Collaboration in chronic care: unpacking the relationship of pharmacists and general medical practitioners in primary care

A qualitative study on asthma management experiences of Turkish community pharmacists

INTRODUCTION

Asthma is seen in more than 4 million people in Turkey. Numerous studies have shown the beneficial effects of pharmacist interventions on medication adherence and therapeutic outcomes. The aim of this study was to gain insight into the current situation by examining the experiences of Turkish community pharmacists in relation to the counseling and referral of asthma patients, the responsibilities of pharmacists and the recommendations made by pharmacists to improve asthma management.

METHODS

In this qualitative study, the constructivist-interpretivist paradigm was adopted. To conduct qualitative interviews, a semi-structured interview guide was devised to gather insights from the pharmacists. The interviews were coded verbatim. Subsequently, various themes and sub-themes were developed based on the aim and objectives of the study.

RESULTS

A total of 14 pharmacists engaged in semi-structured interviews conducted between June and August 2023. The wealth of information gathered during these interviews facilitated a meticulous thematic analysis, yielding four overarching themes: 1) Patient-related difficulties, 2) Communication with physicians, 3) Desired traits and responsibilities of pharmacists, 4) Pharmacists' expectations. Pharmacists placed significant emphasis on their challenges in allocating time to patients, primarily due to high workloads and limited collaboration with physicians.

CONCLUSION

Considering the workload and time limitations faced by pharmacists, a collaborative model involving pharmacists and physicians is seen as essential. Enhancing the collaboration between pharmacists and physicians, especially for chronic diseases, holds the potential to enhance public health outcomes while alleviating the workload of pharmacists.

Acceptance rate of clinical pharmacists' recommendations-an ongoing journey for integration

Introduction: Multidisciplinary expert team collaboration in the clinical setting, which includes clinical pharmacist involvement can facilitate significant improvements in outcomes and optimize patient management by preventing drug-related problems (DRP). This type of collaboration is particularly valuable in patients with multi-morbidity and polypharmacy such as diabetic foot patients. Evidence regarding the successful integration of a new clinical pharmacist, without previous experience into a unit is still scarce. Therefore, this study aimed to describe and evaluate the actual successful integration process of the clinical pharmacist into a diabetic foot unit by measuring the change in recommendation acceptance rate over time. Methods: A prospective, exploratory treatment effectiveness study based on the recommendation acceptance rate of a new clinical pharmacist introduced into the diabetic foot unit was conducted over a 9- month period. The clinical pharmacist identified medical and drug-related problems (DRP) or any discrepancies in the prescribing and administration of medications. Each identified DRP was documented and formulated as a recommendation by the clinical pharmacist. The main outcome measure was the acceptance rate of recommendations over time. Results: A total of 86 patients, of which 67% were men, averagely aged 66.5 (SD 11.8) years were evaluated. Calculated BMI was 30.2 (SD 6.2). The average number of medical diagnoses was 8.9 (SD3.2), and 11.1 (SD 3.7) prescribed drugs for each patient. Cardiovascular disease was presented by 95% (n = 82) of the patients and 33% of them (n = 28) had uncontrolled hyperglycemia. Averagely, 3.3 (SD 1.9) DRPs were identified pre patient. The efficacy-related DRP recommendation acceptance rate increased over the study period from 37.8% in the first 4 months to 79.4% after a period of 4.75 months. Safety-related DRP recommendation acceptance rate increased from 56% to 67.6%. Conclusion: Improved clinical outcomes and optimized pharmacologic patient management may be achieved by the successful integration of a clinical pharmacist into the team. This study provides evidence of the increasing recommendation acceptance rate of integrated, pharmacist-driven comprehensive medication management in an unexperienced unit. To overcome challenges, team members should collaborate to fully integrate the clinical pharmacist into the team-based structure and utilize proper strategies to minimize and transcend barriers.

Interprofessional education and collaborative practice in Nigeria - Pharmacists' and pharmacy students' attitudes and perceptions of the obstacles and recommendations

INTRODUCTION

Many countries have implemented interprofessional education (IPE) and interprofessional collaborative practice (IPCP), but there is a dearth of information on the state of IPE in Nigeria. We evaluated the attitude of Nigerian pharmacy students and pharmacists towards IPE and IPCP and the perceived barriers to and recommendations for the implementation of IPE and IPCP.

METHODS

A cross-sectional survey of 238 community and hospital pharmacists and 765 pharmacy students in Nigeria was conducted with an online questionnaire using the Interprofessional Attitude Scale. Information on the perceived barriers to and recommendations for implementing IPE was also collected.

RESULTS

Two hundred and seven pharmacists (87%) and 629 (82.2%) pharmacy students agreed that it is necessary for health profession students to learn together. Perceived barriers to the implementation of IPE and IPCP included professional pride [pharmacists = 51 (21.42%), pharmacy students = 55 (7.19%)], prejudice against other health professions [pharmacists = 35 (14.7%), pharmacy students = 74 (9.67%)], uni-professional training [pharmacists = 5 (2.1%), pharmacy students = 7 (0.92%)], and government policies that discourage IPE and IPCP [pharmacists = 10 (4.2%), pharmacy students = 20 (2.61%)]. Recommendations proposed were the integration of IPE in undergraduate pharmacy curricula, cooperation among health professionals to curb professional rivalry, and the provision of necessary facilities and resources by the government.

CONCLUSIONS

Nigerian pharmacists and pharmacy students had positive attitudes towards IPE and IPCP. The perceived barriers to implementing IPE in Nigeria include discouraging government policies. Deliberate and implementable government policies on IPE are needed.

Continuity and care coordination of primary health care: a scoping review

BACKGROUND

Healthcare coordination and continuity of care conceptualize all care providers and organizations involved in health care to ensure the right care at the right time. However, systematic evidence synthesis is lacking in the care coordination of health services. This scoping review synthesizes evidence on different levels of care coordination of primary health care (PHC) and primary care.

METHODS

We conducted a scoping review of published evidence on healthcare coordination. PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science and Google Scholar were searched until 30 November 2022 for studies that describe care coordination/continuity of care in PHC and primary care. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to select studies. We analysed data using a thematic analysis approach and explained themes adopting a multilevel (individual, organizational, and system) analytical framework.

RESULTS

A total of 56 studies were included in the review. Most studies were from upper-middle-income or high-income countries, primarily focusing on continuity/care coordination in primary care. Ten themes were identified in care coordination in PHC/primary care. Four themes under care coordination at the individual level were the continuity of services, linkage at different stages of health conditions (from health promotion to rehabilitation), health care from a life-course (conception to elderly), and care coordination of health services at places (family to hospitals). Five themes under organizational level care coordination included interprofessional, multidisciplinary services, community collaboration, integrated care, and information in care coordination. Finally, a theme under system-level care coordination was related to service management involving multisectoral coordination within and beyond health systems.

CONCLUSIONS

Continuity and coordination of care involve healthcare provisions from family to health facility throughout the life-course to provide a range of services. Several issues could influence multilevel care coordination, including at the individual (services or users), organizational (providers), and system (departments and sectors) levels. Health systems should focus on care coordination, ensuring types of care per the healthcare needs at different stages of health conditions by a multidisciplinary team. Coordinating multiple technical and supporting stakeholders and sectors within and beyond health sector is also vital for the continuity of care especially in resource-limited health systems and settings.

Factors influencing clinical pharmacists' integration into the clinical multidisciplinary care team

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.

