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

Non-dispensing pharmacists integrated into general practices as a new interprofessional model: a qualitative evaluation of general practitioners' experiences and views

BACKGROUND

A new interprofessional model incorporating non-dispensing pharmacists in general practice teams can improve the quality of pharmaceutical care. However, results of the model are dependent on the context. Understanding when, why and how the model works may increase chances of successful broader implementation in other general practices. Earlier theories suggested that the results of the model are achieved by bringing pharmacotherapeutic knowledge into general practices. This mechanism may not be enough for successful implementation of the model. We wanted to understand better how establishing new interprofessional models in existing healthcare organisations takes place.

METHODS

An interview study, with a realist informed evaluation was conducted. This qualitative study was part of the Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in primary care Teams (POINT) project. We invited the general practitioners of the 9 general practices who (had) worked closely with a non-dispensing pharmacist for an interview. Interview data were analysed through discussions about the coding with the research team where themes were developed over time.

RESULTS

We interviewed 2 general practitioners in each general practice (18 interviews in total). In a context where general practitioners acknowledge the need for improvement and are willing to work with a non-dispensing pharmacist as a new team member, the following mechanisms are triggered. Non-dispensing pharmacists add new knowledge to current general practice. Through everyday talk (discursive actions) both general practitioners and non-dispensing pharmacists evolve in what they consider appropriate, legitimate and imaginable in their work situations. They align their professional identities.

CONCLUSIONS

Not only the addition of new knowledge of non-dispensing pharmacist to the general practice team is crucial for the success of this interprofessional healthcare model, but also alignment of the general practitioners' and non-dispensing pharmacists' professional identities. This is essentially different from traditional pharmaceutical care models, in which pharmacists and GPs work in separate organisations. To induce the process of identity alignment, general practitioners need to acknowledge the need to improve the quality of pharmaceutical care interprofessionally. By acknowledging the aspect of interprofessionality, both general practitioners and non-dispensing pharmacists will explore and reflect on what they consider appropriate, legitimate and imaginable in carrying out their professional roles.

TRIAL REGISTRATION

The POINT project was pre-registered in The Netherlands National Trial Register, with Trial registration number NTR-4389.

Involving community pharmacists in interprofessional collaboration in primary care: a systematic review

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.

Developing a quality framework for community pharmacy: a systematic review of international literature

OBJECTIVE

To identify the defining features of the quality of community pharmacy (CP) services and synthesise these into an evidence-based quality framework.

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

International research evidence (2005 onwards) identified from six electronic databases (Embase, PubMed, Scopus, CINAHL, Web of Science and PsycINFO) was reviewed systematically from October 2022 to January 2023. Search terms related to 'community pharmacy' and 'quality'.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Titles and abstracts were screened against inclusion or exclusion criteria, followed by full-text screening by at least two authors. Qualitative, quantitative and mixed-method studies relevant to quality in CP were included.

DATA EXTRACTION AND SYNTHESIS

A narrative synthesis was undertaken. Following narrative synthesis, a patient and public involvement event was held to further refine the quality framework.

RESULTS

Following the title and abstract screening of 11 493 papers, a total of 81 studies (qualitative and quantitative) were included. Of the 81 included studies, 43 investigated quality dimensions and/or factors influencing CP service quality; 21 studies assessed patient satisfaction with and/or preferences for CP, and 17 studies reported the development and assessment of quality indicators, standards and guidelines for CPs, which can help define quality.The quality framework emerging from the global literature consisted of six dimensions: person-centred care, access, environment, safety, competence and integration within local healthcare systems. Quality was defined as having timely and physical access to personalised care in a suitable environment that is safe and effective, with staff competent in the dispensing process and pharmacy professionals possessing clinical knowledge and diagnostic skills to assess and advise patients relative to pharmacists' increasingly clinical roles.

CONCLUSION

The emerging framework could be used to measure and improve the quality of CP services. Further research and feasibility testing are needed to validate the framework according to the local healthcare context.

Does power distance in healthcare teams linked to patient satisfaction? A multilevel study of interprofessional care teams in a referral hospital in Indonesia

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.

Perceptions of conflicting information about long-term medications: a qualitative in-depth interview study of patients with chronic diseases in the Swiss ambulatory care system

OBJECTIVE

Patients with multiple long-term conditions visit various healthcare professionals and are exposed to medication information from various sources causing an increased risk of patients perceiving contradictory medication information. The aims of this study are to: (1) characterise conflicting medication information perceived by patients with long-term conditions, (2) better understand the related impact on patients' medication self-management and healthcare system navigation and (3) explore ways in which such events could be prevented.

DESIGN

This study was conducted through qualitative semistructured interviews. Data were analysed using thematic analysis.

SETTING

Community pharmacies and medical centres in Geneva, Switzerland.

PARTICIPANTS

This study included outpatients from April 2019 to February 2020. Patients were included after participating in a quantitative survey of perceived conflicting information about medications for long-term diseases.

METHODS

Semistructured audiotaped interviews of 20 to 60 min following a pre-established interview guide to explore participants' perceptions of conflicting information. Interviews were transcribed verbatim, and a thematic analysis was conducted with inductive and deductive coding using MAXQDA (2018, Release 18.2.3).

RESULTS

Twenty-two patients were interviewed, until data saturation, mentioning indication or need for a medication as the main topic of conflicting information between two healthcare professionals. Perceived conflicting information often resulted from insufficient information provided and poor communication leading to confusion, doubts and medication non-adherence. Patients expected more information and more interprofessional communication on their medications. As a result of conflicting information, most participants learnt or were learning to take an active role and become partners of the healthcare providers.

CONCLUSION

The need to strengthen and improve communication and interprofessional collaborative practice among healthcare professionals and with the patient is emerging to increase the quality and consistency of information about medications, and consequently, to ensure better use and experience of medications.

Positioning of community pharmacists in interactions with general practitioners and patients regarding prescribing and using antibiotics

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.

Effect of an Educational Video Miniseries on Interprofessional Preceptor Development

OBJECTIVE

Experiential rotation preceptors may lack confidence in instructing interprofessional learners. This study examined the effect of a 12-episode, professionally produced video miniseries on attitudinal, satisfaction, and confidence outcomes in a cohort of interprofessional preceptors comprising pharmacy, medicine, nursing, and other allied health professionals.

METHODS

An invitation to view the miniseries was distributed to all health science preceptors within 1 large, public health science university. Participants were asked survey questions addressing their attitudes toward the miniseries, their comfort in precepting, and their satisfaction with the miniseries.

RESULTS

A total of 61 interprofessional preceptors enrolled in the study, with 33 completing the entire miniseries. Participants displayed highly positive attitudes toward the miniseries. In addition, members of all professions enrolled demonstrated an increase in precepting confidence after viewing the miniseries episodes (2.31 vs 2.7 on a 3-point Likert scale). Subgroup analyses demonstrated that preceptors with>10 years of professional experience displayed less positive attitudes toward the miniseries than those with 2-10 years of professional experience.

CONCLUSION

The miniseries model proved effective as a preceptor development strategy for a group of health professional preceptors. Given the diversity of learners, a collection of training options that allows preceptor self-selection of programming may be beneficial.

General practitioners' perceptions of the roles of community pharmacists and their willingness to collaborate with pharmacists in primary care

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.

