highlight the need for more standardization in research on CP-led medication reviews. While intervention delivery should be more precisely described to capture potential differences between interventions, outcome assessment should be standardized in terms of outcome selection by application of the COS, and with regard to the selected core outcome measurement instruments to enable comparison of the results.
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Affiliation(s)
- Cathrin J Vogt
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Robert Moecker
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Christian O Jacke
- Scientific Institute of Private Health Insurance (WIP), Gustav-Heinemann-Ufer 74c, 50968, Cologne, Germany.
| | - Walter E Haefeli
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Hanna M Seidling
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Lambert M, Wonink A, Benko R, Plejdrup Hansen M, van Dijk L, Taxis K. Pharmacists combating antimicrobial resistance: A Delphi study on antibiotic dispensing. Res Social Adm Pharm 2024; 20:723-732. [PMID: 38702286 DOI: 10.1016/j.sapharm.2024.04.006] [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: 11/28/2023] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The daily work of community pharmacists includes dispensing antibiotics, but little is known about how this should be done to ensure quality use of antibiotics. OBJECTIVE To define specific tasks of the community pharmacist when dispensing antibiotics and to assess to what extent these tasks can be implemented in practice in Europe. METHODS A Delphi study with community pharmacist experts in the European Economic Area. Statements on potential tasks for pharmacists during the antibiotic dispensing process were based on a systematic literature review. Participants rated the statements for importance and feasibility of implementation in practice in 3 rounds on a scale from 1 to 9. Consensus of importance was defined as ≥ 80 % of experts rating a statement between 7 and 9. An online expert meeting was conducted between rounds 1 and 2. Scores for all statements were analysed descriptively. RESULTS Overall, 38 experts from 21 countries participated in the study. Experts reached consensus on 108 statements within 5 themes: 1) collaboration with prescribers, 2) checking prescriptions and dispensing, 3) counselling, 4) education, and 5) pharmacy services. Potential tasks included advising and collaborating with prescribers, performing safety checks, and having access to specific prescription information. Additionally, pharmacists should counsel patients related to the dispensed antibiotic and on antimicrobial resistance and infectious diseases. With few exceptions, pharmacists should not dispense antibiotics without prescriptions or prescribe antibiotics. Consensus on feasibility of implementation was only reached for statements in the categories "counselling patients" and "education". Barriers to changing practice included structure of the healthcare system, resistance to change from prescribers or pharmacy staff, lack of time and finances, legal barriers, and patient expectations. CONCLUSION Community pharmacists have an important role when dispensing antibiotics. This study provides important steps towards better community pharmacy antibiotic dispensing practices throughout the EEA.
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Affiliation(s)
- Maarten Lambert
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713, AV, Groningen, the Netherlands.
| | - Anneloes Wonink
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713, AV, Groningen, the Netherlands
| | - Ria Benko
- Institute of Clinical Pharmacy and Albert Szent-Györgyi Medical Center, Central Pharmacy and Emergency Care Department, University of Szeged, 6720, Szeged, Hungary
| | | | - Liset van Dijk
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713, AV, Groningen, the Netherlands; Nivel, Netherlands Institute for Health Services Research, 3513, CR, Utrecht, the Netherlands
| | - Katja Taxis
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713, AV, Groningen, the Netherlands
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Wang J, Chen L, Wang Z, Fang X, Zhen Y. Perceptions, Attitudes, Beliefs, and Practices Toward Traditional Chinese Medicine Therapies for Herpes Zoster: A Cross-Sectional Study of Healthcare Professionals. Risk Manag Healthc Policy 2024; 17:1239-1251. [PMID: 38765781 PMCID: PMC11102122 DOI: 10.2147/rmhp.s461149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Traditional Chinese medicine (TCM) holds great potential in promoting healing and relieving pain for herpes zoster (HZ) treatments. Evidence showed that both healthcare professionals' (HCPs) belief and knowledge influence their attitudes, which result in their expression and direct behavior. However, little is known in this area regarding TCM treatments for HZ. This study aimed to understand the HCPs' perceptions, attitudes, beliefs, and practices toward TCM and its services for HZ. Methods During July 2021 and October 2022, a cross-sectional study of HCPs querying demographics, perceptions, attitudes, beliefs, and practices toward TCM and TCM services for HZ was conducted. The frequency and percentage or mean and standard deviation were used to present categorical data and continuous data, respectively. A Chi-square analysis compared nurses' and doctors' views on TCM treatments for HZ. Results Out of 306 eligible respondents, 66.0% used TCM content in clinical practice less than 40% of the time. Respondents reported that there were three main advantages of TCM for HZ, including better crusting and healing, fewer side effects, and mitigating complications. A total of 41.3% (81/196) of the respondents who had cared for/treated HZ patients applied TCM treatments. The three factors most associated with referrals/providing TCM to patients were postherpetic neuralgia, early erythema or papules, and acute pain. Compared to nurses, doctors showed more endorsement of the efficacy and cost-effectiveness of TCM treatments for HZ patients. Conclusion The study found that most healthcare professionals in HZ had a favorable view of TCM, but lacked practical experience administering it to patients. Programs should be developed to provide evidence-based TCM treatments and encourage combining TCM with Western medicine for better patient care.
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Affiliation(s)
- Jiani Wang
- School of Nursing, Sun Yat-Sen University, Guangzhou City, Guangdong Province, People’s Republic of China
| | - Liudan Chen
- Department of Traditional Chinese Medicine, Sun Yat-Sen Memorial Hospital, Guangzhou City, Guangdong Province, People’s Republic of China
| | - Zhuangfei Wang
- Department of Dermatology, Sun Yat-Sen Memorial Hospital, Guangzhou City, Guangdong Province, People’s Republic of China
| | - Xiaohong Fang
- Department of Dermatology, Sun Yat-Sen Memorial Hospital, Guangzhou City, Guangdong Province, People’s Republic of China
| | - Yan Zhen
- Department of Traditional Chinese Medicine, Sun Yat-Sen Memorial Hospital, Guangzhou City, Guangdong Province, People’s Republic of China
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Ardyansyah BD, Cordier R, Brewer M, Parsons D. An evaluation of the psychometric properties of the Australian Collaborative Practice Assessment Tool. PLoS One 2024; 19:e0302834. [PMID: 38722882 PMCID: PMC11081231 DOI: 10.1371/journal.pone.0302834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 04/14/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES This study aimed to validate the Collaborative Practice Assessment Tool (CPAT) in the Australian setting and provide a quality instrument in terms of psychometric properties that can be used to measure interprofessional outcomes for both healthcare practitioners and students. The outcomes evaluated include the capacity to work in an interprofessional team, good interprofessional communication skills, leadership skills, ensuring clear division of tasks and roles in a team, effective conflict management, and being actively involved with patients and their families/communities in care. METHODS The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) taxonomy and standards were used as guides for evaluating the psychometric properties of the Australian CPAT, which include evaluations regarding instrument development requirements of sample target and size, content validity, internal structure (structural validity, internal consistency reliability and measurement invariance), and hypotheses testing. CPAT Australia was developed through two stages involving pilot studies and a validation study, both of which included healthcare practitioners and students as participants. A pilot study examined content validity regarding item relevance, item comprehensibility, and instrument comprehensiveness. The validation study was carried out to assess the internal structure of CPAT Australia for aspects of structural validity, internal consistency reliabilities, and configural, metric and scalar measurement invariance. The structural validity was explored using the following three steps: exploratory, confirmatory, and multi-group factor analysis. Construct validity was evaluated to confirm direct and indirect paths of assumptions based on a previously validated model. Data collected between August 2021 and May 2022. RESULTS The content validity evaluation confirmed that all items were relevant, understandable and comprehensive for measuring interprofessional collaborative care in Australia. Three hundred ninety-nine participants contributed to the validation study (n=152 practitioners; n=247 students). The original instrument model of 8-Factor 56-Item was improved in the Australian CPAT. Two items, Item 27 (Physicians assume the ultimate responsibility) and Item 49 (Final decision rest with the physician), were consistently rejected and therefore discarded. The internal structure of the 7-Factor 54-Item solution was confirmed as a suitable model with fit indices meeting COSMIN standards for a good model in practitioner and student cohorts. Configural, metric and scalar invariances were confirmed, indicating the invariance of the instruments when used for the practitioner and student cohorts. The construct validity evaluation indicated that 81.3% of direct and indirect assumptions were accepted, fulfilling the COSMIN requirement of >75% of proposed assumptions being accepted. CONCLUSION The Australian CPAT with a 7-factor 54-item solution was confirmed as a quality measure for assessing interprofessional education and collaborative practice for both healthcare practitioners and students in Australia with robust psychometric properties.
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Affiliation(s)
- Bau Dilam Ardyansyah
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Department of Medical Education, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - Reinie Cordier
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon the Tyne, United Kingdom
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Margo Brewer
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Dave Parsons
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
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Angibaud M, Jourdain M, Girard S, Rouxel L, Mouhib A, Nogueira A, Rat C, Huon JF. Involving community pharmacists in interprofessional collaboration in primary care: a systematic review. BMC PRIMARY CARE 2024; 25:103. [PMID: 38561676 PMCID: PMC10983710 DOI: 10.1186/s12875-024-02326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The World Health Organization supports interprofessional collaboration in primary care. On over the past 20 years, community pharmacists had been taking a growing number of new responsibilities and they are recognized as a core member of collaborative care teams as patient-centered care providers. This systematic review aimed to describe interprofessional collaboration in primary care involving a pharmacist, and its effect on patient related outcomes. METHODS A systematic review of randomized controlled trials cited in the MEDLINE, EMBASE, PsycInfo and CINAHL in English and French was conducted from inception to November 2022. Studies were included if they described an intervention piloted by a primary care provider and included a pharmacist and if they evaluated the effects of intervention on a disease or on patient related outcomes. The search generated 3494 articles. After duplicates were removed and titles and abstracts screened for inclusion, 344 articles remained. RESULTS Overall, 19 studies were included in the review and assessed for quality. We found 14 studies describing an exclusive collaboration between physician and pharmacist with for all studies a three-step model of pharmacist intervention: a medication review, an interview with the patient, and recommendations made to physician. Major topics in the articles eligible for inclusion included cardiovascular diseases with blood pressure, diabetes, dyslipidemia, and risk of cardiovascular diseases. Positive effects concerned principally blood pressure. CONCLUSIONS Collaboration involving pharmacists is mainly described in relation to cardiovascular diseases, for which patient-centered indicators are most often positive. It underscores the need for further controlled studies on pharmacist-involved interprofessional collaboration across various medical conditions to improve consensus on core outcomes measures.
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Affiliation(s)
- Morgane Angibaud
- Primary Care Federative Department, Faculty of Medicine, Nantes Université, Nantes, France.