Family physicians collaborating for health system integration: a scoping review

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Empowerment of care home staff through effective collaboration with healthcare

Integrative local health delivery models in the UK, under the framework of Enhanced Health in Care Homes (EHICH), have been developed to improve joint working between health and social care to benefit the patient. Despite this drive toward health and social care integration, research on the barriers, facilitators, and impact of partnership working on role of care home staff is underdeveloped. This study set out to explore views on how closer working between health and social care can impact on the role of care home staff and any barriers to effective integration. Staff from 25 care homes and GPs from their partnered practices were interviewed to explore the impact of the partnership. Homes receiving regular visits from the same health professional found the relationship between the two sectors had benefitted both residents and staff. The development of trusting relationships, access to support and information, and recognition and respect were all seen as facilitating the partnership and enhancing patient care. Regular and effective interactions with health-care professionals were key and had the potential to empower and increase confidence of care home staff in their role around health care. Factors negatively impacting on strength of relationship such as visits by inconsistent professional and high turnover of care home staff were a barrier to successful partnerships. Experiences of poor interactions with those from health-care services where there was an absence of a trusting relationship were disempowering to care home staff and remain a barrier to effective wider health and social care collaboration.

What outcomes of moral case deliberations are perceived important for healthcare professionals to handle moral challenges? A national cross-sectional study in paediatric oncology

Background

In paediatric oncology, healthcare professionals face moral challenges. Clinical ethics support services, such as moral case deliberation (MCD), aim to assist them in dealing with these challenges. Yet, healthcare professionals can have different expectations and goals related to clinical ethics support services.

Methods

In this study, the perceptions held by healthcare professionals (nursing assistants, registered nurses, physicians, and others) regarding the importance of possible outcomes of MCDs, prior to implementation of MCDs, were investigated. A multisite, cross-sectional, quantitative study was performed at all six Paediatric Oncology Centres in Sweden. Healthcare professionals answered the Euro-MCD instrument with 26 potential MCD outcomes using a scale from Not important (1) to Very important (4). Descriptive and comparative statistical analyses were carried out.

Results

All outcomes were rated high, i.e., between 3.12 and 3.78. More open communication, developing skills to analyse ethically difficult situations, better mutual understanding, and deciding on concrete actions were rated as most important. Understanding of ethical theories and critical examination of policies were rated less important. Most often nursing assistants rated higher and physicians lower than the other professions did. Women and participants without previous experience of MCDs perceived outcomes as more important. There were differences between centres as one centre had significantly higher, and one centre had significantly lower ratings compared to the others.

Conclusion

It is clear that healthcare professionals want MCDs to improve teamwork and skills in order to analyse and manage ethically difficult situations. When comparing to previous research about important MCD outcomes, there were similarities in what healthcare professionals consider to be important when handling moral challenges regardless of country and potential differences in healthcare settings and systems, such as paediatric vs. adult care.

A Novel GPPAS Model: Guiding the Implementation of Antimicrobial Stewardship in Primary Care Utilising Collaboration between General Practitioners and Community Pharmacists

Interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs) is central to implement antimicrobial stewardship (AMS) programmes in primary care. This study aimed to design a GP/pharmacist antimicrobial stewardship (GPPAS) model for primary care in Australia. An exploratory study design was followed that included seven studies conducted from 2017 to 2021 for the development of the GPPAS model. We generated secondary and primary evidence through a systematic review, a scoping review, a rapid review, nationwide surveys of Australian GPs and CPs including qualitative components, and a pilot study of a GPPAS submodel. All study evidence was synthesised, reviewed, merged, and triangulated to design the prototype GPPAS model using a Systems Engineering Initiative for Patient Safety theoretical framework. The secondary evidence provided effective GPPAS interventions, and the primary evidence identified GP/CP interprofessional issues, challenges, and future needs for implementing GPPAS interventions. The framework of the GPPAS model informed five GPPAS implementation submodels to foster implementation of AMS education program, antimicrobial audits, diagnostic stewardship, delayed prescribing, and routine review of antimicrobial prescriptions, through improved GP–CP collaboration. The GPPAS model could be used globally as a guide for GPs and CPs to collaboratively optimise antimicrobial use in primary care. Implementation studies on the GPPAS model and submodels are required to integrate the GPPAS model into GP/pharmacist interprofessional care models in Australia for improving AMS in routine primary care.

A systematic review and thematic synthesis to identify factors that influence pharmacists' involvement in asthma care services: An identity crisis

Background

Asthma is a common chronic disease worldwide affecting an estimated 300 million people. Pharmacists can play key roles to support optimal health outcomes for patients with asthma. Goffman's Dramaturgical Theory was used in this review to critically examine the literature describing the role of pharmacists in asthma services.

Objectives

The aim of this review is to identify factors that influence the role of pharmacists in asthma care services.

Methods

A systematic literature search was conducted of seven electronic databases including: CINAHL, Midline (Ovid), PubMed, Scopus, Web of science, Embase and PsycInfo.). The search was not restricted by language or date of publication. Studies were screened according to inclusion criteria which included much relate to pharmacists, asthma services and include qualitative findings. Data was extracted and thematically synthesised to create demographic, descriptive and analytical findings.

Results

Eighteen studies were included. The majority of studies were conducted in high income countries, with most of the studies conducted in Australia (n = 10). Semi-structured interview was used as a method for data collection in most studies (n = 11). Evidence indicated pharmacists engaged in asthma services positively and wanted to expand their roles in patient care. However, literature reported patients' attitudes and health-system factors such as remuneration, as well as inter-professional collaboration and expected low levels of knowledge and skills of pharmacists were barriers to implementation of pharmacy-led asthma care. Analytical findings suggest that pharmacists' involvement in asthma care services were influenced by patients' and healthcare professionals' expectations which were juxtaposed with pharmacists' own self-perceived identity.

Conclusions

This review demonstrates pharmacists self-identified as being capable and equipped with appropriate knowledge and skills, however the expectations of patients and other healthcare professionals prohibited their involvement in delivering asthma care services.

Probing pharmacists' interventions in Long-Term Care: a systematic review

PURPOSE

Long-Term Care (LTC) systems have experienced recent developments driven by changes in healthcare and demography (e.g. population ageing). As well, pharmacists are changing from traditional roles to more patient-oriented services. The present study aimed to identify and assess pharmacists' and/or pharmacy-based interventions in institutional LTC settings, also mapping relevant medications.

METHODS

The review was undertaken in general accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), using three main literature databases (PubMed, Scopus, and Web of Knowledge). A set of 16 keywords, divided into three domains (professional, type of care and type of setting), were combined into search equations. Selected studies were assessed through the Quality Assessment Tool for Quantitative Studies.

RESULTS

Twenty-six studies met the inclusion criteria, out of 794 initial hits. Most studies (12) described pharmacist/pharmacy-driven interventions assessing Medication Management Reviews' impact in different endpoints or outcomes. Other studies (3) assessed pharmacists' interventions on specific medication groups. Good Administration Practices, new pharmaceutical care models, antibiotic stewardship programs, and studies assessing other pharmacists' interventions, such as pharmacy-managed informatics and education, were addressed by 11 other papers. Six studies were classified as Strong after quality assessment.

CONCLUSION

LTC is a clinically complex type of care benefiting from interdisciplinary work. Despite the overall lower quality of the identified studies, pharmacists perform in a wide array of LTC areas. The broad implementation of pharmaceutical activities in institutional LTC settings opens opportunities to optimise medicines' use.

Divergent and Convergent Attitudes and Views of General Practitioners and Community Pharmacists to Collaboratively Implement Antimicrobial Stewardship Programs in Australia: A Nationwide Study

Setting up an interprofessional team for antimicrobial stewardship (AMS) to improve the quality and safety of antimicrobial use in primary care is essential but challenging. This study aimed to investigate the convergent and divergent attitudes and views of general practitioners (GPs) and community pharmacists (CPs) about AMS implementation and their perceived challenges of collaboration to design a GP–pharmacist collaborative AMS (GPPAS) model. Nationwide surveys of GPs and CPs across Australia were conducted January-October 2019. Chi square statistics and a theoretical framework were used for comparative analyses of quantitative and qualitative data, respectively. In total, 999 participants responded to the surveys with 15.4% (n = 386) response rates for GPs and 30.7% (n = 613) for CPs. GPs and CPs were aware about AMS however their interprofessional perceptions varied to the benefits of AMS programs. CPs indicated that they would need AMS training; significantly higher than GPs (GP vs. CP; 46.4% vs. 76.5%; p < 0.0001). GPs’ use of the Therapeutic Guideline Antibiotic was much higher than CPs (83.2% vs. 45.5%; p < 0.0001). No interprofessional difference was found in the very-limited use of patient information leaflets (p < 0.1162) and point-of-care tests (p < 0.7848). While CPs were more willing (p < 0.0001) to collaborate with GPs, both groups were convergent in views that policies that support GP–CP collaboration are needed to implement GPPAS strategies. GP–pharmacist collaborative group meetings (54.9% vs. 82.5%) and antimicrobial audit (46.1% vs. 86.5%) models were inter-professionally supported to optimise antimicrobial therapy, but an attitudinal divergence was significant (p < 0.001). The challenges towards GP–CP collaboration in AMS were identified by both at personal, logistical and organisational environment level. There are opportunities for GP–CP collaboration to improve AMS in Australian primary care. However, strengthening GP–pharmacy collaborative system structure and practice agreements is a priority to improve interprofessional trust, competencies, and communications for AMS and to establish a GPPAS model in future.