The Critical Role of Pharmacists in the Clinical Delivery of Pharmacogenetics in the U.S

Since the rebirth of pharmacogenomics (PGx) in the 1990s and 2000s, with new discoveries of genetic variation underlying adverse drug response and new analytical technologies such as sequencing and microarrays, there has been much interest in the clinical application of PGx testing. The early involvement of pharmacists in clinical studies and the establishment of organizations to support the dissemination of information about PGx variants have naturally resulted in leaders in clinical implementation. This paper presents an overview of the evolving role of pharmacists, and discusses potential challenges and future paths, primarily focused in the U.S. Pharmacists have positioned themselves as leaders in clinical PGx testing, and will prepare the next generation to utilize PGx testing in their scope of practice.

Community pharmacists' perceptions on multidisciplinary heart failure care: an exploratory qualitative study

BACKGROUND

Heart failure (HF) is an important health problem and guidelines recommend multidisciplinary management. The pharmacist is an important member of the multidisciplinary heart failure team, both in the hospital and community setting. This study aims to explore the perceptions of community pharmacists on their role in HF care.

METHODS

We conducted a qualitative study based on face-to-face semi-structured interviews with 13 Belgian community pharmacists between September 2020 and December 2020. We used the Qualitative Analysis Guide of Leuven (QUAGOL) method as guidance for data analysis until data saturation was reached. We structured interview content into a thematic matrix.

RESULTS

We identified two major themes: heart failure management and multidisciplinary management. Pharmacists feel responsible for the pharmacological and non-pharmacological management of heart failure, citing easy access and pharmacological expertise as important assets. Diagnostic uncertainty, lack of knowledge and time, disease complexity and difficulties in communication with patients and informal care providers are barriers to optimal management. General practitioners are the most important partners in multidisciplinary community heart failure management, although pharmacists perceive a lack of appreciation and cooperation and deplore communication difficulties. They feel intrinsically motivated to provide extended pharmaceutical care in HF but cite the lack of financial viability and information sharing structures as important barriers.

CONCLUSION

The importance of pharmacist involvement in multidisciplinary heart failure teams is undisputed by Belgian pharmacists, who cite easy access and pharmacological expertise as important assets. They point out several barriers impeding evidence-based pharmacist care for outpatients with heart failure: diagnostic uncertainty and disease complexity, lack of multidisciplinary information technology and insufficient resources. We recommend that future policy should focus on improved medical data exchanges between primary and secondary care electronic health records as well as the reinforcement of interprofessional relationships between locally affiliated pharmacists and general practitioners.

Questionnaire survey on pharmacists' roles among non- and health care professionals in medium-sized cities in Japan

Although the scope of pharmacists' work has expanded in Japan, people's perception of this is unclear. To contribute to medical care together with non- and health care professionals, clarifying the perceptions of these groups is important to best utilize pharmacist professionals. We conducted a cross-sectional questionnaire survey among non-health care professionals (n = 487) and nurses (n = 151), medical doctors (n = 133), and pharmacists (n = 204) regarding the work of pharmacists. The questionnaire comprised 56 items in four categories associated with the roles of pharmacists. For each questionnaire item, we performed logistic regression analysis to compare pharmacists' opinions with those of other professionals and non-health care professionals. Opinions were similar between pharmacists and nurses or medical doctors regarding "collecting patient information" and "providing drug information to patients." However, there were differences in perceptions regarding "medical collaboration" (nurses; 8/23 items, physicians; 11/23 items) and "community medicine" (nurses; 9/15 items, physicians; 11/15 items), and pharmacists themselves perceived greater roles related to health care collaboration and community health care. Perceptions of non-health care professionals were poorer than those of pharmacists in all categories (47/56 items). These results suggest that pharmacists must actively communicate to help others understand their specialty and build trusting relationships to improve patient care.

[Evaluation of simulation-based training program intended to improve interprofessional communication skills of community pharmacy and general medicine students]

OBJECTIVES

The objective of this work is to assess the impact of a simulation session on the ability of pharmacy and medicine students in general practice to communicate in the resolution of patient-facing situations.

METHODS

The evaluation of the impact of the session on the representation of the professions used a questionnaire to be completed before and after the session by the students. The evaluation of the impact of the session on the perception of communication and associated skills was based on an audio recording of the debriefings, which, after transcription and thematic analysis, was used as a preliminary analysis for the drafting of a questionnaire proposed the following year. This questionnaire focused on the issues of interprofessional communication and on the seminar process.

RESULTS

During the 2018 and 2019 seminars, 518 students attended, 39% were pharmacy students (n=201) and 61% were medical students (n=317). The majority of medical students initially responded that physician-pharmacist communication was confraternal and rare. More pharmacy students felt that the quality of the physician-pharmacist relationship was poor. However, there was a marked improvement for all students on this aspect of communication after the seminar. Both groups also generally agreed that this relationship could be improved.

CONCLUSIONS

The evaluation shows that an interprofessional simulation program improves the ability of pharmacy and general practice students to communicate in patient-facing situations.

Community pharmacists as antimicrobial guardians and gatekeepers - A qualitative study of the perspectives of pharmacy sector stakeholders

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.

Exploring the discord between pharmacy education and practice in antimicrobial stewardship

Background

Antimicrobial stewardship (AMS) is a critical global intervention aimed at optimising antimicrobial use and decreasing antimicrobial resistance (AMR) with pharmacists playing a pivotal role within AMS teams. However, AMS is not comprehensively taught in pharmacy curricula and little is known about the relevance of pharmacists' training to meet AMS needs in South Africa.

Aim

This study aimed to explore the attitudes, knowledge and perceptions of clinical pharmacists towards AMS participation and training in South Africa.

Setting

This study was conducted among clinically practicing pharmacists in public and private healthcare sectors in South Africa.

Methods

A quantitative exploratory research design was selected for this study. The study was conducted using a self-administered structured survey. Categorical variables were analysed using simple descriptive statistics. Mann-Whitney and Kruskal-Wallis tests were applied to determine differences between variables.

Results

Pharmacists demonstrated good attitudes knowledge and perceptions towards AMS (median 4.3). There was statistical significant differences in AMS participation between pharmacists of different years of experience (p = 0.005), sector of employment (p = 0.01), position of employment (p = 0.015) and presence of AMS programmes (p = 0.004). Pharmacists indicated that their Bachelor of Pharmacy undergraduate studies inadequately prepared them for their role in AMS (median 4.3).

Conclusion

Pharmacists show positive attitudes, knowledge and perceptions towards AMS. Education and training in AMS principles is obtained through master's programmes, short courses, Continued Professional Development (CPDs) and workshops and insufficiently incorporated in undergraduate programmes.

Contribution

This study confirms that undergraduate pharmacy programmes inadequately prepare pharmacists for their role in AMS.

Hello Operator? A Pharmacy Practice Simulation to Increase Student Confidence in Telephone Communication Skills

Background: Communicating interprofessionally using the telephone is an essential skill within pharmacy practice. Student pharmacists' ability to perform this task effectively and efficiently may be hindered by generational changes, social anxiety, and very few opportunities to practice these skills. Objective: The purpose of this study was to develop and implement a simulation allowing students to practice interprofessional communication and assess the simulation's impact on students' confidence in providing pharmacy-related interventions to another health care professional via telephone. Methods: Faculty developed a simulation focused on interprofessional telephone communication. Baseline student information was collected to quantify pharmacy work experience in terms of practice setting, duration of employment, and skills. Presimulation and postsimulation surveys evaluated self-assessed telephone-related skills, attitudes, and confidence. Quantitative data were analyzed with descriptive statistics. Qualitative data were evaluated through a thematic analysis of students' reflective responses to 2 open-ended questions. Results: Of the 53 pharmacy students that participated in the simulation, 44 (83%) and 43 (81%) completed the anonymous presimulation and postsimulation surveys. Students significantly improved as reflected in the following response: "I have confidence in my ability to provide pharmacy-related interventions to another health care professional in a logical and concise manner via telephone call." Significant improvement also occurred in the ability to work independently, communicate an order change to another health care professional, justify recommendations, answer a drug information question, and discuss recommendations in a logical and concise manner. Conclusion: The simulation discussed in this article provided students an opportunity to practice interprofessional telephone communication in a low-risk environment and resulted in significant growth in confidence and skills.