- National Institute for Health and Medical Research, INSERM U1302 Team 2, INCIT, Team 2, Nantes, France.
| | - Maud Jourdain
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Solene Girard
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Louise Rouxel
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Adam Mouhib
- Clinical Pharmacy Unit, Faculty of Pharmacy, Nantes Université, Nantes, France
| | - Antoine Nogueira
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Cédric Rat
- National Institute for Health and Medical Research, INSERM U1302 Team 2, INCIT, Team 2, Nantes, France
- Department of General Practice, Faculty of Medicine, Nantes Université, Nantes, France
| | - Jean-François Huon
- Nantes Université, CHU Nantes, Pharmacie, F-44000, France
- UMR INSERM 1246 SPHERE "methodS in Patient-centered Outcomes and HEalth ResEarch, Nantes Université, Université de Tours, Tours, France
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Clarke V, Lehane E, Cotter P, Mulcahy H. Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence-based practice into routine care: An interpretative phenomenological analysis. J Adv Nurs 2024; 80:1559-1573. [PMID: 37950366 DOI: 10.1111/jan.15917] [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: 02/15/2023] [Revised: 09/02/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023]
Abstract
AIM To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care. DESIGN A qualitative interpretative phenomenological analysis. METHODS A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis. RESULTS Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice. CONCLUSION There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care. IMPACT AND IMPLICATIONS The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients. CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care. REPORTING METHOD Consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Vanessa Clarke
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
- Nursing and Midwifery Planning and Development, Health Service Executive North East, Ardee, County Louth, Ireland
| | - Elaine Lehane
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Patrick Cotter
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Helen Mulcahy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Padilla BI. Interprofessional Education and Essential Approach to Health care. Nurs Clin North Am 2024; 59:37-47. [PMID: 38272582 DOI: 10.1016/j.cnur.2023.11.005] [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] [Indexed: 01/27/2024]
Abstract
In today's changing landscape of the US health care system, it is imperative to have a health care delivery model that is patient-centered and delivered by a multidisciplinary collaborative team with an understanding of each other's roles and responsibilities as well as communicate effectively. Academic institutions must create partnerships with health systems and ambulatory care settings to provide health profession students with authentic and inclusive interprofessional learning opportunities which include practice-ready skills which are needed to enter the health care workforce. Nurses are well positioned to lead this effort and practice within interprofessional teams in health care organizations.
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Affiliation(s)
- Blanca Iris Padilla
- Duke University School of Nursing, Duke University Health System, DUMC 3322, 307 Trent Drive, Durham, NC 27707, USA.
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8
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Ardyansyah BD, Cordier R, Brewer ML, Parsons D. Psychometric evaluation of the culturally adapted interprofessional socialisation and valuing scale (ISVS)-19 for health practitioners and students in Indonesia. J Interprof Care 2024; 38:283-293. [PMID: 38044538 DOI: 10.1080/13561820.2023.2285020] [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: 05/11/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023]
Abstract
We aimed to develop a culturally appropriate psychometrically robust measure for assessing interprofessional socialization for health practitioners and students in Indonesia. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) were used as guidelines. Our study was organized in three phases (a) translation, (b) cross-cultural validation by evaluating the content validity and internal structure of the translated instrument (i.e. structural validity, internal consistency reliability, and measurement invariances), and (c) hypotheses testing for construct validity. A total of 266 health practitioners and 206 students from various professional backgrounds participated. The Indonesian ISVS-19 was confirmed unidimensional. Content validity evaluation confirmed the inclusion of relevant, understandable items and was comprehensive. Factor analysis supported removal of two items. Configural, metric, and scalar tests confirmed the invariance of the 1-Factor 19-Items model in practitioner and student cohorts. Age was a differentiating factor in both cohorts; length of work was only significant for practitioners, and educational background was significant for students (80% of assumptions were accepted, fulfilling COSMIN requirement for construct validity). The Indonesian ISVS-19 has good psychometric properties regarding content validity, internal structure, and construct validity and, therefore, is a psychometrically robust measure for assessing interprofessional socialization for health practitioners and students in Indonesia.
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Affiliation(s)
- Bau Dilam Ardyansyah
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Department of Medical Education, Hasanuddin University, Makassar, Indonesia
| | - Reinie Cordier
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle, UK
- Department of Health & Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Margo L Brewer
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Dave Parsons
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Morris C, McDonald J, Officer TN, Fa'asalele Tanuvasa A, Smiler K, Parore N, Dunn P, McKinlay E, Kennedy J, McBride-Henry K, Cumming J. A realist evaluation of the development of extended pharmacist roles and services in community pharmacies. Res Social Adm Pharm 2024; 20:321-334. [PMID: 38065764 DOI: 10.1016/j.sapharm.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Internationally, community pharmacy models of care have been moving away from a focus on dispensing to extended, clinically-focused roles for pharmacists. OBJECTIVES To identify how community pharmacy strategies were being implemented in Aotearoa New Zealand; how changes were expected to influence health and health system outcomes; what extended services were being delivered; the responses of pharmacists, other health professionals and consumers to these developments; and the contexts and mechanisms supporting the successful implementation of new community pharmacy services. METHODS A realist evaluation methodology was employed, to explore a complex policy intervention. Realist evaluation explores the contexts (C) within which initiatives are introduced and identifies the mechanisms (M) triggered by different contexts to produce outcomes (O). Realist evaluation processes iteratively develop, test, and refine CMO configurations. In this study, initial programme theories were developed through key government and professional policy documents, then refined through key informant interviews, a survey and interviews with pharmacists and intern (pre-registration) pharmacists, and finally, 10 case studies of diverse community pharmacies. RESULTS Four intermediate health service outcomes were identified: development of extended community pharmacist services; consumers using extended community pharmacist services; more integrated, collaborative primary health care services; and a fit-for-purpose community pharmacy workforce. Enabling and constraining contexts are detailed for each outcome, along with the mechanisms that they trigger (or inhibit). CONCLUSIONS There are wide-ranging and disparate levers to support the further development of extended community pharmacy services. These include aligning funding with desired services, undergraduate educators and professional leaders setting expectations for the pharmacists' role in practice, and the availability of sufficient funding and time for both specific extended service accreditation and broader postgraduate training. However, no simple "fix" can be universally applied internationally, nor even in pharmacies within a single jurisdiction, to facilitate service development.
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Affiliation(s)
- Caroline Morris
- Department of Primary Health Care & General Practice, University of Otago, Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand.
| | - Janet McDonald
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Tara Nikki Officer
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Ausaga Fa'asalele Tanuvasa
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Kirsten Smiler
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Nora Parore
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Phoebe Dunn
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Eileen McKinlay
- Department of Primary Health Care & General Practice, University of Otago, Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand.
| | - Jonathan Kennedy
- Department of Primary Health Care & General Practice, University of Otago, Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand.
| | - Karen McBride-Henry
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
| | - Jacqueline Cumming
- Te Hikuwai Rangahau Hauora, Health Services Research Centre, Te Herenga Waka-Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand.
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Fernández Castillo G, Khalid M, Salas E. Beyond communication: an update on transforming healthcare teams. Front Med (Lausanne) 2024; 11:1282173. [PMID: 38449884 PMCID: PMC10915010 DOI: 10.3389/fmed.2024.1282173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/01/2024] [Indexed: 03/08/2024] Open
Affiliation(s)
| | | | - Eduardo Salas
- Making Effective Teams Laboratory, Department of Psychological Science, Rice University, Houston, TX, United States
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11
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Bogaerts C, Schoenmaekers N, Haems M, Storme M, De Loof H. A quality improvement study of the implementation and initial results of a pragmatic clinical decision support system in the community pharmacy setting. Int J Clin Pharm 2024; 46:141-149. [PMID: 37962780 DOI: 10.1007/s11096-023-01648-z] [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: 01/18/2023] [Accepted: 09/06/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND A six year collaboration between academics, community pharmacists and informaticians, led to the development of nine guidelines for a clinical decision support system, enhancing community pharmacists' ability to address drug-related problems and improve care. AIM The objective of this study was to assess the effectiveness of clinical decision support system rules in enhancing medication management within the community pharmacy setting. This was achieved through retrospective monitoring of real-world usage and measuring the pharmacotherapeutic impact of the rules. METHOD In 2019, a retrospective observational evaluation appraised the acceptance rate of the clinical decision support system components in 490 Belgian pharmacies. Among these, 51 pharmacies underwent a longitudinal analysis involving (i) co-prescription of methotrexate and folic acid, (ii) gastroprotection with non-steroidal anti-inflammatory drugs, and (iii) drug combinations causing QT prolongation. The study period spanned one year pre-launch, one year post-launch, and two years post-launch. RESULTS Of the targeted pharmacies, 80% used 7 of the 9 rules. After four years, methotrexate-folic acid co-prescription increased 4%, reaching 79.8%. Gastroprotection improved by 3% among older patients and 7.47% in younger individuals (< 70 year) with multiple risk factors. The QT prolongation rules faced implementation difficulties. CONCLUSION Pharmacists' acceptance of the developed rules was high and coincided with a decline in drug-related problems, holding potential public health impact. This real-world data can inform the future implementation of such systems, as it demonstrated the need for more detailed data-gathering and more intensive training of pharmacists in the handling of more complex problems such as QT prolongation.
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Affiliation(s)
- Carolien Bogaerts
- Royal Society of Pharmacists of East Flanders (KOVAG), Brouwerijstraat 1, 9031, Ghent, Belgium
| | - Nele Schoenmaekers
- Royal Society of Pharmacists of East Flanders (KOVAG), Brouwerijstraat 1, 9031, Ghent, Belgium.
| | - Marleen Haems
- Royal Society of Pharmacists of East Flanders (KOVAG), Brouwerijstraat 1, 9031, Ghent, Belgium
| | - Michael Storme
- Royal Society of Pharmacists of East Flanders (KOVAG), Brouwerijstraat 1, 9031, Ghent, Belgium
| | - Hans De Loof
- Laboratory of Physiopharmacology, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
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12
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Rahayu SA, Widianto S, Defi IR, Abdulah R. Does power distance in healthcare teams linked to patient satisfaction? A multilevel study of interprofessional care teams in a referral hospital in Indonesia. BMC Health Serv Res 2024; 24:83. [PMID: 38229081 DOI: 10.1186/s12913-023-10534-3] [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: 03/19/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Interprofessional care teams collaborate to provide care to patients in hospitals to ensure their full recovery. To provide quality patient care, healthcare workers must have a comprehensive understanding of each other's roles and collaborate effectively. Good interpersonal skills are also essential for maintaining cooperative and collaborative relationships, listening, and respecting other team member's values and positions. Therefore, this study aimed to investigate the effect of power distance in interprofessional care on patients' satisfaction. METHOD A quantitative study was conducted in a hospital by using a questionnaire instrument to collect information from patients and members of the interprofessional care team. The respondents included 10 geriatric, 19 palliative, 36 cancer, 8 burn, and 18 medical intermediate care (MIC) teams. Subsequently, a hierarchical regression analysis was conducted to examine whether interprofessional care could significantly predict the relationship between team power distance and patient satisfaction. RESULTS The measurement of the effect of power distance in interprofessional care among doctors, nurses, pharmacists, and nutritionists on patient satisfaction revealed nonsignificant results. However, the final analysis indicated negative coefficients with regard to power distance for nutritionists (-0.033098), nurses (-0.064912), and pharmacists (-0.006056). These findings indicated that the power distance associated with these professions was linked with decreased patient satisfaction. CONCLUSIONS The results suggested that power distance within an interprofessional care team can reduce patient satisfaction.