The Launch of the European Patients' Academy on Therapeutic Innovation in the Netherlands: A Qualitative Multi-Stakeholder Analysis

Background: Involving patients' representatives in the research and development of medicinal products (medicines R&D) leads to better medical treatment. In 2014, the European Patients' Academy on Therapeutic Innovation (EUPATI) was started with the goal of increasing the capacity and capabilities of patient representatives in this field. To make this academy more accessible and applicable for the Netherlands, a Dutch version was launched in September 2019. To explore the options for a durable infrastructure for organizing the Dutch EUPATI course, a multi-stakeholder qualitative study was done. The views of various stakeholders from pharmaceutical industry, governmental organizations, patient organizations, and the academic world were examined about the benefits and challenges of this course for patient involvement in medicines R&D. Methods: From April to June 2019, 10 semi-structured interviews were completed, each with two representatives of all stakeholders involved. In addition, individual Dutch graduates of the European EUPATI (EUPATI fellows) were consulted via an e-mail questionnaire. Using a directed content analysis based on the Business Canvas Model, the transcribed interviews were coded, analyzed, and final attributes consolidated. Results: The semi-structured interviews and completed questionnaires explored how the stakeholders are aiming to assist patient involvement in medicines R&D through the Dutch EUPATI course. The building blocks of the Business Canvas Model were described with concrete attributes for making the business case. Stakeholders stated that the Dutch EUPATI course was an incentive for patient involvement in medicines development, for patient-oriented research and outcomes, for the availability of patient representatives (expert ones in particular), and for the content and representation quality of patient representatives. The key values for collaborating in the network as mentioned by the stakeholders were neutrality, patients' interests, equality, independence, shared objectives, long-term commitment, transparency, understanding, trust, and respect. Conclusions: Patient involvement in medicines R&D is evolving and the demand for qualified patient representatives is growing. Dutch stakeholders confirmed the added value of the patients' academy and expressed their willingness to contribute. Important values and conditions for long term collaboration were formulated.

The acceptance and awareness of healthcare providers towards doctor of pharmacy (Phram D) in the Palestinian health care system

Clinical pharmacy (Pharm.D or MSc Clinical Pharmacy graduates) is a patient care oriented specialty. It aims to improve patient therapeutic outcomes and minimize medication errors. In Palestine, it is a new specialty taught at two universities. In order to implement this new specialty in healthcare settings, healthcare providers should have a high awareness about it, its role and importance in clinical settings. This study aimed to evaluate the awareness and acceptance levels among healthcare providers' about clinical pharmacy specialty. A cross sectional study carried out using a self-administered questionnaire that was developed and tested by a panel of experts for validity and reliability, then it was distributed and filled by the convenient sample of health care providers in the northern and middle of Palestine between January and March 2019. An awareness scale and acceptance scale were developed from the questions used to identify the healthcare providers' awareness and acceptance. Chi-square (X2) -testing was performed to check for the significant association. Data were analyzed using SPSS (version22). Among 309 respondents, 203(65.7%) were male, 67(21.7%) were working at Jerusalem, 229(74.1%) of them completed their first degree at Arab countries and 69(54.7%) completed higher education. Regarding their work, 169(54.7%) were physicians, followed by 85(27.5%) nurses and 55(17.8%) pharmacists. Results revealed that the majority of healthcare providers had a moderate 182(58.9%) and good 81(26.2%) awareness level toward the Clinical pharmacy specialty roles and 217 (70.2%) had a good acceptance level toward their implementation among the health worker team. Significant differences were found between healthcare providers' awareness level and their sex (P = 0.001), professions (P = 0.006) and job descriptions (P = 0.013). There were no significant differences between the health care providers' acceptance level and their age, sex, qualification, profession and job descriptions. Our results revealed the ability to collaborate in the integration of such specialty within the Palestinian healthcare system. Additional interest from the Ministry of Health is recommended to integrate clinical pharmacy workers among the health system and promote their relations with other disciplines.

Health professional perspectives of expanded practice in rural community pharmacy in Australia

OBJECTIVES

Expanded pharmacy service delivery for rural and remote Australia has potential to address the rural health disparity. Pharmacists practising to their full scope are recognised as being most beneficial in rural and regional communities, where access to health professionals (HPs) is not comparable to those in metropolitan areas. However, research on HP perspectives on expanded pharmacy practice is limited. This study aims to determine rural and remote HP (doctors, nurses, allied health and other HPs) perspectives of expanded services to be delivered through community pharmacy.

METHODS

Australian rural and remote HPs participated in a questionnaire survey which explored views on expanded pharmacy services in their local communities. Potential expanded pharmacy services were provided, and participants were asked to indicate what expanded pharmacy would benefit their local community and their level of support for the services. Analysis of the data included frequency analyses and one-way ANOVA tests with post hoc Tukey's HSD tests using IBM SPSS Statistic 25.

RESULTS

Health professionals (N = 121) from rural and remote locations participated. Sexually transmitted disease testing, vaccinations, diabetes and asthma management were the most frequently chosen services that HPs agreed would improve the health of people in their community. Doctors chose the least number of services (mean = 1 services) compared with all other HPs (mean => 5 services). Sixty-eight per cent of participants agreed/strongly agreed that providing these additional services would improve health, with participants (73%) agreeing/strongly agreeing that they would support the implementation of these additional services, not otherwise available in their community. Comparing professional groups, doctors were only half as supportive of expanded pharmacy services, when compared with all other HPs.

CONCLUSION

This study confirms the importance of a collaborative, local model to deliver expanded pharmacy services for rural communities. Health professionals were found to largely support expanding pharmacy practice, agreeing about the improved access to health care that would be provided for people living in rural and remote Australia.

Understanding perceptions of involving community pharmacy within an integrated care model: a qualitative study

BACKGROUND

Over the past several years, there has been more emphasis on integration within health care. Community pharmacy is often under-represented within integrated care models. This study explored stakeholder perceptions and enablers of including community pharmacy within an integrated care model.

METHODS

A qualitative study was undertaken. Participants were recruited through professional networks and social media, as well as snowball recruitment from other participants. They included community pharmacists, clinicians, and decision-makers working in Ontario, Canada. Data were collected using telephone interviews completed with a semi-structured interview guide based on Consolidated Framework for Implementation Research from June to September 2018. Data were analysed inductively and deductively following the Qualitative Analysis Guide of Leuven. An additional theoretical framework (Rainbow Model of Integrated Care) was used to categorize enablers.

RESULTS

Twenty-two participants were interviewed including nine pharmacists, seven clinicians, and six decision-makers. Three key themes were identified: 1) Positive value of including pharmacy in integrated care models; 2) One model does not fit all; and 3) Conflict of interest. Four key enablers were identified reflecting functional and normative factors: functional - 1) remuneration, 2) technology; normative - 3) engagement, and 4) relationships. While both functional and normative factors were discussed, the latter seemed to be more important to facilitate the inclusion of community pharmacy. Many participants characterized community pharmacists' lack of skills or confidence to provide patient care.