Long-term care professionals' views on pharmacists: a qualitative study using Role Theory

BACKGROUND

Qualitative research investigating pharmacists' participation in Long-Term Care (LTC) within interdisciplinary teams is scarce.

AIM

To characterize how pharmacists' participation in a national network of LTC is perceived by healthcare professionals and other key stakeholders.

METHOD

Individual, in-depth, semi-structured interviews of participants (nurses, physicians, pharmacists, and LTC researchers) enrolled purposively or through snowballing sampling techniques, with the final sample being comprised of fourteen participants. Data analysis followed a deductive coding approach framed by Role Theory and supplemented with an inductive coding for additional themes.

RESULTS

Four Role Theory constructs were identified from the primary data-role identity, overqualification, ambiguity, underqualification. Clinical pharmacy services, logistics and educational activities were pointed out as representing the identity of pharmacists' interventions. Despite the clear identification of LTC pharmacists' interventions, pharmacist expertise on medicine optimization seemed to be underused (role overqualification), as a result of lack of time, lower proactivity in healthcare teams' integration, and the absence of a legal framework targeted to LTC pharmacy practice (role ambiguity). Additional clinical training, including in the management of older people's health conditions, nutrition, and palliative care were missing (role underqualification).

CONCLUSION

LTC pharmacists can provide essential services (e.g., clinical pharmacy, logistics, educational interventions), although additional training and a clearer legal framework are missing to better define pharmacists' roles in LTC pharmacy practice.

Pharmacists reducing medication risk in medical outpatient clinics: a retrospective study of 18 clinics

BACKGROUND

The role of pharmacists in hospital inpatient settings is well recognised; however, pharmacists are relatively new to outpatient clinic settings in Australia. Evidence to justify the clinical effectiveness of pharmacists, in terms of identifying and resolving medication-related problems in an outpatient setting in Australia is limited.

AIMS

To investigate the clinical effectiveness of outpatient clinic pharmacists across multiple medical disciplines.

METHODS

A retrospective observational study was conducted by auditing medical records for patients who had an outpatient clinic pharmacist consult between June 2019 and February 2020 in a large quaternary hospital. All pharmacist recommendations targeting a medication-related problem were audited. Recommendations were considered 'resolved' if accepted and actioned by the patient and/or a clinician. The resolved recommendations were risk rated using a validated tool for medication-related patient harm.

RESULTS

There were 18 clinic pharmacist roles across multiple medical disciplines, of which 46 pharmacists conducted outpatient consults. A total of 7599 consults was conducted and a purposeful random sample of 572 (8%) consults was audited for 552 unique patients. There were 399 recommendations recorded in the notes by clinic pharmacists, a mean (standard deviation) of 0.95 (0.97) per patient. Of these, 328 (82%) were resolved; 269 (82%) were classified as low or moderate risk and 59 (18%) were classified as high-risk recommendations.

CONCLUSIONS

Clinic pharmacists in multidisciplinary outpatient clinics are effective at identifying and resolving medication-related problems. Our research demonstrated that 18% of these resolved recommendations prevented a high-risk medication-related harm event.

Interprofessional education focused on medication safety: a systematic review

Safe medication use necessitates interprofessional working, with calls to enhance interprofessional education (IPE) focusing on medication safety (MS) in healthcare professional (HCP) curricula. Little is known about the design, delivery or evaluation of such activities. This systematic literature review describes MS-focused IPE activities in pre-qualification HCP programmes. MedLine, EMBASE, CINAHL and ERIC were searched, relevant studies identified and data extracted. The McGill Mixed Methods Appraisal Tool was employed. The 3P (presage-process-product) theory structured deductive analysis. Thirty-one studies were included, reporting on 30 activities, mostly undertaken in North America or United Kingdom. Presage/Design: Most reported activities involved pharmacy, nursing, medical or physician assistant students learning with one or more other HCP group. Few studies matched student groups' skills or experiences. Few studies reported theoretical underpinnings. Process/Delivery: Multiple pedagogical approaches were employed, mostly social construction, and low- and high-fidelity simulation-based learning. Few studies reported learning outcomes or summative assessment, more reported formative assessment. Product/evaluation: Outcomes measured were learners' opinions, satisfaction or attitudes toward interprofessional working and findings were generally positive. Few studies reported on student development or outcomes specific to medication safety. Lack of integration of qualitative/quantitative components of mixed methods studies and limited outcome measurements' validity or reliability weakened study quality. MS-focused IPE for pre-qualification HCPs is well received by students. Design of future activities could be enhanced by employing theory and ensuring matching of students' and groups' skills, professional identity and learner attributes to enhance learning in an interprofessional setting. Future delivery should embed MS-focused IPE into the standard curricula to optimize constructive alignment, learner engagement, quality and drive development. The required skillset in pre-qualification HCP programmes to facilitate future safe medication practice, together with the associated learning outcomes and assessment approaches, should be defined. The quality of scholarly studies examining these activities needs improvement.

Community pharmacists' attitudes towards, and experiences of, providing medication reviews after hospital discharge: a questionnaire survey

OBJECTIVES

To investigate the attitudes and experiences of community pharmacists providing medicines-use review (MUR) and post-discharge medicines-use review (PD-MUR) services.

METHODS

An online survey for community pharmacists who had experience providing the MUR service.

KEY FINDINGS

In total, 495 community pharmacists responded to the survey. A total of 89% (n = 382) of community pharmacists wanted to receive the patient's full discharge summary and 79% (n = 363) preferred electronic communication. Community pharmacists thought they could build trusted relationships with patients and felt that patients were willing to discuss post-discharge medicines-related issues with them. Less experienced pharmacists conducted more MURs than more experienced pharmacists (P = 0.004), and pharmacists working in large multiples (>50 pharmacies) conducted more MURs than those working in independent pharmacies (<5 pharmacies) (P = 0.001). Community pharmacists working in independent pharmacies conducted more PD-MURs than those working in large multiples (P = 0.004). Community pharmacists working in rural areas also thought they were best placed to provide PD-MURs while those working in urban areas thought that practice pharmacists were best suited to provide this service (P = 0.007).

CONCLUSIONS

Community pharmacists believe they have a vital role in supporting patients after hospital discharge. They can build long-lasting, trusted relationships with patients and patients are willing to discuss medication issues with them. By providing community pharmacists in all locations with timely access to accurate discharge information, they could use their knowledge and skills to better support patients after hospital discharge.

General practitioners' attitude towards cooperation with other health professionals in managing patients with multimorbidity and polypharmacy: A cross-sectional study

Background

Cooperation between general practitioners (GPs) and other healthcare professionals appears to help reduce the risk of polypharmacy-related adverse events in patients with multimorbidity.

Objectives

To investigate GPs profiles according to their opinions and attitudes about interprofessional cooperation and to study the association between these profiles and GPs’ characteristics.

Methods

Between May and July 2016, we conducted a cross-sectional survey of a panel of French GPs about their management of patients with multimorbidity and polypharmacy, focussing on their opinions on the roles of healthcare professionals and interprofessional cooperation. We used agglomerative hierarchical cluster analysis to identify GPs profiles, then multivariable logistic regression models to study their associations with the characteristics of these doctors.