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Affiliation(s)
- Susi Afrianti Rahayu
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, 45363, Indonesia
- Bumi Siliwangi College of Pharmacy, Bandung, Indonesia
| | - Sunu Widianto
- Department of Management and Business, Faculty of Economics and Business, Universitas Padjadjaran, Jatinangor, 45363, Indonesia
| | - Irma Ruslina Defi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Padjadjaran, Jatinangor, 45363, Indonesia
- Department of Physical Medicine and Rehabilitation, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, 45363, Indonesia.
- Center for Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia.
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13
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Maerten-Rivera J, Woodruff AE, Zhao Y, Fusco NM. Longitudinal Assessment of Pharmacy Students' Collaborative Practice Abilities. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100627. [PMID: 37972758 DOI: 10.1016/j.ajpe.2023.100627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/17/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Interprofessional education (IPE) varies across schools/colleges of pharmacy. Long-term impact of IPE on interprofessional collaborative competencies remains uncertain despite available data on singular experiences. This study aimed to evaluate changes in pharmacy students' collaborative abilities over the second and third professional years (PYs). METHODS Students completed the Interprofessional Collaborative Competency Attainment Scale - Revised (ICCAS-R) after 2 large-scale interprofessional forums that occurred approximately 8 months apart. Four cohorts of students were used to examine the longitudinal change in collaborative abilities: cohort 1 (2019), cohort 2 (2020), cohort 3 (2021) and cohort 4 (2022). The ICCAS-R was used to capture data from 4 timepoints for each student in each cohort: prior to the Spring Forum in PY2 (T1), after the Spring Forum in PY2 (T2), prior to the Fall Forum in PY3 (T3), and after the Fall Forum in PY3 (T4). Using repeated measures analysis of variance, 4 total mean scores (T1 = pre1, T2 = post1, T3 = pre2, T4 = post2) were compared. RESULTS Four cohorts (N = 414) completed the interprofessional forums and 336 (81%) completed the ICCAS-R instrument and were included. In each cohort, total mean scores increased T1 to T2 and T3 to T4, indicating an increase in self-assessed abilities pre/post-forum. Total mean scores decreased between T2 and T3, indicating that collaborative abilities decreased during the period between interprofessional forums. CONCLUSION While students' collaborative abilities increased around the time of the forum experiences, these changes decreased in between experiences. These findings suggest that interprofessional competencies should be reinforced at multiple time points to support enduring effects.
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Affiliation(s)
- Jaime Maerten-Rivera
- University at Buffalo, School of Pharmacy & Pharmaceutical Sciences, Buffalo, NY, USA
| | - Ashley E Woodruff
- University at Buffalo, School of Pharmacy & Pharmaceutical Sciences, Buffalo, NY, USA
| | - Yichen Zhao
- University at Buffalo, School of Pharmacy & Pharmaceutical Sciences, Buffalo, NY, USA
| | - Nicholas M Fusco
- University at Buffalo, School of Pharmacy & Pharmaceutical Sciences, Buffalo, NY, USA.
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14
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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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15
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Ho JT, See MTA, Tan AJQ, Levett-Jones T, Lau TC, Zhou W, Liaw SY. Healthcare professionals' experiences of interprofessional collaboration in patient education: A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 116:107965. [PMID: 37677919 DOI: 10.1016/j.pec.2023.107965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 07/14/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES This study explores interprofessional collaboration amongst healthcare professionals in patient education. METHODS A systematic review was conducted. A search in seven databases was conducted from 2011 to 2022 and screened against the inclusion criteria. Quality appraisal was done independently by two reviewers. Studies were extracted and synthesised using the data-based convergent synthesis design. RESULTS Twenty-one studies were included. Five themes on factors affecting interprofessional collaboration in patient education emerged: 1) role clarification, 2) communication infrastructure, 3) shared space for collaboration, 4) interprofessional trust, and 5) organisational support. CONCLUSION Findings highlighted the importance of developing trustful relationships within the multidisciplinary team in delivering patient education. Channels for additional infrastructural support, guidelines and training in patient education delivery is required. Future research could explore patients' perspectives on how their learning needs in patient education may be optimised through a multidisciplinary approach. PRACTICE IMPLICATIONS Healthcare leaders could promote shared goals within the team by facilitating a common space and time for interprofessional team rounding, and by developing shared patient education resources and documentation processes. Interprofessional education focusing on the delivery of team-based patient education could be implemented to foster understanding of the interdependent role of multidisciplinary healthcare professionals.
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Affiliation(s)
| | - Min Ting Alicia See
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Apphia Jia Qi Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Tracy Levett-Jones
- School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Tang Ching Lau
- Yong Loo Lin School Medicine, National University of Singapore, Singapore
| | - Wentao Zhou
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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16
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Cai S, Huang X, Van C, Li W, Yan M, Lu Y, Li H, Deng Z, Lu P, Xu Z. General practitioners' attitudes towards and frequency of collaboration with pharmacists in China: a cross-sectional study. BMC Health Serv Res 2023; 23:1174. [PMID: 37891601 PMCID: PMC10612245 DOI: 10.1186/s12913-023-10151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Building interprofessional working relationships between general practitioners (GPs) and pharmacists is essential to ensure high-quality patient care. However, there is limited Chinese literature on GP-pharmacist collaboration, and few studies have explored GPs' experiences with pharmacist integration into general practices. This study aimed to investigate GPs' attitudes towards and frequency of collaboration with pharmacists in China. METHODS This cross-sectional study used an online self-administered questionnaire integrating two scales, ATCI-GP and FICI-GP, which had been translated and validated to investigate 3,248 GPs from February 15 to March 15, 2023 across Zhejiang Province, China. Descriptive analyses were used, and the factors associated with GPs' frequency of collaboration with pharmacists were explored using logistic regression analysis. RESULTS A total of 2,487 GPs (76.6%) responded and consented to participate in the survey; 52.3% were male and the mean age was 35.4 years. Most GPs agreed that they shared common goals and objectives with pharmacists when caring for patients (90.0%), and pharmacists were open to working with them on patients' medication management (80.8%). However, half of the GPs did not change or seldom changed the patient's medication on the pharmacist's advice (51.4%). Logistic regression analysis showed that GPs who were older and had more years of practice were more likely to agree that pharmacists were willing to collaborate, had common goals for treatment and that they would change the patient's medication on the advice of the pharmacist. GPs who had regular communication protocols (adjusted odds ratio1 [aOR1] = 1.88, 95% CI 1.45-2.45; aOR2 = 3.33, 95% CI 2.76-4.02), participated in joint continuing education (aOR1 = 1.87, 95% CI 1.44-2.43; aOR2 = 2.27, 95% CI 1.91-2.70), provided recommendations for medication review (aOR1 = 3.01, 95% CI 2.07-4.38; aOR2 = 3.50, 95% CI 2.51-4.86), and communicated with pharmacists during resident training (aOR1 = 2.15, 95% CI 1.78-2.60; aOR2 = 1.38, 95% CI 1.18-1.62) were associated with a more positive attitude towards and higher frequency of cooperation. CONCLUSIONS GPs in China displayed a positive attitude towards cooperating with pharmacists, but they did not demonstrate a similar level of practice. As environmental determinants impact interdisciplinary collaboration, healthcare managers and policy-makers need to implement measures that foster a supportive environment conducive to interdisciplinary collaboration.
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Affiliation(s)
- Songtao Cai
- Department of General Practice, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, 518172, China
| | - Xianghui Huang
- Xinsheng Community Health Service Center, Shenzhen Longgang Central Hospital, Shenzhen, 518116, China
| | - Connie Van
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Wanchao Li
- Lincheng Healthcare Center of Changxing County, Huzhou, 310016, China
| | - Ming Yan
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Yiting Lu
- Department of General Practice, Tongji University School of Medicine, Shanghai, 200092, China
| | - Haixin Li
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Zhiling Deng
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Panpan Lu
- Department of General Practice, Taizhou Municipal Hospital, Taizhou, 318000, China
| | - Zhijie Xu
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88, Jiefang Rd, Hangzhou, Shangcheng District, 310009, China.
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17
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Chong JBK, Yap CYH, Tan SLL, Thong XR, Fang Y, Smith HE. General practitioners' perceptions of the roles of community pharmacists and their willingness to collaborate with pharmacists in primary care. J Pharm Policy Pract 2023; 16:114. [PMID: 37789392 PMCID: PMC10546622 DOI: 10.1186/s40545-023-00613-5] [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: 01/24/2023] [Accepted: 09/16/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Community pharmacists (CPs) have the capacity to contribute to patient care given their expertise in medication and accessibility to residents in the community. However, multidisciplinary patient care programmes where CPs collaborate with general practitioners (GPs) in patient care is rare in Singapore despite increasing healthcare demand. OBJECTIVES This study explores GPs' perceptions of CPs' current roles and GPs' ideas for and attitudes towards interprofessional collaboration. METHODS Semi-structured qualitative interviews were conducted with 20 private GPs from August to December 2020 via an online video-chat platform. GPs were recruited from the Primacy Care Research Network (pcRn), primary care networks, and using snowballing strategies. All interviews were recorded, transcribed and coded thematically. RESULTS Current working relationships between GPs and CPs appeared amicable but limited. GPs appreciate the existing roles of CPs: dispensing drugs not stocked in their practices and clarifying prescription details. Still, GPs appeared to rarely consider collaborative working. GPs acknowledged that CPs could enhance patient care with initiatives including medication reconciliation and advising on using medical devices. It was suggested that CPs could coordinate the purchase of drugs for primary care networks to improve GPs' inventory management, but less enthusiasm was expressed for clinical collaborations with CPs. Major concerns about GP-CP clinical collaborations included direct competition with GPs' own business interests, perceived low acceptability of pharmacy-led services by patients (citing extra time and cost), threat to continuity of care and the absence of a shared patient electronic health record system. Current funding mechanisms do not enable reimbursement of clinical services provided by CPs. Adoption of telemedicine technologies and governmental financial support were identified as possible enablers of GP-CP collaboration. CONCLUSIONS GPs saw potential in CPs' increased involvement in patient care, but perceived multiple barriers. Strategies focusing on overcoming these barriers could enable GP-CP collaboration to enhance patient care.
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Affiliation(s)
- Joy Boon Ka Chong
- Watson's Personal Care Stores Pte Ltd, 300 Beach Road, The Concourse, #39-01/04, Singapore, 199555, Singapore.
| | - Clivia Yao Hua Yap
- Watson's Personal Care Stores Pte Ltd, 300 Beach Road, The Concourse, #39-01/04, Singapore, 199555, Singapore.
| | - Shawn Lien Ler Tan
- Ministry of Health Holdings Pte Ltd, 1 Maritime Square, #11-25, Singapore, 099253, Singapore
| | - Xuan Rong Thong
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Yang Fang
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Helen E Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore
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18
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Madisa M, Filmalter CJ, Heyns T. Healthcare professionals and pregnant and post-natal women's perceptions of interprofessional collaboration in a maternity care facility: A qualitative study from Botswana. Midwifery 2023; 125:103768. [PMID: 37467547 DOI: 10.1016/j.midw.2023.103768] [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: 11/23/2022] [Revised: 05/11/2023] [Accepted: 06/25/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To explore the perceptions of healthcare professionals and pregnant and post-natal women regarding interprofessional collaboration in a maternity care setting in Botswana, a low-to-middle-income country in Sub-Sahara Africa. DESIGN A descriptive qualitative design using in-depth interviews with forty participants, including healthcare professionals and women in maternity wards. Data were transcribed and thematically analysed. SETTING Antenatal, delivery and post-natal maternity wards in a referral hospital that provides basic and specialist care in Botswana. PARTICIPANTS We interviewed 13 pregnant and post-natal women and 27 healthcare professionals in the maternity care wards. FINDINGS Participants perceived several interrelated factors that influenced the delivery of interprofessional collaborative care. Interpersonal factors such as poor communication, disrespectful behaviours and inadequate teamwork practices prevented interprofessional collaboration. Other barriers to collaboration included lack of understanding of each other's roles and responsibilities, ineffective coordination of resources, hierarchical power struggles and poor collaborative leadership. KEY CONCLUSIONS Effective interprofessional collaboration remains elusive in this maternity care setting. Healthcare systems in low-to-middle-income countries may benefit from interventions for healthcare professionals to learn and practice interprofessional collaborative care.