CONCLUSIONS

This study confirms previously known views about concerns with community pharmacy's conflict of interest. However, discordant perceptions of conflict of interest and negative perceptions about capabilities of community pharmacy need to be addressed for successful integration. Normative enablers, such as culture, are likely important for organizational integration and require additional inquiry.

Men's views of antidepressant treatment for depression, and their implications for community pharmacy practice

BACKGROUND

Men with depression can express and navigate their condition differently to women. Understanding this population's needs, and experiences, can help healthcare professionals better support these patients. There is a lack of knowledge in this area, and no studies have explored men's depression in the context of community pharmacy.

OBJECTIVES

Explore views of men around their medication for the treatment of depression and the role of community pharmacy in their treatment.

SETTING

United Kingdom (UK) primary care.

METHOD

Semi-structured in-depth interviews were conducted. Eligible participants were male, aged 18-65 years, and treating depression with antidepressants. Participants were recruited through 5 UK pharmacies (via the pharmacist or poster recruitment) and a UK University (poster recruitment). A thematic approach was used for analysis.

RESULTS

14 men aged 26-61 years, predominantly of white ethnicity were interviewed. Key themes were found. The theme 'Antidepressant's attributions to benefits' highlighted all men noticed benefits when taking antidepressants, but held uncertainty on what extent their antidepressants caused this. The themes 'Views of pharmacist's role influences engagement', and 'Influence of cognitive state upon healthcare interactions' demonstrated men were not inclined to discuss concerns with the community pharmacist. These men didn't see this as the pharmacist's role, nor had these men given cognitive space to evaluate their treatment beliefs or information needs. Yet the theme 'Reflection of support and information needs' shows men did have unmet information and support needs. This also links into the 'Hegemonic Masculinity and taking antidepressants' theme, where taking antidepressants could challenge ones masculinity.

CONCLUSION

Community pharmacists should create opportunities for men to engage in conversations around their antidepressants and wider support. Men, as a requisite for engagement, will need to see such interactions as within the community pharmacists' remit, and as part of a collaborative healthcare system.

Factors influencing interprofessional collaboration between community pharmacists and general practitioners-A systematic review

Effective interprofessional collaboration is critical for sustaining high quality care in the context of the increasing burden on primary healthcare services. Despite this, there is limited understanding of the factors contributing to effective collaboration between general practitioners and community pharmacists. The aim of this systematic review was to identify the factors that impact on interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs). Keywords and synonyms were combined and applied to four databases (EMBASE, CINAHL, SCOPUS, and MEDLINE) to identify articles published between January 2000 to April 2017. Relevant journals and reference lists were also hand-searched. A total of 37 articles met the eligibility criteria. Factors that posed a challenge to effective interprofessional collaboration were the perceived imbalance in hierarchy and power between the professions and a lack of understanding of each other's skills and knowledge. Experience of collaboration with the other party led to greater understanding of each other's capabilities and potential role in co-delivering patient care. The physical environment was also identified as important, with co-location and other resources to facilitate clear and regular communication identified as important facilitators of interprofessional collaboration. The review findings highlight a range of approaches that may positively influence interprofessional collaboration between GPs and CPS such as co-location, co-education to understand the professional capabilities of each group, and utilising compatible technologies to facilitate communication between the two professions.

General practitioner-pharmacist collaboration in Germany: an explanatory model

Background In Germany, no validated measure and model of pharmacist-physician collaboration existed. Objectives To provide evidence for the factor structure of the previously validated Frequency of Inter-professional Collaboration Instrument and the Attitudes Toward Collaboration Instrument in measuring attitudes toward and frequency of collaboration from the general practitioner's perspective in the context of primary care in Germany; to develop an explanatory model which illustrates factors influencing collaboration. Setting The study was conducted in the primary health care sector in Mecklenburg-Western Pomerania, Germany with a cohort of general practitioners. Method The two measures were translated into German and the survey was administered to 1438 practitioners. Exploratory factor analysis was used to assess the structure of the instruments. Structural equation modelling was used to determine how demographic variables and attitudes influence collaborative behaviour. Main outcome measure Outcome measure comprised frequency of and attitudes toward collaboration among German general practitioners and an explanatory model of practitioner-pharmacist collaboration. Results A response rate of 35.9% was achieved. Exploratory factor analysis revealed one factor for the instrument measuring attitudes and two factors for frequency. The factors were interpreted as 'Communication and Collaboration' and 'Pharmacist medication management'. The significant demographic predictors of collaboration were age, population of the surgery's location, distance to the pharmacy, specialty. Conclusion The results provide evidence for the factor structure of both measures in measuring attitudes toward and frequency of collaboration. A model of collaboration in which behaviour and extent of collaboration are directly influenced by individual and context characteristics is supported.

Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis

Interprofessional primary care (IPPC) teams are promoted as an alternative to single profession physician practices in primary care with focus on preventive care and chronic disease management. Characteristics of teams can have an impact on their performance. We synthesized quantitative, qualitative or mixed-methods evidence addressing the design of IPPC teams. We searched Ovid MEDLINE, Embase, CINAHL, and PAIS using search terms focused on IPPC teams. Studies were included if they discussed the influence of team structure, organization, financial arrangements, or policies and procedures, or either health care processes or outputs, health outcomes, or costs, and were conducted in Australia, Canada, the United Kingdom or New Zealand between 2003 and 2016. We screened 11,707 titles, 5366 abstracts, and selected 77 full text articles (38 qualitative, 31 quantitative and 8 mixed-methods). Literature focused on the implications of team characteristics on team processes, such as teamwork, collaboration, or satisfaction of patients or providers. Despite heterogeneity of contexts, some trends are observable: shared space, common vision and goals, clear definitions of roles, and leadership as important to good teamwork. The impacts of these on health care outputs or patient health are not clear. To move the state of knowledge beyond perception of what works well for IPPC teams, researchers should focus on quantitative causal inference about the linkages between team characteristics and patient health.

How do general practitioners and pharmacists experience antibiotic use in out-of-hours primary care? An exploratory qualitative interview study to inform a participatory action research project

RATIONALE

Antibiotics (ABs) are one of the most prescribed medications in out-of-hours (OOH) care in Belgium. Developing a better understanding of why ABs are prescribed in this setting is essential to improve prescribing habits.

OBJECTIVES

To assess AB prescribing and dispensing challenges for general practitioners (GPs) and pharmacists in OOH primary care, and to identify context-specific elements that can help the implementation of behaviour change interventions to improve AB prescribing in this setting.

DESIGN

This is an exploratory qualitative study using semistructured interviews. This study is part of a participatory action research project.

SETTING AND PARTICIPANTS

Participants include 17 GPs and 1 manager, who work in a Belgian OOH general practitioners cooperative (GPC), and 5 pharmacists of the area covered by the GPC. The GPC serves a population of more than 187 000 people.

RESULTS

GPs feel the threshold to prescribe AB in OOH care is lower in comparion to office hours. GPs and pharmacists talk about the difference in their professional identity in OOH (they define their task differently, they feel more isolated, insecure, have the need to please and so on), type of patients (unknown patients, vulnerable patients, other ethnicities, demanding patients and so on), workload (they feel time-pressured) and lack of diagnostic tools or follow-up. They are aware of the problem of AB overprescribing, but they do not feel ownership of the problem.

CONCLUSION

The implementation of behaviour change interventions to improve AB prescribing in OOH primary care has to take these context specifics into account and could involve interprofessional collaboration between GPs and pharmacists.

TRIAL REGISTRATION NUMBER

NCT03082521; Pre-results.