Results

1183 GPs responded to the questionnaire. We identified four profiles of GPs according to their declared attitudes towards cooperation: GPs in the ‘very favourable’ profile (14%) were willing to cooperate with various health professionals, including the delegation of some prescribing tasks to pharmacists; GPs in the ‘moderately favourable’ profile (47%) had favourable views on the roles of health professionals, with the exception for this specific delegation of the task; GPs from the ‘selectively favourable’ profile (27%) tended to work only with doctors; GPs from the ‘non-cooperative’ profile (12%) did not seem to be interested in cooperation. Some profiles were associated with GPs’ ages or participation in continuing medical education.

Conclusion

Our study highlights disparities between GPs regarding cooperation with other professionals caring for their patients and suggests ways to improve cooperation.

Patients' perceptions of conflicting information on chronic medications: a prospective survey in Switzerland

OBJECTIVE

The number of patients with chronic diseases and subsequent visits to various healthcare professionals has been rising over the past decades, exposing patients to potential risks of receiving conflicting medication information. This study aims to investigate the prevalence of conflicting information on medications perceived by chronic patients in Switzerland and to understand its impact on patients' medication self-management and navigation in the healthcare system.

PARTICIPANTS

This cross-sectional study included adult patients taking at least one prescribed medication for at least 6 months, who had visited at least two physicians in the past 3 months.

MAIN OUTCOME MEASURES

Data on patients' perceptions of conflicting information were collected in person through a 17-item questionnaire available on paper and electronically with four domains: (1) whether the patient had perceived any conflicting information, (2) categories of conflicting information, (3) impact and (4) sources involved in the conflicting information.

RESULTS

Of the 405 included patients, 47% perceived conflicting information related to one or more medication topics including indication, schedule, dosage, risk, severity or duration of side effects. Patients who perceived conflicting information were prescribed more drugs than those perceiving no conflicting information (p&lt;0.01). Consequently, 65% of the participants modified their navigation of the healthcare system and 34% reported medication non-adherence. General practitioners (82%), specialist physicians (74%) and pharmacists (49%) were the healthcare professionals most often involved in conflicting information. Experience with the medication, its package insert and significant others were more frequently involved in conflicting information than internet or social media.

CONCLUSION

Nearly half the patients in our study perceived conflicting information in the outpatient healthcare system, which can decrease medication effectiveness and pose safety issues. This issue is widely overlooked and unaddressed. Consistency of information among healthcare providers in partnership with patients should be reinforced through guidelines and new models of interprofessional care.

Defining and enhancing collaboration between community pharmacists and primary care providers to improve medication safety

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.

Relationship between Dysphagia and Home Discharge among Older Patients Receiving Hospital Rehabilitation in Rural Japan: A Retrospective Cohort Study

Dysphagia refers to swallowing difficulty, which impacts patients' quality of life. Dysphagia influences clinical outcomes, including mortality rates and length of hospital stay of older hospitalized patients. Dysphagia may affect the current and future quality of life of these patients. However, its exact impact remains unclear. We aimed to clarify the impact of dysphagia on discharge to home in older patients in a rural rehabilitation unit. We conducted a secondary analysis using data from a retrospective cohort study including patients aged over 65 years who had been discharged from a community hospital rehabilitation unit in rural Japan. Data from the participants had been previously collected from April 2016 to March 2020. The primary outcome was home discharge. The average participant age was 82.1 (standard deviation, 10.8) years; 34.5% were men. Among medical conditions, brain stroke (44.3%) was the most frequent reason for admission; the most frequent orthopedic condition was femoral fracture (42.9%). The presence of dysphagia (odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.20-0.73), polypharmacy (OR = 0.5, 95% CI: 0.32-0.90), and admission for internal medicine diseases (OR = 0.44, 95% CI: 0.26-0.77) were negatively associated with home discharge. High motor domain scores of the Functional Independence Measure were positively associated with home discharge (OR = 1.07, 95% CI: 1.05-1.08). Dysphagia was negatively associated with home discharge as were polypharmacy and admission for internal medicine diseases and conditions. By clarifying effective interventions through interventional studies, including approaches to managing multimorbidity and polypharmacy through interprofessional collaboration, the health conditions of older patients in rural areas may be improved.

Task sharing in an interprofessional medication management program - a survey of general practitioners and community pharmacists

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.

Effectiveness and cost-effectiveness of an intervention to improve Initial Medication Adherence to treatments for cardiovascular diseases and diabetes in primary care: study protocol for a pragmatic cluster randomised controlled trial and economic model (the IMA-cRCT study)

BACKGROUND

Between 2 and 43% of patients who receive a new prescription in PC do not initiate their treatments. Non-initiation is associated with poorer clinical outcomes, more sick leave and higher costs to the healthcare system. Existing evidence suggests that shared decision-making positively impacts medication initiation. The IMA-cRCT assesses the effectiveness of the IMA intervention in improving adherence and clinical parameters compared to usual care in patients with a new treatment for cardiovascular disease and diabetes prescribed in PC, and its cost-effectiveness, through a cRCT and economic modelling.

METHODS

The IMA intervention is a shared decision-making intervention based on the Theoretical Model of Non-initiation. A cRCT will be conducted in 24 PC teams in Catalonia (Spain), randomly assigned to the intervention group (1:1), and community pharmacies in the catchment areas of the intervention PC teams. Healthcare professionals in the intervention group will apply the intervention to all patients who receive a new prescription for cardiovascular disease or diabetes treatment (no other prescription from the same pharmacological group in the previous 6 months). All the study variables will be collected from real-world databases for the 12 months before and after receiving a new prescription. Effectiveness analyses will assess impact on initiation, secondary adherence, cardiovascular risk, clinical parameters and cardiovascular events. Cost-effectiveness analyses will be conducted as part of the cRCT from a healthcare and societal perspective in terms of extra cost per cardiovascular risk reduction and improved adherence; all analyses will be clustered. Economic models will be built to assess the long-term cost-effectiveness of the IMA intervention, in terms of extra cost for gains in QALY and life expectancy, using clinical trial data and data from previous studies.

DISCUSSION

The IMA-cRCT represents an innovative approach to the design and evaluation of behavioural interventions that use the principles of complex interventions, pragmatic trials and implementation research. This study will provide evidence on the IMA intervention and on a new methodology for developing and evaluating complex interventions. The results of the study will be disseminated among stakeholders to facilitate its transferability to clinical practice.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05026775 . Registered 30th August 2021.

Healthcare Provider Perspectives on Digital and Interprofessional Medication Management in Chronically Ill Older Adults of Turkish Descent in Germany: A Qualitative Structuring Content Analysis

Medication management for chronically ill older adults with a history of migration can be associated with specific challenges, for instance language barriers. This study examined healthcare provider perspectives on interprofessional cooperation and digital medication management tools as approaches for increasing medication safety for chronically ill older adults of Turkish descent in Germany. Semi-structured interviews were conducted with 11 healthcare providers, including general practitioners, pharmacists, a geriatric consultant, a hospital social worker, and an expert on digitalization in nursing care. The interviews were analyzed by means of qualitative structuring content analysis. This article presents selected results of the analysis relating to medication management, barriers to optimal medication management, interprofessional cooperation, and digital tools. Compliance was perceived to be high among chronically ill older adults of Turkish descent and the involvement of family members in medication management was rated positively by respondents. Barriers to medication management were identified in relation to health literacy and language barriers, systemic problems such as short appointments and generic substitution, and racism on behalf of healthcare providers. Additionally, the respondents highlighted structural barriers to interprofessional communication in the German healthcare system. Furthermore, two technology acceptance models presented in this article to illustrate the respondents' perspectives on a) a digital application for medication management to be used by chronically ill older adults of Turkish descent and b) a digital tool for interprofessional communication. The discussion highlights the implications of the results for medication management within the German healthcare system.