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Affiliation(s)
- Montlenyane Madisa
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa.
| | - Celia J Filmalter
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Tanya Heyns
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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19
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Smith SE, Kerins J, McColgan-Smith S, Stewart F, Power A, Mardon J, Tallentire VR. The development of a marker system for Pharmacists' Behavioural Skills. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:520-527. [PMID: 37452687 DOI: 10.1093/ijpp/riad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Pharmacists increasingly require complex behavioural skills to fulfil enhanced roles within healthcare teams. Behavioural marker systems are used to assess behavioural (or non-technical) skills during immersive simulation. This study aimed to develop a marker system for pharmacists' behavioural skills in patient-focussed care scenarios, and to investigate its content validity. METHODS Literature describing existing marker systems and the requisite behavioural skills of pharmacists were presented to two expert panels, alongside video examples of pharmacists in patient-focussed care simulations. The expert panels used this information to develop a new behavioural marker system. A third expert panel assessed the content validity, and the item- and scale-content validity indices were calculated. KEY FINDINGS The resulting tool contains four categories, each with three or four skill elements: situation awareness (gathering information; recognising and understanding information; anticipating, preparing and planning), decision-making and prioritisation (identifying options; prioritising; dealing with uncertainty; implementing or reviewing decisions), collaborative working (involving the patient; information sharing; leadership or followership), self-awareness (role awareness; speaking up; escalating care; coping with stress). The scale-content validity index was 0.95 (ideal) and the only item below the acceptable cut-off was 'leadership or followership' (0.7). CONCLUSIONS This tool is the first marker system designed to assess the behavioural skills of pharmacists in patient-focussed care scenarios. There is evidence of good content validity. It is hoped that once validated, the Pharmacists' Behavioural Skills marker system will enable pharmacy educators to provide individualised and meaningful feedback on simulation participants' behavioural skills.
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Affiliation(s)
- Samantha Eve Smith
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
- NHS Lothian, Edinburgh, UK
| | - Joanne Kerins
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | | | | | - Julie Mardon
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
| | - Victoria Ruth Tallentire
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
- NHS Lothian, Edinburgh, UK
- NHS Education for Scotland, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
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20
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Harris S, Mills E, Venables RH, Bradley F, White S. Developing consensus on the principles and key actions for collaborative working between general practices and community pharmacies: a modified eDelphi study. BMJ Open 2023; 13:e074023. [PMID: 37734889 PMCID: PMC10514654 DOI: 10.1136/bmjopen-2023-074023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES To develop consensus on the principles and key actions for collaborative working in practice between general practice, community pharmacy and patients and their carers. DESIGN Three-round modified eDelphi study, starting from an established conceptual model of collaboration between general practitioners (GPs) and community pharmacists. SETTING Community pharmacies and general practices in England, UK. PARTICIPANTS A panel of 123 experts: 43% from a community pharmacy background; 36% from a GP background; 13% patients, carers or patient representatives and 8% from academic or commissioner backgrounds. Panellist numbers reduced by approximately 30% in rounds 2 and 3. PRIMARY AND SECONDARY OUTCOME MEASURES Consensus between expert panellists, defined as at least 75% agreement. RESULTS A high level of consensus (>80%) was achieved on all components of a model of collaboration composed of Fundamental Principles of Collaboration and Key Activities for Action, supported by a series of aspirational statements and suggested practical actions. The fundamental principles and key activities are appended by contextual points. The findings indicate that collaboration in practice involves team members other than just GPs and community pharmacists and recognises that patients often want to know how each professional team is involved in their care. This study also provides insights into how collaboration between general practice and community pharmacy settings appears to have shifted during the COVID-19 pandemic, especially through opportunities for virtual collaboration and communication that can transcend the need for close geographical proximity. CONCLUSION A consensus-based model of collaboration between general practice teams, community pharmacy teams, and patients and their carers has been developed. It is practically focused, values the patient voice and incorporates general practice and community pharmacy team members. While developed in England, the model is likely to also have applicability to other countries with similar health systems that include general practices and community pharmacies.
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Affiliation(s)
| | | | | | - Fay Bradley
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - Simon White
- School of Pharmacy and Bioengineering, Keele University, Keele, UK
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21
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Yang DW, Son KB. Impact of the COVID-19 Pandemic on the Public Perceptions of the Roles and Functions of Community Pharmacies in South Korea: Updated Cross-Sectional Self-Reported Web-Based Survey. JMIR Public Health Surveill 2023; 9:e46723. [PMID: 37390391 PMCID: PMC10453941 DOI: 10.2196/46723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/29/2023] [Accepted: 06/29/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Community pharmacists confronted dual burdens in response to the COVID-19 pandemic by expanding the scope of pharmaceutical practices. OBJECTIVE This study aimed to assess the perceived roles and functions of community pharmacies during the pandemic and to explore their updated roles after the pandemic began. METHODS We conducted a self-reported web-based survey in October 2022. Based on Korean census data, we recruited the study participants (n=1000) through quota sampling stratified by age, sex, and region, yielding a 7.45% (1000/13,423) response rate. The questionnaires were composed of 3 sections: demographics, the roles and functions of community pharmacies during the pandemic, and the updated roles of community pharmacies during disasters. Each question in the second and third sections was rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree), and each item's mean scores and SDs were reported. The study participants were categorized into 2 groups: individuals who had a family pharmacy and those who did not. A chi-square test and ordered logistic regression analyses were conducted. RESULTS Out of 1000 respondents, 418 (41.8%) had a history of COVID-19, and 639 (63.9%) had a family pharmacy. Assigning specific roles and functions to community pharmacies during the pandemic contributed to positive assessments. Respondents gave higher scores to community pharmacies that had responded appropriately (a mean Likert score of 3.66, SD .077 out of 5) and provided continuous pharmaceutical services (mean 3.67, SD 0.87) during the pandemic. The pandemic served as an opportunity to positively recognize the role of community pharmacies (mean 3.59, SD 0.83). In the ordered logistic model, having a family pharmacy was consistently associated with positive perceptions. Respondents perceived that community pharmacies collaborated with general practitioners and health authorities. However, community pharmacies need to function appropriately in terms of knowledge. The mean score of the 4 domains of community pharmacy functions was the highest for collaboration (mean 3.66, SD 0.83), followed by communication (mean 3.57, SD 0.87), responsiveness (mean 3.54, SD 0.87), and knowledge (mean 3.41, SD 0.91). CONCLUSIONS The pandemic resulted in interprofessional collaboration between community pharmacists and general practitioners. Family pharmacies could be a valuable asset to the comprehensive case management of patients. However, community pharmacists should have the expertise to build solid interprofessional collaborations and fulfill their expanded and updated roles.
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Affiliation(s)
- Dong-Wook Yang
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Kyung-Bok Son
- College of Pharmacy, Hanyang University, Ansan, Gyeonggi-do, Republic of Korea
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22
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Zusman EZ, Munro S, Norman WV, Soon JA. Dispensing mifepristone for medical abortion in Canada: Pharmacists' experiences of the first year. Can Pharm J (Ott) 2023; 156:204-214. [PMID: 37435503 PMCID: PMC10331362 DOI: 10.1177/17151635231176270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 07/13/2023]
Abstract
Background Mifepristone for medical abortion was first dispensed by community pharmacists in Canada directly to patients in January 2017. We asked about pharmacists' experiences over their first year dispensing mifepristone in order to evaluate the frequency of the new practice and assess availability in urban/rural pharmacies. Methods From August to December 2019, we invited 433 community pharmacists who had completed a baseline survey at least 1 year prior to participate in a follow-up online survey. We summarized categorical data using counts and proportions and conducted a qualitative thematic analysis of open-ended responses. Results Among 122 participants, 67.2% had dispensed the product, and 48.4% routinely stocked mifepristone. Pharmacists reported a mean of 26 and median of 3 (interquartile range, 1, 8) mifepristone prescriptions filled in their pharmacies in the previous year. Participants perceived that the benefits of making mifepristone available in pharmacies included increased abortion access for patients (n = 115; 94.3%), reduced pressure on the health care system (n = 104; 85.3%), increased rural and remote abortion access (n = 103; 84.4%) and increased interprofessional collaborations (n = 48; 39.3%). Few participants reported challenges to maintaining adequate stock of mifepristone, but these challenges included low demand (n = 24; 19.7%), short expiry dating (n = 12; 9.8%) and drug shortages (n = 8; 6.6%). The overwhelming majority, 96.7%, reported that their communities did not resist the provision of mifepristone by their pharmacy. Interpretation Participating pharmacists reported many benefits and very few barriers to stocking and dispensing mifepristone. Both urban and rural communities responded positively to enhanced access to mifepristone in their community. Conclusions Mifepristone is well accepted by pharmacists within the primary care system in Canada.
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Affiliation(s)
- Enav Z. Zusman
- Contraception and Abortion Research Team of the Women’s Health Research Institute, UBC, and of the Collaboration for Outcomes Research and Evaluation
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver
| | - Sarah Munro
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research, Vancouver, British Columbia
| | - Wendy V. Norman
- Department of Family Practice, University of British Columbia, Vancouver
| | - Judith A. Soon
- Contraception and Abortion Research Team of the Women’s Health Research Institute, UBC, and of the Collaboration for Outcomes Research and Evaluation
- Department of Family Practice, University of British Columbia, Vancouver
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Wang C, Li M, Huang Y, Xi X. Factors influencing clinical pharmacists' integration into the clinical multidisciplinary care team. Front Pharmacol 2023; 14:1202433. [PMID: 37377923 PMCID: PMC10291231 DOI: 10.3389/fphar.2023.1202433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Objectives: To investigate the factors influencing clinical pharmacists' integration into the clinical multidisciplinary care team, using interprofessional collaboration between clinical pharmacists and physicians as the focus. Methods: Through stratified random sampling, a cross-sectional questionnaire survey was conducted among clinical pharmacists and physicians in secondary and tertiary hospitals in China from July to August 2022. The questionnaire, comprising the Physician-Pharmacist Collaborative Index (PPCI) scale to reflect the collaboration level and a combined scale to measure influencing factors, was made available in two versions for clinical pharmacists and physicians. Multiple linear regression was adopted to analyze the association between the collaboration level and influencing factors, as well as the heterogeneity of the significant factors in hospitals of different grades. Results: Valid self-reported data from 474 clinical pharmacists and 496 paired physicians were included, who were serving in 281 hospitals from 31 provinces. In terms of participant-related factors, standardized training and academic degree, respectively, exerted significant positive effects on the perceived collaboration level by clinical pharmacists and physicians. In terms of context characteristics, manager support and system construction were the main factors for improving collaboration. In terms of exchange characteristics, clinical pharmacists having good communication skills, physicians trusting others' professional competence and values, and both parties having consistent expectations had significant positive effects on collaboration. Conclusion: The study provides a baseline data set on the current level and associated factors of clinical pharmacists' collaboration with other professionals in China and other countries with a related health system, providing references for individuals, universities, hospitals, and national policymakers to facilitate the development of clinical pharmacy and multidisciplinary models and further improve the patient-centered integrated disease treatment system.