Perspectives of practising pharmacists towards interprofessional education and collaborative practice in Qatar

Background Healthcare is provided by a variety of different professionals, including pharmacists who are integral members of the team, and all are expected to work collaboratively to provide quality care. Little is known about the perceptions of pharmacists in Qatar towards interprofessional collaboration. Positive attitudes towards interprofessional education are essential to successful implementation of interprofessional collaboration. Therefore, to develop effective collaboration strategies in practice settings, it was essential to survey the attitudes of practising pharmacists towards collaboration. Objective To explore the awareness, views, attitudes and perceptions of practising pharmacists in Qatar towards interprofessional education and collaborative practice. Setting Community, hospital and primary healthcare settings in Qatar. Methods This was a two-staged sequential explanatory mixed method design. It utilised a quantitative survey (Stage 1), based on a modified version of the Readiness for Interprofessional Learning Scale. This was followed by a qualitative stage, utilising focus groups (Stage 2). Main outcome measures (1) Qatar pharmacists' attitudes towards interprofessional education and collaborative practice; (2) Practising pharmacists' perspectives in relation to enablers, barriers and recommendations regarding interprofessional education and collaborative practice. Results 63% of the practising pharmacists (n = 178) responded to the survey. Three focus groups followed (total n = 14). High scores indicating readiness and positive attitudes towards interprofessional education were reported for pharmacists working in hospital, community and primary healthcare settings. Qualitative analysis identified three overarching themes in relation to the enablers, barriers and recommendations for practising pharmacists working collaboratively. The enabling themes were: professional and patient related benefits, and current positive influences in Qatar; the barriers were patients' negative perceptions; the status of the pharmacy profession and current working practices and processes; the recommendations related to improving patients' perceptions about pharmacists and enhancing the status of pharmacy profession in Qatar. The findings from this study highlighted two major observations: the lack of existence of collaborative practice and hierarchy and power play. Conclusion Pharmacists demonstrated willingness and readiness to develop interprofessional learning and collaborative practice with significant steps already taken towards improving collaborative working practices in different care settings.

Healthcare professionals' perceptions related to the provision of clinical pharmacy services in the public health sector: A case study

BACKGROUND

In Mexico, the Modelo Nacional de Farmacia Hospitalaria (MNFH, or National Hospital Pharmacy Model), published in 2009, mainly aims to promote the provision of clinical pharmacy services in private and public hospitals. However, there is little scientific documentation about the quality of these services.

OBJECTIVES

To explore healthcare professionals' perceptions related to the quality of clinical pharmacy services provision.

METHODS

A case-study based on a qualitative approach was performed at the pharmaceutical services unit at a public hospital located in Mexico City, which operates under the administrative control of the Ministry of Health. Donabedian's conceptual model was adapted to explore health care professionals' perceptions of the quality of clinical pharmacy services provision. Semi-structured interviews were carried out with pharmacists, physicians and nurses and then transcribed and analyzed via discourse analysis and codification techniques, using the software package Atlas. ti.

RESULTS

Limitations in pharmaceutical human resources were identified as the main factor affecting coverage and quality in clinical pharmacy services provision. However, the development in pharmacy staff of technical competences and skills for clinical pharmacy service provision were recognized. Significant improvements in the rational use of medicines were associated with clinical pharmacy services provision.

CONCLUSIONS

The perception analysis performed in this study suggested that it is necessary to increase pharmacy staff in order to improve interprofessional relationships and the quality of clinical pharmacy services provision.

Comparing interprofessional and interorganizational collaboration in healthcare: A systematic review of the qualitative research

BACKGROUND

Interprofessional and interorganizational collaboration have become important components of a well-functioning healthcare system, all the more so given limited financial resources, aging populations, and comorbid chronic diseases. The nursing role in working alongside other healthcare professionals is critical. By their leadership, nurses can create a culture that encourages values and role models that favour collaborative work within a team context.

OBJECTIVES

To clarify the specific features of conceptual frameworks of interprofessional and interorganizational collaboration in the healthcare field. This review, accordingly, offers insights into the key challenges facing policymakers, managers, healthcare professionals, and nurse leaders in planning, implementing, or evaluating interprofessional collaboration.

DESIGN

This systematic review of qualitative research is based on the Joanna Briggs Institute's methodology for conducting synthesis.

DATA SOURCES

Cochrane, JBI, CINAHL, Embase, Medline, Scopus, Academic Search Premier, Sociological Abstract, PsycInfo, and ProQuest were searched, using terms such as professionals, organizations, collaboration, and frameworks.

METHODS

Qualitative studies of all research design types describing a conceptual framework of interprofessional or interorganizational collaboration in the healthcare field were included. They had to be written in French or English and published in the ten years between 2004 and 2014.

RESULTS

Sixteen qualitative articles were included in the synthesis. Several concepts were found to be common to interprofessional and interorganizational collaboration, such as communication, trust, respect, mutual acquaintanceship, power, patient-centredness, task characteristics, and environment. Other concepts are of particular importance either to interorganizational collaboration, such as the need for formalization and the need for professional role clarification, or to interprofessional collaboration, such as the role of individuals and team identity. Promoting interorganizational collaboration was found to face greater challenges, such as achieving a sense of belonging among professionals when differences exist between corporate cultures, geographical distance, the multitude of processes, and formal paths of communication.

CONCLUSIONS

This review sets a direction to follow for implementing changes that meet the challenge of a changing healthcare system and the transition towards non-institutional care. It also shows that collaboration between nurses and healthcare professionals from different healthcare organizations is still poorly explored. This is a major limitation in the existing scientific literature, especially given the potential role that could be played by nurses in enhancing interorganizational collaboration.

Qualitative meta-synthesis of barriers and facilitators that influence the implementation of community pharmacy services: perspectives of patients, nurses and general medical practitioners

OBJECTIVES

The integration of community pharmacy services (CPSs) into primary care practice can be enhanced by assessing (and further addressing) the elements that enable (ie, facilitators) or hinder (ie, barriers) the implementation of such CPSs. These elements have been widely researched from the perspective of pharmacists but not from the perspectives of other stakeholders who can interact with and influence the implementation of CPSs. The aim of this study was to synthesise the literature on patients', general practitioners' (GPs) and nurses' perspectives of CPSs to identify barriers and facilitators to their implementation in Australia.

METHODS

A meta-synthesis of qualitative studies was performed. A systematic search in PubMed, Scopus and Informit was conducted to identify studies that explored patients', GPs' or nurses' views about CPSs in Australia. Thematic synthesis was performed to identify elements influencing CPS implementation, which were further classified using an ecological approach.

RESULTS

Twenty-nine articles were included in the review, addressing 63 elements influencing CPS implementation. Elements were identified as a barrier, facilitator or both and were related to four ecological levels: individual patient (n=14), interpersonal (n=24), organisational (n=16) and community and healthcare system (n=9). It was found that patients, nurses and GPs identified elements reported in previous pharmacist-informed studies, such as pharmacist's training/education or financial remuneration, but also new elements, such as patients' capability to follow service's procedures, the relationships between GP and pharmacy professional bodies or the availability of multidisciplinary training/education.

CONCLUSIONS

Patients, GPs and nurses can describe a large number of elements influencing CPS implementation. These elements can be combined with previous findings in pharmacists-informed studies to produce a comprehensive framework to assess barriers and facilitators to CPS implementation. This framework can be used by pharmacy service planners and policy makers to improve the analysis of the contexts in which CPSs are implemented.

Utilization of registered nurses in primary care teams: A systematic review

BACKGROUND

Registered nurses are increasingly becoming embedded in primary care teams yet there is a wide variability in nursing roles and responsibilities across organizations. Policy makers are calling for a closer look at how to best utilize registered nurses in primary care teams. Lack of knowledge about effective primary care nursing roles and responsibilities challenges policy makers' abilities to develop recommendations to effectively deploy registered nurses in primary care needed to assure efficient, evidence-based, and quality health care.

OBJECTIVE

To synthesize international evidence about primary care RN roles and responsibilities to make recommendations for maximizing the contributions of RNs in team-based primary care models.

DESIGN

Systematic review.

DATA SOURCES

The Meta-Analysis and Systematic Reviews of Observational Studies framework guided the conduct of this review. Five electronic databases (OVID Medline, CINAHL, EMBASE, PubMed and Cochrane Library) were searched using MeSH terms: primary care, roles, and responsibilities. The term "nurs*" was truncated to identify all literature relevant to nursing.