Nurses’ Contributions in Rural Family Medicine Education: A Mixed-Method Approach

Family medicine residents frequently collaborate with nurses regarding clinical decisions and treatments, which contributes to their education. In rural areas, these residents experience a wider scope of practice by collaborating with nurses. However, nurses’ contributions to rural family medicine education have not been clarified. This study measured the contributions of 88 rural community hospital nurses to family medicine education using a quantitative questionnaire and interviews. The interviews were recorded, transcribed verbatim, and analyzed using the grounded theory approach. Nurses’ average clinical experience was 20.16 years. Nurses’ contributions to the roles of teacher and provider of emotional support were statistically lower among participants working in acute care wards than those working in chronic care wards (p = 0.024 and 0.047, respectively). The qualitative analysis indicated that rural nurses’ contributions to family medicine education focused on professionalism, interprofessional collaboration, and respect for nurses’ working culture and competence. Additionally, nurses struggled to educate medical residents amid their busy routine; this education should be supported by other professionals. Rural family medicine education should incorporate clinical nurses as educators for professionalism and interprofessional collaboration and as facilitators of residents’ transition to new workplaces. Subsequently, other professionals should be more actively involved in improving education quality.

Developing an interprofessional people-centred care model for home-living older people with multimorbidities in a primary care health centre: A community-based study

Background

The ageing population with multiple conditions and complex health needs has forced healthcare systems to rethink the optimal way of delivering services. Instead of trying to manage numerous diseases in a siloed approach, the emphasis should be on people-centred practice, in which healthcare services are tailored to people's needs and provided in partnership with them.

Objective

The aim was to develop an interprofessional people-centred care model (PCCM), including the contribution of a clinically trained pharmacist for home-living multimorbid older people in primary care.

Methods

Participatory action research method, including the active involvement of healthcare professionals, was utilised to develop the PCCM in a public health centre in Finland. The data comprised interview transcripts, workshop materials, field notes, surveys, and memos and were analysed using inductive content analysis.

Results

The PCCM was developed in iterative phases, including planning, acting, observing, and reflecting. The PCCM comprised: 1) A self-management evaluation questionnaire sent before a home visit; 2) A person-centred patient interview at home with a named nurse and a pharmacist; 3) A nurse-led health review and a pharmacist-led clinical medication review; 4) An interprofessional (a GP, a pharmacist and a named nurse) case conference meeting; 5) A care plan, including health and medication plans; and 6) Health support and empowerment interventions. The PCCM shifted working practices in the health centre from parallel and consultative practice towards interprofessional people-centred practice and more holistic care. The patient's active involvement in their own care was encouraged. Healthcare professionals appreciated the advantages of the new skill-mix, including the clinically trained pharmacist. Building trust among healthcare professionals and between the professionals and the patients was essential.

Conclusion

The successfully developed PCCM improved holistic and more people-centred care in primary care. Healthcare professionals appreciated the advantages of the skill mix and found that trust was essential for implementing the PCCM.

Electronic transmission of prescriptions in primary care: transformation, timing and teamwork

INTRODUCTION During the coronavirus disease 2019 (COVID-19) pandemic lockdown in New Zealand in March 2020, there was a rapid shift to virtual consultations in primary care. This change was supported by system adjustments to enable electronic transmission of prescriptions without a handwritten signature if they met certain security criteria. International research suggests potential for unintended consequences with such changes, so it is important to understand the effect on professional practice in New Zealand general practice and community pharmacy. AIM The purpose of this study was to undertake a preliminary exploration of the experiences of New Zealand general practitioners and community pharmacists when prescriptions are transmitted electronically directly from prescriber to pharmacy. METHODS Semi-structured interviews with a purposive sample of four pharmacists and four general practitioners gathered qualitative data about their experiences of the shift to electronic transmission of prescriptions. Participants' perceptions of effect on professional workflow, interprofessional interactions between general practitioners and pharmacists, and interactions with patients were explored. Interviews were audio-recorded, and the data analysed thematically using an inductive approach. RESULTS Four themes were identified: workflow transformation; mixed impact on interactions with patients; juggling timing and expectations; and new avenues for interprofessional communication (with some cul-de-sacs). DISCUSSION Both general practitioners and pharmacists experienced transformational changes to workflow. This was positive for general practitioners due to saved time and increased work flexibility. Pharmacists noted potential benefits but also some challenges. To fully reap teamwork benefits, more work is needed on managing the timing issues and patient expectations, and to refine the new modes of communication between health-care practitioners.

Case management programs for people with complex needs: Towards better engagement of community pharmacies and community-based organisations

Introduction

The objectives of this study were 1) to describe how case management programs engaged community pharmacies and community-based organisations in a perspective of integrated care for people with complex needs, and 2) to identify enablers, barriers and potential strategies for this engagement.

Methods

Using a descriptive qualitative design, individual interviews and focus groups with patients, healthcare providers and managers were analysed according to a mixed thematic analysis based on a deductive (Rainbow Model of Integrated Care) and an inductive approach.

Results and discussion

Participants highlighted the individualized service plan as a significant tool to foster a shared person-focused vision of care, information exchanges and concerted efforts. Openness to collaboration was also considered as an enabler for community stakeholders’ engagement. The lack of recognition of community-based organisations by certain providers and the time required to participate in individualized service plans were outlined as barriers to professional integration. Limited opportunities for community stakeholders to be involved in decision-making within case management programs were reported as another constraint to their engagement. Cultural differences between organisations regarding the focus of the intervention (psychosocial vs healthcare needs) and differences in bureaucratic structures and funding mechanisms may negatively affect community stakeholders’ engagement. Formal consultation mechanisms and improvement of communication channels between healthcare providers and community stakeholders were suggested as ways to overcome these barriers.

Conclusion

Efforts to improve care integration in case management programs should be directed toward the recognition of community stakeholders as co-producers of care and co-builders of social policies across the entire care continuum for people with complex needs.

Community pharmacists' views on their current role and future opportunities for antibiotic stewardship: a French qualitative study

Background

Different healthcare professionals should contribute to antibiotic stewardship (ABS) activities. Involvement of community pharmacists (CPs) has been little explored worldwide to date.

Objectives

To explore French CPs' views on ABS and antibiotic resistance, their role and current practices, and future opportunities for ABS.

Methods

A qualitative study using semi-structured face-to-face individual interviews was performed from May to October 2019 among CPs from north-eastern France. Transcripts of the interviews were analysed using a thematic analysis.

Results

Twenty-seven interviews were conducted. Most participants had a clear understanding of antibiotic resistance and ABS. They considered themselves as 'guardians of the appropriate use of drugs' but often failed to fulfil this mission because of difficult relationships with physicians. Their current ABS practices are: (i) counselling patients about the antibiotic treatment; and (ii) reporting to the prescriber when they identify contraindications/drug interactions. Concerning their potential increased involvement in ABS, CPs felt they could perform more rapid diagnostic testing for sore throat; they were divided on the possibility for them to change the antibiotic prescription made by a physician and were mainly against the possibility of initiating an antibiotic prescription. The idea of systematically collecting unused antibiotics was perceived well by CPs, while unit dose delivery was not.

Conclusions

French community pharmacists are willing to become more involved in ABS activities. Collaboration and trust between pharmacists and prescribers should however be improved.