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Affiliation(s)
| | | | | | - Xiaoyu Xi
- *Correspondence: Xiaoyu Xi, ; Yuankai Huang,
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Sudeshika T, Deeks LS, Naunton M, Peterson GM, Kosari S. Interprofessional collaboration within general practice teams following the inclusion of non-dispensing pharmacists. J Pharm Policy Pract 2023; 16:49. [PMID: 36945030 PMCID: PMC10031930 DOI: 10.1186/s40545-023-00550-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Pharmacists have been included in general practice teams to provide non-dispensing services in the Australian Capital Territory (ACT) since 2016. Interprofessional collaboration and team effectiveness are key considerations in providing high-quality patient care. These concepts have not been well studied following the inclusion of a pharmacist in general practice teams. METHODS A mixed methods study was conducted to explore collaboration between pharmacists and health professionals in eight general practices in the ACT, where pharmacists were included in their teams. A validated survey instrument was adapted and utilised to assess the changes in interprofessional collaboration over time following the addition of a pharmacist. Another validated survey was utilised to explore team effectiveness at the end of the study. Semi-structured interviews, with a thematic analysis, were conducted with a purposeful sample of general practice staff members to understand the factors influencing the development of interprofessional collaboration. RESULTS In total, 56 and 41 participants completed the baseline and follow-up survey, including 26 who completed both surveys to assess the change in collaboration over time. Interprofessional collaboration scores were high initially and did not change over time. Team effectiveness was also high at the end of the study. Twenty-one individuals participated in interviews, which generated four main interrelated themes related to interprofessional collaboration: professional working relationships, trust, commitment to collaboration, and barriers to collaboration. Trust was integral to professional working relationships and commitment to collaboration. The barriers to collaboration included not having a role description for pharmacists, inadequate interest to initiate working relationships, lack of dedicated time for interaction, lack of utilisation, and poor awareness of pharmacist-led activities in general practice. CONCLUSION Interprofessional collaboration was initially high and not influenced by the addition of a pharmacist, perhaps reflecting the inherent nature of the general practices willing to include a pharmacist within their team. Introducing a clear job description for pharmacists, and dedicating time to interact with pharmacists, could be beneficial in improving trust and professional working relationships and enhancing collaboration between the pharmacists and other general practice team members.
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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.
| | - Louise S Deeks
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - 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
| | - Sam Kosari
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
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The pharmacist as safety net: an interview-based study of the intersecting dependencies between doctors and pharmacists. J Pharm Policy Pract 2023; 16:40. [PMID: 36894977 PMCID: PMC9999512 DOI: 10.1186/s40545-023-00536-1] [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: 10/27/2022] [Accepted: 02/11/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Social science research has demonstrated how health practitioners negotiate and contest professional roles and jurisdictions in practice, and in ways that reflect the power dynamics that permeate medicine. This article further explores these relational dynamics by examining how general practitioners (GPs) in Aotearoa New Zealand frame their working relationships with pharmacists. METHODS We conducted semi-structured interviews with 16 GPs from around the country. Interviews had a mean duration of 46 min, and were thematically analysed. RESULTS GPs saw and used pharmacists as a key source of information about both medicines and patients; thus it was not only pharmacists' training and expertise, but also their community setting and patient proximity, that made them a useful resource to doctors. Furthermore, GPs framed pharmacists as a critical 'safety net' due to their role in catching errors and checking prescribing details. The pharmacy 'safety net' also came through in participants' comments on discount pharmacies, which have introduced pronounced cost-cutting logics to Aotearoa New Zealand's pharmaceutical landscape; in their reflections on these organisations, prescribers express the importance of robust pharmacy practice to their own work. CONCLUSIONS Whilst the literature often foregrounds tensions in how health providers reinscribe their professional roles, this research highlights the interdependence that doctors identify with pharmacists, and their aspirations for working together. Both professional groups navigate a pressed health system that presents a set of common challenges to good medicines practice.
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26
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Mokoena EM, Rabie T, du Preez A. Challenges in the working relationship between professional nurses and clinical associates in selected district hospitals in South Africa. Health SA 2023; 28:1927. [PMID: 37151614 PMCID: PMC10157416 DOI: 10.4102/hsag.v28i0.1927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/16/2022] [Indexed: 02/25/2023] Open
Abstract
Background Clinical associates were introduced in South Africa to address physician shortages in healthcare. Professional relationships between physicians and professional nurses (PNs) have been widely researched, but none specifically between the new cadre of clinical associates and PNs. Aim This study aimed to understand the professional working relationship between PNs and clinical associates. Setting Selected district hospitals within Mpumalanga Province, South Africa. Method A qualitative descriptive design was used. Professional nurses were purposely sampled, and an all-inclusive sampling method was used for clinical associates in selected district hospitals within Mpumalanga Province, South Africa. Twelve (N = 12) semi-structured, individual interviews (PNs n = 6; clinical associates n = 6) guided by an interview guide were conducted in English. The interviews were audio recorded and transcribed verbatim by an independent transcriptionist. Tesch's eight steps of data analysis were employed to analyse the data. An independent co-coder assisted with data analysis. Results This study yielded four themes: (1) professional relationship defined, (2) professional relationship characteristics, (3) professional challenges applicable to both PNs and clinical associates and (4) personal professional challenges applicable to clinical associates only. Conclusion This study demonstrated that the professional relationships between PNs and clinical associates are affected by various challenges, which could be resolved within the department through in-service training and good communication. Contribution This is one of the first studies that highlight the professional relationship challenges between PNs and clinical associates.
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Owen EC, Abrams R, Cai Z, Duddy C, Fudge N, Hamer-Hunt J, Husson F, Mahtani KR, Ogden M, Swinglehurst D, Turner M, Whittlesea C, Wong G, Park S. Community pharmacy and general practice collaborative and integrated working: a realist review protocol. BMJ Open 2022; 12:e067034. [PMID: 36581431 PMCID: PMC9806063 DOI: 10.1136/bmjopen-2022-067034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Increasing collaborative and integrated working between General practice (GP) and Community pharmacy (CP) is a key priority of the UK National Health Service and has been proposed as a solution to reducing health system fragmentation, improving synergies and coordination of care. However, there is limited understanding regarding how and under which circumstances collaborative and integrated working between GP and CP can be achieved in practice and how regulatory, organisational and systemic barriers can be overcome. METHODS AND ANALYSIS The aim of our review is to understand how, when and why working arrangements between GP and CP can provide the conditions necessary for optimal communication, decision-making, and collaborative and integrated working. A realist review approach will be used to synthesise the evidence to make sense of the complexities inherent in the working relationships between GP and CP. Our review will follow Pawson's five iterative stages: (1) finding existing theories; (2) searching for evidence (our main searches were conducted in April 2022); (3) article selection; (4) data extraction and (5) synthesising evidence and drawing conclusions. We will synthesise evidence from grey literature, qualitative, quantitative and mixed-methods research. The research team will work closely with key stakeholders and include patient and public involvement and engagement throughout the review process to refine the focus of the review and the programme theory. Collectively, our refined programme theory will explain how collaborative and integrated working between GP and CP works (or not), for whom, how and under which circumstances. ETHICS AND DISSEMINATION Formal ethical approval is not required for this review as it draws on secondary data from published articles and grey literature. Findings will be widely disseminated through: publication in peer-reviewed journals, seminars, international conference presentations, patients' association channels, social media, symposia and user-friendly summaries. PROSPERO REGISTRATION NUMBER CRD42022314280.
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Affiliation(s)
- Emily Claire Owen
- Department of Primary Care & Population Health, University College London, London, UK
| | - Ruth Abrams
- School of Health Sciences, University of Surrey, Surrey, UK
| | - Ziyue Cai
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nina Fudge
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK, London, UK
| | - Julia Hamer-Hunt
- Department of Primary Care & Population Health, University College London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Fran Husson
- Department of Primary Care & Population Health, University College London, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Kamal Ram Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Margaret Ogden
- Department of Primary Care & Population Health, University College London, London, UK
| | - Deborah Swinglehurst
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK, London, UK
| | - Malcolm Turner
- Department of Primary Care & Population Health, University College London, London, UK
| | - Cate Whittlesea
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sophie Park
- Department of Primary Care & Population Health, University College London, London, UK
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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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Lim K, Broom A, Olsen A, Seale H. Community pharmacists as antimicrobial guardians and gatekeepers - A qualitative study of the perspectives of pharmacy sector stakeholders. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 9:100212. [PMID: 36582997 PMCID: PMC9793303 DOI: 10.1016/j.rcsop.2022.100212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
Background Community pharmacists, as primary care providers, are an underutilised resource in antimicrobial stewardship (AMS). Primary care plays an important role in tackling antimicrobial resistance (AMR) as the principle of balancing access to antimicrobials while ensuring optimal use is agnostic to health setting. Understanding the sector's perceptions and practices towards AMS involvement is a continuing focus area of research. However, there is an opportunity to understand the sociological factors which influence the profession's contribution to stewardship practice, particularly across a broader spectrum of sector stakeholders at the individual, practice, system, and policy levels. Objective To explore stakeholders' perceptions of the Australian community pharmacy sector's AMS involvement. Methods Semi-structured interviews were conducted with fifteen key informants from the Australian community pharmacy sector. Participants' insights were invited across three broad areas: (1) understanding of AMR and AMS; and the (2) current and (3) future state of community pharmacy's AMS involvement. Interviews were audio-recorded, transcribed verbatim and analyzed using a combined method of inductive (informed by the Theoretical Domains Framework) and deductive thematic analysis. Results Perceptions on promoting community pharmacists' AMS involvement within their existing role in promoting the quality use of medicines were heard. Adopting an antimicrobial guardian or gatekeeper role was perceived as influenced by the timing of their interaction with a patient either prior to, or post-consultation with a general practitioner (GP). Suggestions that the profession's potential and actual role in AMS could be challenged or even delimited due to lack of access to completeness of clinical information, and perceived consequences from a clinical and professional engagement perspective were also heard. Conclusion Collaborative partnerships between GPs and community pharmacists, framing stewardship within a quality use of medicines agenda, and highlighting connections between pharmacists' professional services such as minor ailments are key elements enabling community pharmacist's antimicrobial gatekeeper and guardian role.