REVIEW METHODS

The initial search yielded 2243. Abstracts and titles were screened for relevance and seventy-one full text reviews were completed by two researchers. Inclusion criteria included: (1) registered nurses practicing in interprofessional teams; (2) description of registered nursing roles and responsibilities; (3) primary care setting. All eligible studies underwent quality appraisal using the Integrative Quality Criteria for Review of Multiple Study Designs tool.

RESULTS

Eighteen studies met eligibility across six countries: Australia, United States, Spain, Canada, New Zealand, and South Africa. Registered nurses play a large role in chronic disease management, patient education, medication management, and often can shift between clinical and administrative responsibilities. There are a limited number of registered nurses that participate in primary care policy making and research.

CONCLUSION

Integrating registered nurses into primary care has the potential to increase patient access to a primary care provider because registered nurses can supplement some of the provider workload: they renew prescriptions, address patient questions, and provide patient education. Clear practice protocols and nursing policy should be written by registered nurses to ensure safe, and effective nursing care. The use of a medical assistant or nurse's aide to perform non-nursing tasks allows registered nurses to take on more complex patient care. Future research should expand on emerging payment models for nurse-specific tasks.

Perceptions of interprofessional collaboration of general practitioners and community pharmacists - a qualitative study

BACKGROUND

Despite numerous evidences for the positive effect of community pharmacists on health care, interprofessional collaboration of pharmacists and general practitioners is very often limited. Though highly trained, pharmacists remain an underutilised resource in primary health care in most western countries. This qualitative study aims at investigating pharmacists' and general practitioners' views on barriers to interprofessional collaboration in the German health care system.

METHODS

A total of 13 narrative in-depth interviews, and two focus group discussions with 12 pharmacists and general practitioners in Mecklenburg-Western Pomerania, a predominantly rural region of North-Eastern Germany, were conducted. The interviews aimed at exploring general practitioners' and pharmacists' attitudes, views and experiences of interprofessional collaboration. At a second stage, two focus group discussions were performed. Fieldwork was carried out by a multi-professional team. All interviews and focus group discussions were audio taped and transcribed verbatim. The constant comparative method of analysis from grounded theory was applied to the data.

RESULTS

There are three main findings: First, mutual trust and appreciation appear to be important factors influencing the quality of interprofessional collaboration. Second, in light of negative personal experiences, pharmacists call for a predefined, clear and straightforward way to communicate with physicians. Third, given the increasing challenge to treat a rising number of elderly patients with chronic conditions, general practitioners desire competent support of experienced pharmacists.

CONCLUSIONS

On the ground of methodological triangulation the findings of this study go beyond previous investigations and are able to provide specific recommendations for future interprofessional collaboration. First, interventions and initiatives should focus on increasing trust, e.g. by implementing multi-professional local quality circles. Second, governments and health authorities in most countries have been and still are reluctant in advancing political initiatives that bring together physicians and pharmacists. Proactive lobbying and empowerment of pharmacists are extremely important in this context. In addition, future physician and pharmaceutical training curricula should focus on comprehensive pharmacist-physician interaction at early stages within both professional educations and careers. Developing and fostering a culture of continued professional exchange and appreciation is one major challenge of future policy and research.

Interprofessional communication between community pharmacists and general practitioners: a qualitative study

Background While collaboration between community pharmacists (CPs) and general practitioners (GPs) is essential to provide comprehensive patient care, their communication often is scarce and hampered by multiple barriers. Objective We aimed to assess both professions' perceptions of interprofessional communication with regard to content and methods of communication as a basis to subsequently develop best-practice recommendations for information exchange. Setting Ambulatory care setting in Germany. Method CPs and GPs shared their experience in focus groups and in-depth interviews which were conducted using a semi-structured interview guideline. Transcribed recordings were assessed using qualitative content analysis according to Mayring. Main outcome measure Specification of existing barriers, CPs'/GPs' general perceptions of interprofessional communication and similarities and differences regarding prioritization of specific information items and how to best communicate with each other. Results Four focus groups and fourteen interviews were conducted. Seven internal (e.g. professions were not personally known to one another) and nine external barriers (e.g. mutual accessibility) were identified. Ten organizational, eight medication-related, and four patient-related information items were identified requiring interprofessional communication. Their relevance varied between the professions, e.g. CPs rated organizational issues higher than GPs. Both professions indicated communication via phone to be the most frequently used method of communication. Conclusion CPs and GPs opinions often differ. However, communication between CPs and GPs is perceived as crucial suggesting that a future concept has to offer standardized recommendations, while leaving CPs and GPs room to adjust it to their individual needs.

Preventing drug-related adverse events following hospital discharge: the role of the pharmacist

Transition of care (ToC) points, and in particular hospital admission and discharge, can be associated with an increased risk of adverse drug events (ADEs) and other drug-related problems (DRPs). The growing recognition of the pharmacist as an expert in medication management, patient education and communication makes them well placed to intervene. There is evidence to indicate that the inclusion of pharmacists in the health care team at ToC points reduces ADEs and DRPs and improves patient outcomes. The objectives of this paper are to outline the following using current literature: 1) the increased risk of medication-related problems at ToC points; 2) to highlight some strategies that have been successful in reducing these problems; and 3) to illustrate how the role of the pharmacist across all facets of care can contribute to the reduction of ADEs, particularly for patients at ToC points.

Acceptance and attitudes of healthcare staff towards the introduction of clinical pharmacy service: a descriptive cross-sectional study from a tertiary care hospital in Sri Lanka

Background

Multidisciplinary patient management including a clinical pharmacist shows an improvement in patient quality use of medicine. Implementation of a clinical pharmacy service represents a significant novel change in practice in Sri Lanka. Although attitudes of doctors and nurses are an important determinant of successful implementation, there is no Sri Lankan data about staff attitudes to such changes in clinical practice. This study determines the level of acceptance and attitudes of doctors and nurses towards the introduction of a ward-based clinical pharmacy service in Sri Lanka.

Methods

This is a descriptive cross-sectional sub-study which determines the acceptance and attitudes of healthcare staff about the introduction of a clinical pharmacy service to a tertiary care hospital in Sri Lanka. The level of acceptance of pharmacist’s recommendations regarding drug-related problems (DRPs) was measured. Data regarding attitudes were collected through a pre-tested self-administered questionnaires distributed to doctors (baseline, N =13, post-intervention period, N = 12) and nurses (12) worked in professorial medical unit at baseline and post-intervention period.

Results

A total of 274 (272 to doctors and 2 to nurses) recommendations regarding DRPs were made. Eighty three percent (225/272) and 100% (2/2) of the recommendations were accepted by doctors and nurses, respectively. The rate of implementation of pharmacist’s recommendations by doctors was 73.5% (200/272) (95% CI 67.9 – 78.7%; P < 0.001). The response rate of doctors was higher at the post-intervention period (92.3%; 12/13) compared to the baseline (66.7%; 8/12). At the post-intervention survey 91.6% of doctors were happy to work with competent clinical pharmacists and accepted the necessity of this service to improve standards of care. The nurses’ rate of response at baseline and post-intervention surveys were 80.0 and 0.0% respectively. Their perceptions on the role of clinical pharmacist were negative at baseline survey.

Conclusions

There was high acceptance and implementation of clinical pharmacist’s recommendations regarding DRPs by the healthcare team. The doctors’ views and attitudes were positive regarding the inclusion of a ward-based pharmacist to the healthcare team. However there is a need to improve liaison between clinical pharmacist and nursing staff.

Trial registration

Sri Lanka Clinical Trials Registry SLCTR/2013/029 Date: 13 September 2013; retrospectively registered.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2001-1) contains supplementary material, which is available to authorized users.