Medical and Pharmacy Students’ Attitudes Towards Physician-Pharmacist Collaboration in Indonesia: A Case Study Approach

Learning process evaluation of Interprofessional Education (IPE) was crucial to determine the implementation process’s success. The evaluation can be done by researching student attitudes in IPE activities. Research on students' attitudes in medical education and pharmacy study programs is expected to be a guideline for the IPE curriculum drafting team at the Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, to develop future IPE learning activities. The study design was observational analytic with a cross-sectional method involving all medical and pharmacy students of the Faculty of Medicine, Universitas Islam Sultan Agung who had participated in a Small Group Discussion with TB management and met the inclusion criteria. Data collection was carried out in August 2020 using an online google form questionnaire. Data obtained through the Scale of Attitudes Toward Psychic-Pharmacist Collaboration questionnaire contains 16 questions tested for validity and reliability. Questions were answered using a 4-point Likert Scale. The statistical test analysis results on the total score of the collaboration attitude scale using the Mann Whitney Test was a p-value of 0.000. The median total score of medical and pharmacy students was 47.00 and 56.00, respectively. The p-value indicates a significant difference between the total scores of medical and pharmacy students. Based on the analysis results, the study shows significant differences in collaboration attitudes. Medical education students fall into the "moderate" category and pharmacy students in the "high" category. The pharmacy students have a more positive collaboration attitude than medical education students toward future collaborative relationships.

Ensuring quality qualitative research reporting in community pharmacy: a systematic literature review

OBJECTIVES

To evaluate the reporting quality for a sample of community pharmacy qualitative research articles based on the Standards for Reporting Qualitative Research (SRQR) guidelines, data interpretation and use of theory.

METHODS

A systematic literature search was conducted using Ovid MEDLINE to identify qualitative research related to community pharmacy. Data were extracted and evaluated based on the SRQR standards, data interpretation level and use of theory. Adherence to standards was analysed using descriptive statistics.

KEY FINDINGS

Eighty-one studies were retrieved through the database search (n = 81). Then, 31 studies met the inclusion criteria after screening abstracts and full texts. Twelve out of 21 SRQR were present in more than 80% of the studies. However, essential standards, such as research approach, reflexivity and trustworthiness techniques, were absent or partially present in 30 (97%) studies, 30 (97%) studies and 21 (68%) studies, respectively. Data interpretation level was descriptive in 27 (87%) studies and interpretive or partially interpretive in 4 (13%) studies. Theory was absent in 19 (60%) and implied, partially integrated or retrospectively applied in 12 (40%) of the studies.

CONCLUSION

Trustworthiness and quality of qualitative inferences within community pharmacy research could be enhanced with increasing awareness about reporting; the approach and paradigm, reflexivity, trustworthiness techniques, data interpretation level and theoretical use.

From uniprofessionality to interprofessionality: dual vs dueling identities in healthcare

Healthcare systems are at times still viewed as siloed performances of single professions, wherein some groups hold hierarchical positions based on their expertise and prestige, rather than a collective functioning of interprofessional teams. Current policies, procedures, and regulations in healthcare education and practice seem to contribute to this context in which the various health and social care professions are set in opposition to one another. The historical, and still prominent, uniprofessional education and socialization practices position health and social care professions to view each as rivals and threats toward achieving their profession/al advancement and growth. The transformation from uniprofessionality to interprofessionality in healthcare requires the application of interprofessional socialization not just at the individual level, but also at the professional and system levels. In this process of interprofessional socialization, we need to embrace the uniqueness of each profession while cultivating an interprofessional collaboration culture in the system (dual identity). In so doing, we can facilitate a shifting mind-set, culture, operations, and policies in healthcare to recognize and foster the contribution and accountability of each profession toward achieving the quadruple aim of better care, better health, better value, and better work experience.

Re-Engineering Collaborative Practice in Primary Care: Integrating Community Pharmacy to the Clinic; Creating a Pharmacy Referral and Quality Circle

Pharmacy practice is part of a value chain made up of suppliers(S), inputs(I), processes(P), outputs(O), and customers(C). The interface between community pharmacies and clinic-based prescribers is complicated by challenges related to gaps in the design of the chain. The supplier-input-process-outcome-customer (SIPOC) model can be used to re-engineer the chain: integrating an intervening clinical pharmacist in the interface creates a structure for interprofessional collaboration and communication across the interface. This innovation has important implications for patient referral between clinic and pharmacy, and the future role and scope of all patient-facing pharmacists.

Perceptions and Attitudes of Pharmacogenomics Through the Lens of Community Pharmacists and Patients

Background Pharmacists represent some of the most accessible healthcare workers and are in an opportune position to spearhead new clinical initiatives, such as pharmacogenomics (PGx) services. It is important that we understand the perceptions and attitudes both pharmacists and patients have regarding PGx and potential barriers of implementing it into routine clinical practice. Methods A cross-sectional survey study was conducted across one regional division of a large community pharmacy chain to assess the perceptions and attitudes of pharmacists and patients regarding PGx in California. A secondary aim was to determine perceived barriers to PGx implementation into community pharmacies. Results The majority (67%) of pharmacists agreed or strongly agreed to understanding PGx compared to 35% of patients being aware of PGx (p<0.001). More patients (62%) preferred their pharmacist compared to pharmacists (43%) preferring themselves as a provider to manage patients' medications based on their PGx results (p<0.01). Many patients (88%) expressed interest in participating in a PGx test; both pharmacists (84%) and patients (85%) were unlikely to have participated or know someone who has participated in PGx testing. Pharmacists and patients expressed similar concerns about privacy of their PGx data by employers (p=0.287) and insurers (p=0.953), a potential barrier to PGx implementation. Conclusion Pharmacists are well positioned to spearhead PGx consultations and patients are interested in pharmacists using PGx to help manage their medications; however, various barriers were identified that must be overcome for PGx to become incorporated in routine practice.

Exploring Cypriot Pharmacists' Perceptions about their Role in Cardiovascular Disease Prevention: A Descriptive Qualitative Study

Objective:

The age-standardized prevalence of cardiovascular diseases (CVDs) among the Cypriot population in 2017 was estimated to be 5552 per 100,000. Therefore, the CVD prevention in Cyprus is of paramount importance. Pharmacists are one of the most accessible health-care professionals (HCPs) and the first port of call for the public. In Cyprus, there are 55.59 pharmacies per 100,000 inhabitants. Therefore, the role of Cypriot pharmacists (CPs) in primary CVD prevention is essential. This study aimed to explore both the existing and potential future roles of CPs in CVD prevention.

Methods:

A descriptive qualitative study employing structured interviews (SIs) was conducted. Initially, the CPs were identified through a list provided by the Cypriot Pharmaceutical Services. The researcher(s) then contacted CPs by telephone. Face-to-face interviews were scheduled based on the CP's availability. In total, 21 SIs were transcribed verbatim, coded, and analyzed thematically. SIs continued until data saturation was achieved.

Findings:

The findings are reported under the themes of pharmacists' knowledge and role, resources/tools available and training, communication and relations, and barriers. CPs expressed the need for training, and they are ready to have a more proactive role within the primary health care. The main barrier identified was the lack of responsiveness of the public and the lack of CP's time.

Conclusion:

CPs have the potential to actively participate in CVD prevention in Cyprus. CPs want to start offering primary CVD health services, with the smoking cessation being the first intervention.

A Conceptual Framework of the Way Forward to a Community Pharmacist-General Practitioner Collaborative Medication Therapy Management Model for Chronic Diseases in Malaysian Primary Care: A Qualitative Study

BACKGROUND

There is a growing global interest in formulating such policies and strategic plans that help devise collaborative working models for community pharmacists (CPs) and general practitioners (GPs) in primary care settings.