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Affiliation(s)
- Kathryn Lim
- School of Population Health, University of New South Wales, Sydney, Australia,Corresponding author at: School of Population Health, Level 2, Samuels Building, University of New South Wales, Randwick, NSW 2031, Australia.
| | - Alex Broom
- School of Social and Political Sciences, The University of Sydney, Australia
| | - Anna Olsen
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney, Australia
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Yailian AL, Estublier C, Fontana A, Vignot E, Confavreux C, Chapurlat R, de Fréminville H, Janoly-Dumenil A. Practices among General Practitioners in Rheumatoid Arthritis (GEPRA-I): results of a region-wide online survey. BMC PRIMARY CARE 2022; 23:144. [PMID: 35659194 PMCID: PMC9164358 DOI: 10.1186/s12875-022-01744-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/16/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
To assess current practice regarding the management of rheumatoid arthritis patients among general practitioners of a French region, and their perception about the deployment of a multidisciplinary collaboration.
Methods
A cross-sectional online survey was sent to the general practitioners of a French region. The questionnaire comprised of 3 sections to collect data regarding 1/demographics, 2/practice and knowledge in rheumatoid arthritis, and 3/perception about the deployment of a multidisciplinary collaboration.
Results
1/A total of 247 general practitioners (M/F ratio: 1.4; mean age: 46.7 years) completed the survey. 2/More than half of general practitioners believed that their role was very or extremely important in disease diagnosis (72.5%), and management of comorbidities (67.2%). Among respondents, 6.1% considered that they did not face any difficulty concerning the patient management and 61.5% had already identified causes of non-adherence. 3/A total of 151 (61.1%) general practitioners were willing to participate in a multidisciplinary programme to improve medication adherence in rheumatoid arthritis.
Conclusions
General practitioners are motivated to contribute to an overall management of rheumatoid arthritis patients. Nevertheless, they need professional education about rheumatoid arthritis treatment and training in motivational interviews before getting involved in a multidisciplinary collaboration.
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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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Moecker R, Weissenborn M, Klingenberg A, Wirbka L, Fuchs A, Eickhoff C, Mueller U, Schulz M, Kaufmann-Kolle P, Haefeli WE, Seidling HM. Task sharing in an interprofessional medication management program - a survey of general practitioners and community pharmacists. BMC Health Serv Res 2022; 22:1005. [PMID: 35933349 PMCID: PMC9356506 DOI: 10.1186/s12913-022-08378-4] [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: 03/14/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background Pharmacist-led medication review and medication management programs (MMP) are well-known strategies to improve medication safety and effectiveness. If performed interprofessionally, outcomes might even improve. However, little is known about task sharing in interprofessional MMP, in which general practitioners (GPs) and community pharmacists (CPs) collaboratively perform medication reviews and continuously follow-up on patients with designated medical and pharmaceutical tasks, respectively. In 2016, ARMIN (Arzneimittelinitiative Sachsen-Thüringen) an interprofessional MMP was launched in two German federal states, Saxony and Thuringia. The aim of this study was to understand how GPs and CPs share tasks in MMP when reviewing the patients’ medication. Methods This was a cross-sectional postal survey among GPs and CPs who participated in the MMP. Participants were asked who completed which MMP tasks, e.g., checking drug-drug interactions, dosing, and side effects. In total, 15 MMP tasks were surveyed using a 5-point Likert scale ranging from “I complete this task alone” to “GP/CP completes this task alone”. The study was conducted between 11/2020 and 04/2021. Data was analyzed using descriptive statistics. Results In total, 114/165 (69.1%) GPs and 166/243 (68.3%) CPs returned a questionnaire. The majority of GPs and CPs reported (i) checking clinical parameters and medication overuse and underuse to be completed by GPs, (ii) checking storage conditions of drugs and initial compilation of the patient’s medication including brown bag review being mostly performed by CPs, and (iii) checking side-effects, non-adherence, and continuous updating of the medication list were carried out jointly. The responses differed most for problems with self-medication and adding and removing over-the-counter medicines from the medication list. In addition, the responses revealed that some MMP tasks were not sufficiently performed by either GPs or CPs. Conclusions Both GPs’ and CPs’ expertise are needed to perform MMP as comprehensively as possible. Future studies should explore how GPs and CPs can complement each other in MMP most efficiently. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08378-4.
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Affiliation(s)
- Robert Moecker
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Marina Weissenborn
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Anja Klingenberg
- aQua Institute for Applied Quality Improvement and Research in Health Care, Maschmühlenweg 8-10, 37073, Göttingen, Germany
| | - Lucas Wirbka
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Andreas Fuchs
- AOK PLUS - Die Gesundheitskasse, Sternplatz 7, 01067, Dresden, Germany
| | - Christiane Eickhoff
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Heidestraße 7, 10557, Berlin, Germany
| | - Uta Mueller
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Heidestraße 7, 10557, Berlin, Germany
| | - Martin Schulz
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Heidestraße 7, 10557, Berlin, Germany.,Institute of Pharmacy, Freie Universität Berlin, Kelchstraße 31, 12169, Berlin, Germany
| | - Petra Kaufmann-Kolle
- aQua Institute for Applied Quality Improvement and Research in Health Care, Maschmühlenweg 8-10, 37073, Göttingen, Germany
| | | | - Walter E Haefeli
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hanna M Seidling
- Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. .,Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Berenbrok LA, DeRuiter M, Mormer E. OTC Hearing Aids: An Opportunity for Collaborative Working Relationships Between Pharmacists and Audiologists. J Am Pharm Assoc (2003) 2022; 62:1765-1768. [DOI: 10.1016/j.japh.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
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Rondeaux S, Braeckman T, Beckwé M, Biset N, Maesschalck J, Duquet N, De Wulf I, Devroey D, De Vriese C. Diabetes and Cardiovascular Diseases Risk Assessment in Community Pharmacies: An Implementation Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148699. [PMID: 35886551 PMCID: PMC9316424 DOI: 10.3390/ijerph19148699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023]
Abstract
The implementation of a new service is often challenging when translating research findings into routine clinical practices. This paper presents the results of the implementation study of a pilot project for a diabetes and cardiovascular diseases risk-assessment service in Belgian community pharmacies. To evaluate the implementation of the service, a mixed method was used that follows the RE-AIM framework. During the testing stage, 37 pharmacies participated, including five that dropped out due to a lack of time or COVID-19-related temporary obligations. Overall, 502 patients participated, of which 376 (74.9%) were eligible for according-to-protocol analysis. Of these, 80 patients (21.3%) were identified as being at high risk for the targeted diseases, and 100 (26.6%) were referred to general practice for further investigation. We presented the limited effectiveness and the key elements influencing optimal implementation. Additional strategies, such as interprofessional workshops, a data-sharing platform, and communication campaigns, should be considered to spread awareness of the new role of pharmacists. Such strategies could also promote collaboration with general practitioners to ensure the follow-up of patients at high risk. Overall, this service was considered easy to perform and feasible in practice but would require financial and external support to ensure its effectiveness, sustainability, and larger-scale implementation.
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Affiliation(s)
- Sarah Rondeaux
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium; (S.R.); (N.B.)
| | - Tessa Braeckman
- Department of Family Medicine and Chronic Care, Faculty of Medicine, Vrije Universiteit Brussels (VUB), 1090 Brussels, Belgium; (T.B.); (M.B.); (D.D.)
| | - Mieke Beckwé
- Department of Family Medicine and Chronic Care, Faculty of Medicine, Vrije Universiteit Brussels (VUB), 1090 Brussels, Belgium; (T.B.); (M.B.); (D.D.)
| | - Natacha Biset
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium; (S.R.); (N.B.)
| | - Joris Maesschalck
- Association of Pharmacists Belgium, 1000 Brussels, Belgium; (J.M.); (N.D.); (I.D.W.)
| | - Nathalie Duquet
- Association of Pharmacists Belgium, 1000 Brussels, Belgium; (J.M.); (N.D.); (I.D.W.)
| | - Isabelle De Wulf
- Association of Pharmacists Belgium, 1000 Brussels, Belgium; (J.M.); (N.D.); (I.D.W.)
| | - Dirk Devroey
- Department of Family Medicine and Chronic Care, Faculty of Medicine, Vrije Universiteit Brussels (VUB), 1090 Brussels, Belgium; (T.B.); (M.B.); (D.D.)
| | - Carine De Vriese
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium; (S.R.); (N.B.)
- Correspondence: ; Tel.: +32-26-505-310
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Perspectives of primary care providers on multidisciplinary collaboration to prevent medication-related falls. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 6:100149. [PMID: 35755717 PMCID: PMC9218163 DOI: 10.1016/j.rcsop.2022.100149] [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: 10/08/2021] [Revised: 04/14/2022] [Accepted: 06/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background The causes of falls are often multifactorial. The prevention of falls benefits from a multidisciplinary approach. As people who fall are generally older and users of polypharmacy who frequently visit pharmacies, pharmacists may contribute to fall prevention. Objective(s) This study aims to explore the perceptions of primary care providers on multidisciplinary collaboration in fall prevention especially with pharmacists. Methods Two focus groups were held with each of the following health disciplines: physiotherapists, home care nurses, and practice nurses. A topic list was developed based on the capability opportunity motivation – behaviour (COM-B) model and the theoretical domains framework (TDF). Focus groups were audiotaped and transcribed verbatim. Data were collected in the Netherlands between March and June 2021. Results Six online focus groups were held with 17 physiotherapists, 14 home care nurses, and 15 practice nurses. Participants reported to collaborate multidisciplinary to prevent falls, but they had very limited collaboration with community pharmacists regarding fall prevention. Participants had limited knowledge on drugs that increase the risk of falls. This contributed to their low awareness of the potential role of pharmacists in fall prevention. Other reasons for poor collaboration in fall prevention were lack of agreements with pharmacists, limited coordination and communication. Participants were open to more collaboration with pharmacists and believed this could potentially improve patient outcomes. Conclusions Multidisciplinary agreements among health care providers, including community pharmacists, about referral criteria, roles and responsibilities, communication and coordination, could stimulate further collaboration in fall prevention. Fall prevention needs to receive more attention from primary care providers. Primary care providers have low awareness of the potential role of pharmacists in fall prevention. Primary care providers are positive about collaborating with community pharmacists to prevent falls. Primary care providers need enhanced communication and coordination, clarification of roles, and agreements. Primary care providers expect community pharmacists to focus on deprescribing of fall risk-increasing drugs (FRIDs).