Educators' Interprofessional Collaborative Relationships: Helping Pharmacy Students Learn to Work with Other Professions

Similar to other professions, pharmacy educators use workplace learning opportunities to prepare students for collaborative practice. Thus, collaborative relationships between educators of different professions are important for planning, implementing and evaluating interprofessional learning strategies and role modelling interprofessional collaboration within and across university and workplace settings. However, there is a paucity of research exploring educators' interprofessional relationships. Using collaborative dialogical inquiry we explored the nature of educators' interprofessional relationships in a co-located setting. Data from interprofessional focus groups and semi-structured interviews were interpreted to identify themes that transcended the participants' professional affiliations. Educators' interprofessional collaborative relationships involved the development and interweaving of five interpersonal behaviours: being inclusive of other professions; developing interpersonal connections with colleagues from other professions; bringing a sense of own profession in relation to other professions; giving and receiving respect to other professions; and being learner-centred for students' collaborative practice. Pharmacy educators, like other educators, need to ensure that interprofessional relationships are founded on positive experiences rather than vested in professional interests.

Patient asthma networks: understanding who is important and why

BACKGROUND

Multidisciplinary care (MDC) has been proposed as an essential component to the delivery of effective and efficient health care. However, patients have shown to establish their own sources of health advice and support outside the professional domain. It remained unclear as to how patients' choices may impact on MDC.

OBJECTIVE

This study aimed to explore the role of patients in MDC, specifically (i) how and why patients select sources of health services, information and support, that is, their health connections and (ii) the key elements contributing to the nature and development of patients' health connections.

METHODS

In-depth semi-structured interviews were conducted with asthma participants from Sydney, Australia. Participants were recruited from a broad range of primary health-care access points. Face-to-face and telephone interviews were audio recorded, transcribed verbatim, independently reviewed by two authors and analysed using a qualitative approach.

RESULTS

A total of 47 interviews were conducted. Participants established health connections around their asthma needs and selected a combination of professional, personal and impersonal health connections for advice and support. Several key elements were reported to contribute towards the nature and development of patients' health networks. These included participants' perceptions of the role of HCPs, their level of trust in relationships, the convenience of accessing health advice and their perceptions of asthma.

CONCLUSION

By exploring patients' sources of health advice and support, this research provided new insight into how patients choose to manage asthma, particularly the way in which they selected health connections and their potential impact on MDC.

Mapping the terrain: A conceptual schema for a mental health medication support service in community pharmacy

OBJECTIVE

Mental health-related problems pose a serious issue for primary care, and community pharmacy could make a significant contribution, but there is a dearth of information.

METHODS

This article reports synthesis of the literature on mental health interventions across a range of pharmacy models, and pharmacy services in contexts beyond mental health. To best inform the design of a community pharmacy medication support intervention for mental health consumers, the literature was reported as a conceptual schema and subsequent recommendations for development, implementation and evaluation of the service. A broad conceptualisation was taken in this review. In addition to mental health and community pharmacy literature, policy/initiatives, organisational culture and change management principles, and evaluative processes were reviewed. Key words were selected and literature reviews undertaken using EMBASE, PubMed, CINAHL and Web of Science.

RESULTS

Recommendations were made around: medication support intervention design, consumer recruitment, implementation in community pharmacy and evaluation. Surprisingly, there is a scarce literature relating to mental health interventions in community pharmacy. Even so, findings from other pharmacy models and broader medicines management for chronic illness can inform development of a medication support service for mental health consumers. Key learnings include the need to expand medicines management beyond adherence with respect to both intervention design and evaluation.

CONCLUSION

The conceptual framework is grounded in the need for programmes to be embedded within pharmacies that are part of the health system as a whole.

An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice

AIM

To identify facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general (family) practice.

BACKGROUND

Internationally, a shortage of doctors entering and remaining in general practice and an increasing burden of chronic disease has diversified the nurse's role in this setting. Despite a well-established general practice nursing workforce, little attention has been paid to the ways doctors and nurses collaborate in this setting.

DESIGN

Integrative literature review.

DATA SOURCES

CINAHL, Scopus, Web of Life, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews and Trove (dissertation and theses) were searched for papers published between 2000 and May 2014.

REVIEW METHODS

This review was informed by the approach of Whittemore and Knafl (2005). All included papers were assessed for methodological quality. Findings were extracted, critically examined and grouped into themes.

RESULTS

Eleven papers met the inclusion criteria. Thematic analysis revealed three themes common to the facilitators of and barriers to collaboration and teamwork between GPs in general practice: (1) roles and responsibilities; (2) respect, trust and communication; and (3) hierarchy, education and liability.

CONCLUSION

This integrative review has provided insight into issues around role definition, communication and organizational constraints which influence the way nurses and general practitioners collaborate in a team environment. Future research should investigate in more detail the ways doctors and nurses work together in general practice and the impact of collaboration on nursing leadership and staff retention.

Bridging Silos

Canadian family physicians (FPs) and home health staff (HHS) experience significant barriers to collaboration regarding patients whose needs are complex. This study used mixed methods to examine whether pre-scheduled, structured audio-conferencing could improve patient-related collaboration between physicians and HHS. The number of shared patients and contacts was collected across three phases: baseline, pre-intervention, and intervention. Interviews with FPs and focus groups with HHS were conducted post-intervention. Mixed effects Poisson regressions for count data, and content analysis for interview and focus group data, were used. No statistically significant “intervention” effect was observed in either the number of shared patients or the average patient contacts. Physicians participating in at least one audio-conference had a lower patient contact rate than the rest of the intervention group and controls. Qualitative data suggested that audio-conferences led to fewer contacts due to more efficient communication.

Physicians and community pharmacists collaboration in primary care: A review of specific models

BACKGROUND

Since 2008, French healthcare reform encourages community pharmacists (CP) to develop collaborative care with other health care providers through new cognitive pharmacy services.

OBJECTIVES

This review is aimed to identify theoretical models that have been developed to understand the physician-CP collaboration (PCPC) and to identify the associated determinants.

METHODS

English-written abstracts research was conducted on Pubmed/Medline, PsycINFO, Sociological Abstracts, and CINAHL from January 1990 to June 2013. Keywords were based on common terminology of inter-professional relations and community pharmacy.

RESULTS

Of the 1545 single articles identified, the final review was conducted on 16 articles. Four specific models of collaboration centered on PCPC were identified: (i) the Collaborative Working Relationship Model (CWR), (ii) the Conceptual model of GPCP collaboration, (iii) the CP Attitudes towards Collaboration with GPs Model (ATC-P), (iv) the GP Attitudes towards collaboration with CPs (ATC-GP). The analysis of these four PCPC models shows that their respective factors might cover the same concepts, especially for relational and interactional determinants. These key elements are: trust, interdependence, perceptions and expectations about the other HCP, skills, interest for collaborative practice, role definition and communication.

CONCLUSION

A meta-model for PCPC has been postulated. It can be used for qualitative exploration of PCPC, in a context of implementation of collaborative practice including CPs, in the primary care.

A mixed methods investigation into the use of non-technical skills by community and hospital pharmacists

BACKGROUND

Non-technical skills refer to the social and cognitive factors that may influence efficient and safe job performance. Non-technical skills are an important element of patient safety in a variety of health care disciplines, including surgery, anesthesia and nursing. However, the use of non-technical skills in pharmacy practice has not yet been fully assessed.

OBJECTIVE

To examine attitudes toward, and use of, non-technical skills by pharmacy personnel.

METHODS

A mixed methods approach was used: An attitude survey explored pharmacy personnel attitudes towards non-technical skills and inter-professional collaboration, with community and hospital pharmacy staff (n = 62). Qualitative interviews were then conducted using the critical incident technique, with community pharmacists (n = 11).

RESULTS

The survey results demonstrated differences in the opinions of community and hospital pharmacists on three non-technical skill constructs: team structure, mutual support, and situation monitoring, with community pharmacists reporting significantly more positive attitudes about all three constructs. Both groups reported low levels of collaboration with primary care physicians. The interviews identified five non-technical skills as key elements of successful pharmacist performance from the interview transcripts: teamwork; leadership; task management; situation awareness; decision-making.