OBJECTIVE

To conceptualize a stakeholder-driven framework to improve collaboration between CPs and GPs in Malaysian primary care to effectively manage medicines in chronic diseases.

DESIGN AND SETTING

A qualitative study that involved individual semi-structured interviews of the leadership of various associations, guilds, and societies representing CPs, GPs, and Nurses in Malaysia.

METHODS

This study collected and reported data in accordance with the guidelines of the Consolidated Criteria for Reporting of Qualitative Studies. Key informants were recruited based on purposive (expert) sampling. Interviews were transcribed verbatim and data were coded based on the principles of thematic analysis in NVivo.

RESULTS

A total of 12 interviews (5 CPs, 5 GPs, and 2 nurses) were conducted. Five themes emerged: Theme 1 highlighted a comparison of community pharmacy practice in Malaysia and developed countries; Theme 2 involved current practices in Malaysian primary care; Theme 3 encompassed the advantages of CP-GP collaboration in chronic diseases; Theme 4 highlighted the barriers which impede collaboration in Malaysian primary care; and Theme 5 delineated the way forward for CP-GP collaboration in Malaysia.

CONCLUSION

The actionable insights obtained from the Malaysian stakeholders offered an outline of a framework to enhance collaboration between CPs and GPs in primary care. Generally, stakeholders were interested in CP-GP collaboration in primary care and identified many positive roles performed by CPs, including prescription review, adherence support, and patient education. The framework of the way forward includes: separation of CP and GP roles through a holistic revision of relevant legislation to grant an active role to CPs in chronic care; definition of protocols for collaborative practices; incentivization of both stakeholders (CPs and GPs); and design and implementation of an effective regulatory mechanism whereby the Malaysian Ministry of Health may take a leading role.

Over-the-counter medicines, economic conditions, and citizens most in need in Greece: Is it a challenge for primary care research?

INTRODUCTION

Recent austerity experiences in Greece suggest a plausible link between extensive use of over-the-counter (OTC) medicines and socio-economic peculiarities of life.

COMMENTARY

During the economic crisis in Greece, accessibility to healthcare services has been impacted, particularly for people with low income. However, this fact has not been systematically analyzed in conjunction with an observed increase in use of OTC medicines. Gaining a better understanding of the reasons leading to self-care may help to answer additional questions. Further research is needed to assess the gap between self-care and medically assisted care/treatment by designing pilot monitoring actions and focusing on behaviours related to OTC medicine use. Primary care can offer more collaboration between primary care physicians, community pharmacists, patients, and their families.

IMPLICATIONS

It is crucial to create a multimodal research plan to gain a better understanding of motivational reasons that eventually lead to increasing use of OTC medicines. Efforts should be made to develop data collection techniques that will elicit information from various social groups that focus on changeable behaviours and perceived needs in relation to medicine consumption.

Development and Validation of Psychological Contract Scale for Hospital Pharmacists

Objective

To set up a psychological contract scale for hospital pharmacists to strengthen the management of pharmacists and improve the occupational health of pharmacists.

Methods

A psychological contract scale for hospital pharmacists with structured questionnaires was designed according to the professional characteristics of hospital pharmacists and validated through the investigation of pharmacists in 77 public medical institutions in Zunyi, China, which were included through stratified random sampling. Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy and Bartlett’s Test of Sphericity were used to assess the suitability of the sample for factor analysis. Validity of the dimensions was investigated with exploratory factor analysis. The principal component analysis and varimax rotation methods were used to identify the factor structure. The internal consistency was assessed by the Cronbach’s alpha coefficient.

Results

The psychological contract scale for hospital pharmacists was composed of pharmacists’ perceptions regarding the hospital, pharmacists themselves, and government/society responsibility. The KMO values of the three perceptions were 0.957, 0.930 and 0.917, respectively, all greater than 0.6. The significance probability of the Bartlett spherical test was 0.000, indicating good structural validity. The Cronbach’s alpha coefficient and half coefficient of the responsibilities in three sub-scales were all greater than 0.6, indicating good internal reliability of the scale. The average scores of the pharmacist responsibility, the hospital responsibility and the government/society responsibility in the pharmacists’ perception were 5.42±0.637, 4.64±1.069 and 4.49±1.134, respectively. In the pharmacists’ perception, their own responsibility has been better fulfilled than those of hospitals and government/society.

Conclusion

The psychological contract scale for hospital pharmacists can be a useful tool to evaluate the psychological contract of hospital pharmacists for research and occupational health assessments and management in the area of hospital pharmacy.

The medication discrepancy detection service: A cost-effective multidisciplinary clinical approach

OBJECTIVE

To estimate the effectiveness of a Medication Discrepancy Detection Service (MDDS), a collaborative service between the community pharmacy and Primary Care.

DESIGN

Non-controlled before-and-after study.

SETTING

Bidasoa Integrated Healthcare Organisation, Gipuzkoa, Spain.

PARTICIPANTS

The service was provided by a multidisciplinary group of community pharmacists (CPs), general practitioners (GPs), and primary care pharmacists, to patients with discrepancies between their active medical charts and medicines that they were actually taking.

OUTCOMES

The primary outcomes were the number of medicines, the type of discrepancy, and GPs' decisions. Secondary outcomes were time spent by CPs, emergency department (ED) visits, hospital admissions, and costs.

RESULTS

The MDDS was provided to 143 patients, and GPs resolved discrepancies for 126 patients. CPs identified 259 discrepancies, among which the main one was patients not taking medicines listed on their active medical charts (66.7%, n=152). The main GPs' decision was to withdraw the treatment (54.8%, n=125), which meant that the number of medicines per patient was reduced by 0.92 (9.12±3.82 vs. 8.20±3.81; p<.0001). The number of ED visits and hospital admissions per patient were reduced by 0.10 (0.61±.13 vs 0.52±0.91; p=.405 and 0.17 (0.33±0.66 vs. 0.16±0.42; p=.007), respectively. The cost per patient was reduced by €444.9 (€1003.3±2165.3 vs. €558.4±1273.0; p=.018).

CONCLUSION

The MDDS resulted in a reduction in the number of medicines per patients and number of hospital admissions, and the service was associated with affordable, cost-effective ratios.

Complementing or conflicting? How pharmacists and physicians position the community pharmacist

Background:

Interprofessional collaboration between pharmacists and physicians in primary care has been linked to improved patient outcomes. How professionals position themselves and each other can shed light upon their relationship, and positioning theory can be used as a tool to better understand intergroup relations.

Objectives:

1) To identify how community pharmacists position themselves, and how they are positioned by general practitioners. 2) To assess how well these positions correspond, how the positions align with a proactive position for the pharmacists, and discuss how the positions could potentially impact collaboration.

Methods:

In this qualitative study, data were collected through six focus group interviews held between June and October 2019, three with pharmacists and three with physicians. The focus group interviews were conducted using a semi-structured interview guide. Data were audio recorded, transcribed verbatim, and analyzed using the Systematic text condensation method. Positioning theory was used as a theoretical framework to identify the positions assigned to community pharmacists by the pharmacists themselves and by the physicians.

Results:

Twelve pharmacists and ten physicians participated. The pharmacists positioned themselves as the “last line of defense”, “bridge-builders”, “outsiders” – with responsibility, but with a lack of information and authority – and “practical problem solvers”. The physicians positioned pharmacists as “a useful checkpoint”, “non-clinicians” and “unknown”.