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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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Evaluation approaches, tools and aspects of implementation used in pharmacist interventions in residential aged care facilities: A scoping review. Res Social Adm Pharm 2022; 18:3714-3723. [DOI: 10.1016/j.sapharm.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/15/2022] [Accepted: 05/07/2022] [Indexed: 11/21/2022]
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F M, N L, S M, V P, P C. Characteristics, expectations, experiences of care, and satisfaction of patients receiving chiropractic care in a French University Hospital in Toulouse (France) over one year: a case study. BMC Musculoskelet Disord 2022; 23:229. [PMID: 35264131 PMCID: PMC8906111 DOI: 10.1186/s12891-022-05147-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In October 2017, a partnership was established between the University Hospital of Toulouse and the French Chiropractic College, "Institut Franco-Européen de Chiropraxie" (IFEC). Before 2017, chiropractors did not practice in hospitals in France. Chiropractic students and chiropractors are now integrated in an interdisciplinary medical team at University Hospital. Our study aimed to describe the characteristics of patients who received chiropractic care at the University Hospital of Toulouse, their expectations, experiences of care, and satisfaction. METHOD A prospective case study was conducted. Patients referred for chiropractic care in the French University Hospital of Toulouse from January to December 2020 were eligible to participate. Participants provided the following data: demographics, previous chiropractic care treatments, pain location, intensity (NRS) and duration, disability (NDI, ODI), health-related quality of life (SF-12) and depressive symptomatology (PHQ-9). We conducted semi-structured interviews to explore their expectations, barriers and facilitators impacting their experience of care, and satisfaction. RESULTS Seventeen participants were recruited and seven were interviewed. All participants had chronic pain with a median pain intensity of 05/10 (IQR 04-06) on the NRS scale. Nine of 17 participants presented with multiple pain locations. Thirteen of seventeen participants presented with low back pain and eight with neck pain. The median SF-12 health-related quality of life score was 50/100 (IQR 28.5-60.5) for physical health, and 52/100 (IQR 43-62) for mental health. The PHQ-9 median score of depressive symptomatology was 7.7/27 (IQR 2.0-12.5). Overall, participants were satisfied with their care and the collaboration between chiropractors and physicians. Participants expected a caring communication with the chiropractic team. Their experience was facilitated by their trust in their physician. Patients perceived the turnover of chiropractic students as a barrier to their satisfaction. CONCLUSION Our participants presented with chronic musculoskeletal pain and depressive symptoms. Our study identified facilitators and barriers for patient expectation and satisfaction with chiropractic care in a hospital setting. This study provides the first data describing the collaboration between chiropractors and physicians in France in the management of musculoskeletal disorders. These findings will inform the quality improvement of our partnership, student's training and the development of future hospital-based collaborations integrating chiropractic care in a multidisciplinary team in France.
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Affiliation(s)
- Mallard F
- Division of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada. .,Institut Franco-Européen de Chiropraxie, Toulouse, France.
| | - Lemeunier N
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France
| | - Mior S
- Division of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada.,Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Pecourneau V
- Institut Franco-Européen de Chiropraxie, Toulouse, France
| | - Côté P
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
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Wei H, Horns P, Sears SF, Huang K, Smith CM, Wei TL. A systematic meta-review of systematic reviews about interprofessional collaboration: facilitators, barriers, and outcomes. J Interprof Care 2022; 36:735-749. [DOI: 10.1080/13561820.2021.1973975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Holly Wei
- PhD Program, School of Nursing, University of Louisville, Louisville, KY, USA
| | - Phyllis Horns
- College of Nursing, East Carolina University, Greenville, NC, USA
| | - Samuel F. Sears
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Kun Huang
- College of Nursing, East Carolina University, Greenville, NC, USA
| | | | - Trent L. Wei
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Brouwer JMJL, Risselada AJ, de Wit M, Lubberts J, Westerhuis H, Doornbos B, Mulder H. Lithium surveillance by community pharmacists and physicians in ambulatory patients: a retrospective cohort study. Int J Clin Pharm 2022; 44:975-984. [PMID: 35831730 PMCID: PMC9393139 DOI: 10.1007/s11096-022-01420-9] [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: 12/22/2021] [Accepted: 04/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Shared care agreements between clinical pharmacists and physicians can improve suboptimal lithium monitoring in in- and outpatient settings. However, it is unknown whether incorporating community pharmacists in such agreements can also improve lithium monitoring in an outpatient setting. AIM To assess the necessity for a shared care agreement for lithium monitoring in our region by investigating: intervention rates by community pharmacists and whether those are sufficient; lithium monitoring by physicians in ambulatory patients; the extent of laboratory parameter exchange to community pharmacists. METHOD Patient files of lithium users were surveyed in a retrospective cohort study among 21 community pharmacies in the Northern Netherlands. Outcome was the intervention rate by community pharmacists and whether those were deemed sufficient by an expert panel. Additionally, we investigated both the percentages of patients monitored according to current guidelines and of laboratory parameters exchanged to community pharmacists. RESULTS 129 patients were included. Interventions were performed in 64.4% (n = 29), 20.8% (n = 5), and 25.0% (n = 1) of initiations, discontinuations, and dosage alterations of drugs interacting with lithium, respectively. The expert panel deemed 40.0% (n = 14) of these interventions as "insufficient". Physicians monitored 40.3% (n = 52) of the patients according to current guidelines for lithium serum levels and kidney functions combined. Approximately half of the requested laboratory parameters were available to the community pharmacist. CONCLUSION Intervention rates by community pharmacists and lithium monitoring by physicians can be improved. Therefore, a shared care agreement between community pharmacists, clinical pharmacists, and physicians is needed to improve lithium monitoring in ambulatory patients.
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Affiliation(s)
- Jurriaan M. J. L. Brouwer
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Mailbox: 30.001, 9400 RA Assen, The Netherlands ,grid.468637.80000 0004 0465 6592GGZ Drenthe Mental Health Services Drenthe, Assen, The Netherlands ,grid.4830.f0000 0004 0407 1981Department of Psychiatry, Research School of Behavioral and Cognitive Neurosciences, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Arne J. Risselada
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Mailbox: 30.001, 9400 RA Assen, The Netherlands
| | - Marinka de Wit
- grid.4830.f0000 0004 0407 1981Department of Pharmacotherapy, -Epidemiology and -Economics, Department of Pharmacy and Pharmaceutical Sciences, University of Groningen, Groningen, The Netherlands
| | - Janniek Lubberts
- grid.4830.f0000 0004 0407 1981Department of Pharmacotherapy, -Epidemiology and -Economics, Department of Pharmacy and Pharmaceutical Sciences, University of Groningen, Groningen, The Netherlands
| | - Henrieke Westerhuis
- grid.4830.f0000 0004 0407 1981Department of Pharmacotherapy, -Epidemiology and -Economics, Department of Pharmacy and Pharmaceutical Sciences, University of Groningen, Groningen, The Netherlands
| | - Bennard Doornbos
- grid.4830.f0000 0004 0407 1981Lentis Psychiatric Institute, Lentis Research, Groningen, The Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Mailbox: 30.001, 9400 RA, Assen, The Netherlands. .,Dutch Academic Network of Northern Pharmacies (ANNA), Groningen, The Netherlands.
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Abreu MHNGD, Amaral JHLD, Guimarães Zina L, Vasconcelos M, da Silveira Pinto R, Werneck MAF. Role of management and human resource factors on matrix support in secondary oral health care in Brazil. Community Dent Oral Epidemiol 2021; 50:19-26. [PMID: 34859897 DOI: 10.1111/cdoe.12712] [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: 06/01/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the association between health management and human resource factors on matrix support (MS) in a nationally representative sample of Dental Specialty Centres (DSCs) in Brazil. METHODS This survey included 1042 DSCs (Response rate = 94.99%) in the second cycle of the National Program for the Improvement of the Quality and Access to the Dental Specialty Centres (PMAQ-CEO, in Portuguese) in 2018. Previously trained interviewers extracted information on MS, health management and human resources of the DSC by using a structured instrument. An MS score was created by adding the number of positive answers to the 10 MS questions. Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios (RR) and corresponding 95% confidence interval (CI). RESULTS Of all the DSCs (n = 1042), 116 (11.1%) performed all 10 MS procedures. Those DSCs with a manager who had a higher education degree in the area of Public Health or Public Management (RR = 1.01, 95% CI, 1.01-1.02) and with human resources that received incentives, bonuses or financial awards for performance related to the PMAQ-CEO result (RR = 1.01 95% CI 1.01-1.02) are more likely to perform MS, when compared to the reference categories. The DSCs that are more likely to perform MS include those that developed actions as a result of periodic planning and evaluation with confirmatory documentation (RR = 1.06, 95% CI; 1.01-1.10); those that received support for planning and organizing the work scheme (RR = 1.03, 95% CI; 1.01-1.05); those that monitored and analysed the goals set for each specialty offered at the DSC, with (RR = 1.06, 95% CI; 1.01-1.10) or without confirmatory documentation (RR = 1.06, 95%CI; 1.02-1.11); those whose team periodically performed self-assessment processes, using the Ministry of Health's formal self-assessment (AMAQ in Portuguese) (RR = 1.04, 95% CI; 1.02-1.05); those who followed clinical guidelines (with confirmatory documentation) regarding the referral of patients from primary care to the DSC (RR = 1.02, 95% CI; 1.01-1.04). On the contrary, DSCs that did not use the results achieved in previous PMAQ cycles in the organization of the DSC's team work scheme proved to be less likely to perform MS (RR = 0.98, 95% CI; 0.96-0.99). CONCLUSIONS Matrix support is associated with human resources and management factors in secondary oral health care in Brazil. Continuing professional development and some management characteristics are important for secondary dental care quality and could be considered in health policy initiatives.
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Affiliation(s)
| | - João Henrique Lara do Amaral
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lívia Guimarães Zina
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mara Vasconcelos
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rafaela da Silveira Pinto
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marcos Azeredo Furquim Werneck
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Almansour HA, Aloudah NM, Alhawassi TM, Chaar B, Krass I, Saini B. Physicians' views on cardiovascular disease risk prevention services by pharmacists and potential for collaboration. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 4:100077. [PMID: 35479842 PMCID: PMC9029915 DOI: 10.1016/j.rcsop.2021.100077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/10/2021] [Accepted: 09/26/2021] [Indexed: 10/26/2022] Open
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Cheng MK, Collins S, Baron RB, Boscardin CK. Analysis of the Interprofessional Clinical Learning Environment for Quality Improvement and Patient Safety From Perspectives of Interprofessional Teams. J Grad Med Educ 2021; 13:822-832. [PMID: 35070095 PMCID: PMC8672841 DOI: 10.4300/jgme-d-20-01555.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/20/2021] [Accepted: 08/16/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In 2018 the Clinical Learning Environment Review (CLER) Program reported that quality improvement and patient safety (QIPS) programs in graduate medical education (GME) were largely unsuccessful in their efforts to transfer QI knowledge and substantive interprofessional QIPS experiences to residents, and CLER 2.0 called for improvement. However, little is known about how to improve the interprofessional clinical learning environment (IP-CLE) for QIPS in GME. OBJECTIVE To determine the current state of the IP-CLE for QIPS at our institution with a focus on factors affecting the IP-CLE and resident integration into interprofessional QIPS teams. METHODS We interviewed an interprofessional group of residents, faculty, and staff of key units engaged in IP QIPS activities. We performed thematic analysis through general inductive approach using template analysis methods on transcripts. RESULTS Twenty individuals from 6 units participated. Participants defined learning on interprofessional QIPS teams as learning from and about each other's roles through collaboration for improvement, which occurs naturally when patients are the focus, or experiential teamwork within QIPS projects. Resident integration into these teams had various benefits (learning about other professions, effective project dissemination), barriers (difficult rotations or program structure, inappropriate assumptions), and facilitators (institutional support structures, promotion of QIPS culture, patient adverse events). There were various benefits (strengthened relationships, lowered bar for further collaboration), barriers (limited time, poor communication), and facilitators (structured meetings, educational culture) to a positive IP-CLE for QIPS. CONCLUSIONS Cultural factors prominently affected the IP-CLE and patient unforeseen events were valuable triggers for IP QIPS learning opportunities.