CONCLUSION

The survey and interviews identified the non-technical skills that are important to pharmacists. This represents the first step towards the development of a behavioral rating system for training purposes that could potentially improve the non-technical skills of pharmacists and enhance patient safety.

Development and evaluation of an innovative model of inter-professional education focused on asthma medication use

BACKGROUND

Inter-professional learning has been promoted as the solution to many clinical management issues. One such issue is the correct use of asthma inhaler devices. Up to 80% of people with asthma use their inhaler device incorrectly. The implications of this are poor asthma control and quality of life. Correct inhaler technique can be taught, however these educational instructions need to be repeated if correct technique is to be maintained. It is important to maximise the opportunities to deliver this education in primary care. In light of this, it is important to explore how health care providers, in particular pharmacists and general medical practitioners, can work together in delivering inhaler technique education to patients, over time. Therefore, there is a need to develop and evaluate effective inter-professional education, which will address the need to educate patients in the correct use of their inhalers as well as equip health care professionals with skills to engage in collaborative relationships with each other.

METHODS

This mixed methods study involves the development and evaluation of three modules of continuing education, Model 1, Model 2 and Model 3. A fourth group, Model 4, acting as a control.Model 1 consists of face-to-face continuing professional education on asthma inhaler technique, aimed at pharmacists, general medical practitioners and their practice nurses.Model 2 is an electronic online continuing education module based on Model 1 principles.Model 3 is also based on asthma inhaler technique education but employs a learning intervention targeting health care professional relationships and is based on sociocultural theory.This study took the form of a parallel group, repeated measure design. Following the completion of continuing professional education, health care professionals recruited people with asthma and followed them up for 6 months. During this period, inhaler device technique training was delivered and data on patient inhaler technique, clinical and humanistic outcomes were collected. Outcomes related to professional collaborative relationships were also measured.

DISCUSSION

Challenges presented included the requirement of significant financial resources for development of study materials and limited availability of validated tools to measure health care professional collaboration over time.

General practitioners' perspectives of education and collaboration with physiotherapists in Primary Health Care: a discourse analysis

This paper explores the educational factors that underlie the poor collaboration between general practitioners (GPs) and physiotherapists (PTs) in Primary Health Care (PHC), from the GP's perspective. This study was conducted in Majorca, the Balearic Islands (Spain). Participants were nine GPs who graduated from different universities in mainland Spain. A discourse analysis study was developed employing the social-critical paradigm as theoretical framework and in-depth interviews for data collection. The perceived lack of knowledge about physiotherapy was considered by the interviewees as a major factor in the current poor communication between GPs and PTs. The individual learning during medical studies and poor interprofessional learning during clinical residency influenced their gatekeeper role, putting at risk the equity of the health system. Collaboration was considered beneficial for patients but challenging to improve in context due to multiple factors ranging from individual to systemic. The latter encompasses inadequate resources and organization for interprofessional learning. There is a need to further explore other factors influencing the poor collaboration, including PTs' views on this process.

Exploring the General Practitioner-pharmacist relationship in the community setting in Ireland

OBJECTIVE

To explore the General Practitioner (GP)-pharmacist relationship, to gain insight into communication between the professions and evaluate opinion on extension of the role of the community pharmacist.

METHODS

A postal questionnaire sent to 500 GPs and 335 community pharmacists with work addresses in the counties of Cork, Kerry, Tipperary, Waterford and Limerick, Ireland.

KEY FINDINGS

An overall response rate of 56% was achieved. Clear differences of opinion exist between GPs and pharmacists on the extension of the role of the community pharmacist; pharmacist provision of vaccinations (12% of GPs in favour versus 78% of pharmacists), pharmacists prescribing the oral contraceptive pill (18% GP versus 88% pharmacist) and increasing the prescribing power of the pharmacist (37% GP versus 95% pharmacist). Fifty-four percent of GPs and 97% of pharmacists were in favour of pharmacists providing screening services, while 82% of GPs and 96% of pharmacists were in favour of pharmacists dealing with minor ailments. Seventy-three percent of GPs and 43% of pharmacists agreed that communication between the professions was very good.

DISCUSSION

This study identifies a clear difference of opinion on the extension of the role of the community pharmacist and recognises problems in communication between the professions. This comes on the background of continued calls from the Pharmaceutical Society of Ireland for an extension of pharmacist roles and continued opposition from the Irish Medical Organisation to such moves. This study highlights the need for increased dialogue between representative organisations and a commitment for professional agendas to be set aside in the best interests of patients.

Providers' perceptions of student pharmacists on inpatient general medicine practice experiences

OBJECTIVE

To assess health care providers' perceptions of student pharmacists involved as members of a general medicine team.

METHODS

A brief, anonymous, online survey instrument was distributed to 134 health care providers at 4 major medical centers in Massachusetts who interacted with Northeastern University student pharmacists during inpatient general medicine advanced pharmacy practice experiences beginning in March 2011. The survey instrument assessed health care provider perception of student pharmacists' involvement, preparedness, clinical skills, and therapeutic recommendations.

RESULTS

Of the 79 providers who responded, 96.2% reported that student pharmacists were prepared for medical rounds and 87.3% reported that student pharmacists were active participants in patient care. Also, 94.9% and 98.7% of providers indicated that student pharmacist recommendations were appropriate and accurate, respectively. The majority (61.8%) of providers believed that student pharmacist involvement on internal medicine teams was beneficial.

CONCLUSIONS

Provider perceptions regarding student pharmacist participation on general medicine practice experiences were mostly positive.

Attitudes of community pharmacists to antibiotic dispensing and microbial resistance: a qualitative study in Portugal

BACKGROUND

The inappropriate use of antibiotics is considered a main cause of microbial resistance. This is an important public health problem. Community pharmacists have an important role in the management of drugs for outpatients.

OBJECTIVE

Our study sought to explore pharmacists' knowledge, attitudes, perceptions and dispensing habits insofar as to antibiotics and microbial resistance.

SETTING

The study was developed with community pharmacists in the North of Portugal.

METHODS

Qualitative research in the form of focus groups (FG). Focus groups were conducted with 4-7 pharmacists, using a moderator. A topic guide was developed to lead the discussions, which were audio-recorded and transcribed. The study was carried out between December 2010 and March 2011 in the five districts of the Northern Health Region of Portugal (ARS-N). Pharmacists from different regions of each district were invited to participate in the study by an investigator responsible for the study. Participants were informed about the study and that sessions were audio-recorded to facilitate data interpretation. They signed an informed consent form before taking part in the focus groups. The Ethical Committee of ARS-N was informed of this study.

MAIN OUTCOME MEASURE

Pharmacists' knowledge and perceptions on antibiotic use and microbial resistance, attitudes related to antibiotic dispensing habits, and pharmacists' suggestions to improve antibiotic use.

RESULTS

A total of 6 focus groups were conducted with community pharmacists (n = 32). Attitudes related to the problem of resistance were attributed external responsibility, to patients, to physicians, to other pharmacies, and to veterinary consumption. Some attitudes were identified that could lead to antibiotic dispensing without a prescription. These attitudes are complacency, precaution and external complacency.

CONCLUSIONS

Portuguese pharmacists perceive that antibiotic use and bacterial resistance could be improved, showing a behavioural intention to improve antibiotic dispensing habits.

Atypical alliances: the potential for social work and pharmacy collaborations in primary health care delivery

The growing prevalence of chronic conditions is a cause for concern globally, both in terms of its impact on the health of populations and also the strain it is predicted to place on health resources. There is a push to adopt more holistic and collaborative approaches to health care, and for the education of health care professionals to be reformed if these efforts are to be successful. A research project was undertaken in New Zealand in 2010-2011 aimed at exploring the perceptions of health care professionals on competencies in the field of chronic care. This article aims to highlight learning from the project regarding the "atypical alliance" between social work and pharmacy. Based on this, the authors argue that, with the growing expectations for interprofessional collaboration, effective primary and community health care delivery is increasingly dependent on relationships between educators in different health disciplines, between health professionals-in-training, and between education providers and health organizations.