Conclusions:

The study revealed both commonalities and disagreements in how community pharmacists position themselves and are positioned by general practitioners. Few of the positions assigned to pharmacists by the physicians support an active role for the pharmacists, while the pharmacists´ positioning of themselves is more diverse. The physicians´ positioning of pharmacists as an unknown group represents a major challenge for collaboration. Increasing the two professions´ knowledge of each other may help produce new positions that are more coordinated, and thus more supportive towards collaboration.

Professional roles of general practitioners, community pharmacists and specialist providers in collaborative medication deprescribing - a qualitative study

Background

Collaborative care approaches between general practitioners (GPs) and pharmacists have received international recognition for medication optimization and deprescribing efforts. Although specialist providers have been shown to influence deprescribing, their profession so far remains omitted from collaborative care approaches for medication optimization. Similarly, while explorative studies on role perception and collaboration between GPs and pharmacists grow, interaction with specialists for medication optimization is neglected. Our qualitative study therefore aims to explore GPs’, community pharmacists’ and specialist providers’ role perceptions of deprescribing, and to identify interpersonal as well as structural factors that may influence collaborative medication optimization approaches.

Method

Seven focus-group discussions with GPs, community pharmacists and community specialists were conducted in Hesse and Lower Saxony, Germany. The topic guide focused on views and experiences with deprescribing with special attention to inter-professional collaboration. We conducted conventional content analysis and conceptualized emerging themes using the Theoretical Domains Framework.

Results

Twenty-six GPs, four community pharmacists and three community specialists took part in the study. The main themes corresponded to the four domains ‘Social/professional role and identity’ (1), ‘Social influences’ (2), ‘Reinforcement’ (3) and ´Environmental context and resources’ (4) which were further described by beliefs statements, that is inductively developed key messages. For (1), GPs emerged as central medication managers while pharmacists and specialists were assigned confined or subordinated tasks in deprescribing. Social influences (2) encompassed patients’ trust in GPs as a support, while specialists and pharmacists were believed to threaten GPs’ role and deprescribing attempts. Reinforcements (3) negatively affected GPs’ and pharmacists’ effort in medication optimization by social reprimand and lacking reward. Environmental context (4) impeded deprescribing efforts by deficient reimbursement and resources as well as fragmentation of care, while informational and gate-keeping resources remained underutilized.

Conclusion

Understanding stakeholders’ role perceptions on collaborative deprescribing is a prerequisite for joint approaches to medication management. We found that clear definition and dissemination of roles and responsibilities are premise for avoiding intergroup conflicts. Role performance and collaboration must further be supported by structural factors like adequate reimbursement, resources and a transparent continuity of care.

Perspectives of primary care physicians and pharmacists on interprofessional collaboration in Kuwait: A quantitative study

Collaborative practice between physicians and pharmacists has a positive effect on healthcare outcomes. Understanding the local data related to this collaboration is vital in establishing efficient collaboration. Therefore, this study was designed to assess the collaborative relationships between physicians and pharmacists working in the primary healthcare centres regarding their attitudes and experiences, preferred methods of communication, perceptions related to the role of pharmacists, areas of potential further collaboration, and perceived barriers. A cross-sectional study was conducted using two parallel pretested self-administered questionnaires on a sample of 518 randomly selected physicians and pharmacists. Descriptive and comparative analyses were used in data analysis. The overall response rate was 86.3%. Although over 98% of respondents agreed that physician-pharmacist collaboration improves patient outcomes, more than half of the physicians (52.1%) and pharmacists (55.7%) had never practised collaboratively. Both groups preferred to communicate face-to-face (76.7%) or via telephone (76.5%). Both professions showed good agreement on pharmacists' roles related to managing side effects, improving adherence, assisting in dosage adjustment, providing advice regarding drug interactions, and providing drug information to physicians. They indicated disagreements on the importance of dispensing of prescriptions and providing advice to physicians regarding modification of drug therapy. Both groups expressed overall positive perceptions of the potential for further collaboration in areas related to the clinical roles of pharmacists, which were significantly higher among those with practice experience of < 10 years and those aged < 40 years (p<0.05). The top four perceived barriers to collaborative practice were lack of time (84.1%), lack of financial compensation (76.3%), lack of face-to-face communication (68.9%), and the possible fragmentation of patient care by the involvement of multiple healthcare professionals (68.9%). The present findings provide valuable input that could be a catalyst to enhance or establish physician-pharmacist collaboration in primary healthcare settings in Kuwait.

Barriers and enablers to collaborative working between GPs and pharmacists: a qualitative interview study

BACKGROUND

Many UK GP practices now employ a practice pharmacist, but little is known about how GPs and pharmacists work together to optimise medications for complex patients with multimorbidity.

AIM

To explore GP and pharmacist perspectives on collaborative working within the context of optimising medications for patients with multimorbidity.

DESIGN AND SETTING

A qualitative analysis of semi-structured interviews with GPs and pharmacists working in the West of England, Northern England, and Scotland.

METHOD

Thirteen GPs and 10 pharmacists were sampled from practices enrolled in the 3D trial (a complex intervention for people with multimorbidity). Participants' views on collaborative working were explored with interviews that were audiorecorded, transcribed, and analysed thematically. Saturation of data was achieved with no new insights arising from later interviews.

RESULTS

GPs from surgeries that employed a pharmacist tended to value their expertise more than GPs who had not worked with one. Three key themes were identified: resources and competing priorities; responsibility; and professional boundaries. GPs valued pharmacist recommendations that were perceived to improve patient safety, as opposed to those that were technical and unlikely to benefit the patient. Pharmacists who were not known to GPs felt undervalued and wanted feedback from the GPs about their recommendations, particularly those that were not actioned.

CONCLUSION

A good working relationship between the GP and pharmacist, where each profession understood the other's skills and expertise, was key. The importance of face-to-face meetings and feedback should be considered in future studies of interdisciplinary interventions, and by GP practices that employ pharmacists and other allied health professionals.

An intervention model with self-assessment and subsequent multi-professional review might be effective and feasible to improve drug safety in primary healthcare. A survey-based evaluation of SÄKLÄK2

RATIONALE, AIMS, AND OBJECTIVES

Drug-related morbidity is common, which results in suffering for the patients and a high cost to society. SÄKLÄK2 is a multi-professional intervention model aiming at improving drug safety in primary health care. The objective of this study was to elucidate the perceptions of the participants' regarding the efficiency of the intervention and the feasibility to introduce this model widely.

METHOD

SÄKLÄK2 is a multi-professional intervention model in primary health care in Sweden that consisted of self-assessment, peer-review, written feedback, and agreements for change. Web-based surveys were sent to both the management of participating primary health care centres (PHC) and to reviewers. The participating PHCs were fairly well-staffed and had a high interest in improvement work. Descriptive analysis and content analysis was used.

RESULTS

For the PHC management, the following categories were formed: Comprehensive project, Time-consuming, Multi-professional character, Relevant action agreements, and Feasible to implement. For the reviewers, the following categories were formed: Multi-professional character, Relevant action agreements, Feasible to implement, Useful self-assessment questionnaire, and Valuable visit at the PHC. There was a high degree of consistency between the PHC management and the reviewers' answers, especially regarding the efficiency of the model to improve drug safety and the feasibility to implement it on a broad front.

CONCLUSION

SÄKLÄK2, a model with self-assessment, peer review, written feedback, and the formation of action agreements was considered by both the participating heads of the PHC centres and the reviewers to be effective to improve drug safety in primary health care. Though time-consuming, this multi-professional model was considered to be feasible to implement on a broad front and might thereby be one way of working with quality improvement regarding drug safety.