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Affiliation(s)
- Mike K.W. Cheng
- All authors are with the University of California, San Francisco
- Mike K.W. Cheng, MD, is Clinician Educator Fellow (PGY-6), Division of General Internal Medicine, Department of Medicine
| | - Sally Collins
- All authors are with the University of California, San Francisco
- Sally Collins, MA, MSc, is Research Data Analyst, Center for Faculty Educators
| | - Robert B. Baron
- All authors are with the University of California, San Francisco
- Robert B. Baron, MD, MS, is Professor of Medicine, Division of General Internal Medicine, Department of Medicine, and Associate Dean
| | - Christy K. Boscardin
- All authors are with the University of California, San Francisco
- Christy K. Boscardin, PhD, is Professor, Department of Medicine and Department of Anesthesia and Perioperative Care
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Masumoto S, Sato M, Yamakawa T, Hamada S, Inaba T, Kataoka Y, Ozone S, Yokoya S, Hamano J. Evaluation of changes in prescription among Japanese elderly patients before and after transition to home care. J Gen Fam Med 2021; 23:94-100. [PMID: 35261856 PMCID: PMC8888811 DOI: 10.1002/jgf2.506] [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: 07/19/2021] [Revised: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background Most patients receiving home care have multimorbidity and tend to be prescribed multiple drugs with the complicated regimen. Family physicians (FPs) are responsible for patients' prescriptions after transition to home care. This study aimed to assess changes in medication regimen complexity and potentially inappropriate medications (PIMs) made by FPs before and after transition to home care. Methods A retrospective cohort study was conducted in six home care clinics in Ibaraki Prefecture, Japan. Data from patients aged 65 years and older taking any medication who initiated home care between April 2018 and March 2019 were collected using medical records. The medication regimen complexity index‐Japanese version (MRCI‐J) score and the presence of PIMs were assessed before and 3 months after transition to home care. Results The mean age of 169 patients was 84.0 years. MRCI‐J score and percentage of PIMs remained unchanged between before and 3 months after home care initiation. However, MRCI‐J score significantly decreased among patients with polypharmacy, but significantly increased among patients with nonpolypharmacy. In multiple regression analysis, a greater number of medications before home care initiation was associated with a decreasing MRCI‐J score, but pharmacist home visit services were not associated with changes in MRCI‐J score. Conclusions Our results suggest that FPs involved in home care are trying to adjust prescriptions by simplifying the medication regimen of patients with polypharmacy, and adding symptomatic drugs to those with nonpolypharmacy.
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Affiliation(s)
- Shoichi Masumoto
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine University of Tsukuba Tsukuba Japan
- Department of General Medicine Tsukuba Central Hospital Ushiku Japan
| | - Mikiya Sato
- Department of Health Services Research, Faculty of Medicine University of Tsukuba Tsukuba Japan
- Health Services Center, Human Resources Group Sumitomo Heavy Industries, Ltd Tokyo Japan
| | - Tomotsugu Yamakawa
- Graduate School of Comprehensive Human Sciences University of Tsukuba Tsukuba Japan
| | | | - Takashi Inaba
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Yoshihiro Kataoka
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Sachiko Ozone
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Shoji Yokoya
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine University of Tsukuba Tsukuba Japan
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Lukey R, Gray B, Morris C. 'We're just seen as people that give out the methadone…': exploring the role of community pharmacists in the opioid substitution treatment team. J Prim Health Care 2021; 12:358-367. [PMID: 33349324 DOI: 10.1071/hc20108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION People receiving opioid substitution treatment are a vulnerable population who experience significant health inequities and stigma, but have regular interactions with community pharmacists. Many pharmacists now work collaboratively with other health providers to ensure effective and safe use of medicines, as well as being involved in the prevention and management of chronic health conditions. AIM To explore the role of New Zealand community pharmacists in the provision of opioid substitution treatment and how they perceive their role as part of the wider opioid substitution treatment team. METHODS Semi-structured video interviews with a purposive sample of 13 diverse pharmacists explored their current practices in providing opioid substitution treatment, and their perceived role in the treatment team. Interviews were audio-recorded and transcribed verbatim. Data were coded and analysed using an inductive thematic approach. RESULTS This study found that pharmacists are providing accessible support to a population with known barriers to accessing health care. However, participants also identified challenges with communication and a perceived lack of understanding of the pharmacist role as barriers to collaboration with the wider opioid substitution treatment team. DISCUSSION Collaboration within health-care teams has been shown to improve health outcomes, and pharmacists are well placed to provide health-care services as well as offer valuable insight into clients' mental and physical wellbeing. Improved communication channels that facilitate information sharing, as well as the opioid substitution treatment team's recognition of a pharmacist's role, may facilitate collaboration and, in turn, improve the quality of health care provided to this vulnerable population.
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Affiliation(s)
- Rebecca Lukey
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand; and Corresponding author.
| | - Ben Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Caroline Morris
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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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:ijerph18189686. [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.)
- Correspondence: ; Tel.: +48-61-845-27-95
| | - 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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Zielińska-Tomczak Ł, Cerbin-Koczorowska M, Przymuszała P, Marciniak R. How to effectively promote interprofessional collaboration? - a qualitative study on physicians' and pharmacists' perspectives driven by the theory of planned behavior. BMC Health Serv Res 2021; 21:903. [PMID: 34474676 PMCID: PMC8414767 DOI: 10.1186/s12913-021-06903-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/17/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Ajzen's theory of planned behavior (TPB) postulates that individuals' behavioral intention is influenced by their attitudes, subjective norms, and perceived behavioral control. Therefore, it can be used to broaden the understanding of particular behaviors, including healthcare workers' professional activities. METHODS In this study, we used TPB as a theoretical framework to evaluate semi-structured interviews with pharmacists and physicians to build an understanding of the interprofessional collaboration between them. Sixteen semi-structured interviews were conducted with pharmacists and eleven with physicians. The sample of participants comprised a diverse group with varying work experience and workplaces. Data were analyzed independently by two researchers following the thematic analysis method using ATLAS.ti software. Data saturation was set in the absence of new issues arising during the interviews. RESULTS The content analysis allowed for the determination of six main themes: the relationship between previous experiences and attitudes towards collaboration, pharmacist's role in collaboration, mutual reluctance toward collaboration, the role of decision- and policy-makers, knowledge and qualifications gaps regarding collaboration, and lack of organizational paths. CONCLUSIONS Despite both physicians and pharmacists displaying positive attitudes towards collaboration may foster their intention to establish a professional partnership, subjective norms (e.g., the lack of appropriate legal regulations) and perceived behavioral control (physicians' lack of awareness about pharmacists' qualifications and the low level of interpersonal skills) might impede the process.
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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.
| | - Magdalena Cerbin-Koczorowska
- Department of Medical Education, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806, Poznan, Poland
| | - Piotr Przymuszała
- Department of Medical Education, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806, Poznan, Poland
| | - Ryszard Marciniak
- Department of Medical Education, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806, Poznan, Poland
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Experiences of key stakeholders with the implementation of medication reviews in community pharmacies: A systematic review using the Consolidated Framework for Implementation Research (CFIR). Res Social Adm Pharm 2021; 18:2944-2961. [PMID: 34420864 DOI: 10.1016/j.sapharm.2021.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Though medication reviews have shown positive patient outcomes, they are still not widely implemented in community pharmacies. Published reviews on their implementation often include several other pharmacy services, making them non-specific. Using the Consolidated Framework for Implementation Research (CFIR) to focus solely on the experiences of different stakeholders with the implementation of medication reviews will help to better understand relevant facilitators and barriers. OBJECTIVES To critically appraise, synthesise and present the available evidence on experiences of key stakeholders with the implementation of medication reviews and to identify barriers and facilitators to its implementation in community pharmacies. METHODS A systematic literature search was conducted in four databases for studies published in English, Spanish or German. Key search terms included: implementation, pharmac*, medication review, facilitator, barrier. Study selection, quality assessment and data extraction were performed by two independent reviewers. Findings were mapped directly against the constructs of the CFIR. RESULTS Out of 924 retrieved records 24 articles from 9 countries met the inclusion criteria. Key facilitators identified included pharmacists' openness to practice change and a high degree of patient satisfaction post medication review. Attracting patients to the service was stated as challenging due to an unawareness of the scope and potential benefit of a medication review. The dominant barrier was inadequate remuneration, as it impacted all additional resourcing and ultimately the viability of the service. Further barriers included difficult professional relationships with doctors and little mandate from health authorities. Most reports were from the employed pharmacists' perspective and concerned the inner setting, other perspectives were under-reported. CONCLUSIONS Results of this systematic review illustrate different stakeholders' experiences and add to the understanding of challenges in the implementation process. Nevertheless, findings also highlight how scarce reporting of external stakeholders' views is and that filling this gap can unveil hidden barriers and facilitators. REGISTRATION PROSPERO register (CRD 42019122836).
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Araújo HPA, dos Santos LC, Domingos TDS, Alencar RA. Multiprofessional family health residency as a setting for education and interprofessional practices. Rev Lat Am Enfermagem 2021; 29:e3450. [PMID: 34190941 PMCID: PMC8253368 DOI: 10.1590/1518-8345.4484.3450] [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: 05/12/2020] [Accepted: 11/02/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to know the experiences lived during the residency by graduates of a Multiprofessional Residency Program in Family Health that could contribute to the development of Interprofessional Education and/or Collaborative Practice. METHOD a qualitative study with residents who entered a Multiprofessional Residency Program of a Brazilian public university in 2017, a period in which the theme of interprofessionality was implemented in the activities of the residency. Data was collected using an electronic form built from the theoretical framework of interprofessional education. Content analysis was used to process the data. RESULTS nine residents participated, distributed among the professions of Physical Education, Nursing, Nutrition, Dentistry, Psychology and Social Work, five of whom were female and with a mean age of 28.4. Two categories emerged: the Residency as a setting for learning from the other, and the Residency as a setting for understanding the role of the other. Interprofessional education and practice provided opportunities for the development of collaborative skills, enhancing teamwork and interprofessional work. CONCLUSION the multiprofessional logic was evidenced in the resident's practice; and the gradual insertion of activities such as case discussions, shared services and inter-sectoral actions aligned with the theoretical-methodological framework of interprofessionality favored an approach to interprofessional work.
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Affiliation(s)
- Heloísa Pimenta Arruda Araújo
- Universidade Estadual Paulista “Júlio de Mesquita Filho”,
Departamento de Enfermagem, Botucatu, SP, Brazil
- Sociedade Beneficente de Senhoras Hospital Sírio Libanês, Saúde
Corporativa, São Paulo, SP, Brazil
| | - Lucas Cardoso dos Santos
- Universidade Estadual Paulista “Júlio de Mesquita Filho”,
Departamento de Enfermagem, Botucatu, SP, Brazil
- Sociedade Beneficente de Senhoras Hospital Sírio Libanês, Saúde
Corporativa, São Paulo, SP, Brazil
| | - Thiago da Silva Domingos
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem,
Departamento de Enfermagem Clínica e Cirúrgica, São Paulo, SP, Brazil
| | - Rúbia Aguiar Alencar
- Universidade Estadual Paulista “Júlio de Mesquita Filho”,
Departamento de Enfermagem, Botucatu, SP, Brazil
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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: 62] [Impact Index Per Article: 20.7] [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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