Physicians' perspectives on clinical pharmacy services in Northern Sweden: a qualitative study

Yemeni Physicians' Attitudes and Perceived Barriers Toward Ward-Based Clinical Pharmacist in Hospital Settings

Background

Clinical pharmacy services (CPSs) are still in their infancy in Yemen. Furthermore, pharmacists are not members of a multidisciplinary healthcare team, so their responsibilities are limited to drug dispensing and marketing. This study examines physicians' attitudes and perceived obstacles regarding the inclusion of clinical pharmacists in hospital medical wards.

Methods

A descriptive observational study was carried out using a validated, self-administered bilingual questionnaire. The study's questionnaire was conducted among physicians in three leading hospitals. Those hospitals were at the forefront of establishing clinical pharmacy units and embracing clinical pharmacy services. Data were analyzed using descriptive statistics.

Results

Sixty-five responses were included. Our data results indicated that physicians believed the most important contributions for clinical pharmacists to improve patient care were "attending medical rounds", followed by "order review". About 75% of physicians showed positive attitudes toward the clinical pharmacist role. However, more than 70% of physicians believed that clinical pharmacists should leave patient care to other healthcare professionals and focus on drug products. Not enough clinical pharmacist staff working in the health center was considered the top perceived barrier (83.1%), followed by "clinical pharmacist responsibilities were not clearly defined" and "clinical pharmacist recommendations are not properly documented".

Conclusion

Strategies to expand clinical pharmacy services in Yemen should focus on several key areas. Protocols must be established to clearly outline the collaboration between clinical pharmacists and physicians. Additionally, fostering inter-professional relationships is crucial to overcoming resistance and increasing awareness and understanding of CPS adoption among healthcare team members.

Exploring the impact of pharmacist-supported medication reviews in dementia care: experiences of general practitioners and nurses

BACKGROUND

Dementia is a major global public health challenge, and with the growing elderly population, its prevalence is expected to increase in the coming years. In Sweden, municipalities are responsible for providing special housing for the elderly (SÄBO), which offers services and care for older individuals needing specific support. SÄBO is both the person´s home and a care environment and workplace. Polypharmacy in patients with dementia is common and increases the risk of medication interactions. Involving clinical pharmacists in medication reviews has been shown to enhance medication safety and improve prescribing practices. However, the views of the standard care team involved in medication prescribing, administration, monitoring and documentation on integrating pharmacist services have received less attention. Thus, this study aims to explore how pharmacists' contributions can enhance medication safety, improve patient care efficiency, and potentially alleviate the workload of general practitioners for people with dementia living in special housing.

METHODS

This study has a descriptive qualitative study design using semi-structured interviews and qualitative content analysis. The study was conducted in a southern Swedish special housing and included nurses, assistant nurses, general practitioners (GPs), and a pharmacist. Due to the COVID-19 pandemic, interviews were conducted over the phone. The Swedish Ethical Review Authority approved the study.

RESULTS

The analysis revealed three main categories, and eleven subcategories.: (1) Integrating multidisciplinary approaches for holistic dementia care, (2) Strengthening dementia care through effective medication management and (3) Advancing dementia care through pharmacist integration and role expansion. Nurses focused on non-pharmacological treatments, while GPs emphasized the importance of medication reviews in assessing the benefits and side-effects of prescribed medication. Pharmacists were valued for their reliable medication expertise, appreciated by GPs for saving time and providing recommendations prior to consultations with individuals with dementia and their next-of-kin. Although medication reviews were considered beneficial, there was skepticism about their ability to solve all medication-related problems associated with dementia care.

CONCLUSIONS

This study highlights the critical role pharmacists play in enhancing medication safety and patient care efficiency in special housing for individuals with dementia. Despite the value of their contributions, communication barriers within healthcare teams pose significant challenges. Recognising potential pharmacist role expansion is essential to alleviate the workload of GPs and ensure effective collaborative practices for better patient outcomes.

Impact of an integrated medication management model on the collaborative working relationship among healthcare professionals in a hospital: an explanatory mixed methods study

An integrated medication management (IMM) model was implemented in a medical center ward to improve the delivery of clinical pharmaceutical services (CPSs). This model incorporated a ward-based clinical pharmacist who performed medication reconciliation and medication reviews. It was perceived to promote interprofessional collaboration between pharmacists and non-pharmacist healthcare professionals (NPHPs, including attending physicians, nurse practitioners, and registered nurses). This study aimed to evaluate the effects of the IMM on NPHPs' intentions to collaborate with pharmacists and understand the mechanism of the impact of the IMM on interprofessional collaboration. A sequential explanatory mixed methods design was employed in the study. Initially, a questionnaire was administered to assess the effects of the IMM on NPHPs' intentions to collaborate with pharmacists. The NPHPs' experiences with the IMM were then documented using semi-structured interviews with inductive thematic analysis. Fifty-eight NPHPs completed the questionnaire, and NPHPs from the intervention ward reported a higher intention to discuss patient-related medication issues with pharmacists, indicating collaboration. Eleven NPHPs were interviewed, and they stated having better working relationships with pharmacists, experiencing more effective CPSs, and noting improved communication with pharmacists. The integration of quantitative and qualitative findings demonstrates that the critical mechanism of the IMM in promoting collaborative relationships is to integrate pharmacists into medical practice, which familiarizes NPHPs with pharmacists' roles, improves communication, and enables pharmacists to identify NPHPs' needs. To summarize, allowing ward-based pharmacists to engage in medical teams on a regular basis appears vital for improving interprofessional teamwork. Furthermore, stakeholders aiming to promote CPS in their institutions should consider the needs and communication channels among NPHPs.

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.

Physicians' and nurses' perceptions of the factors influencing the implementation of paediatric clinical pharmacy services in Hong Kong: a qualitative study

OBJECTIVES

To identify barriers and facilitators that influence the implementation of paediatric clinical pharmacy services in Hong Kong public hospitals from physicians' and nurses' perspectives.

METHODS

A qualitative study was conducted based on semistructured interviews of physicians and nurses who worked in the field of paediatrics in four public hospitals in Hong Kong. Interviews were held via telephone conversations using spoken Cantonese which were audio recorded, then translated and transcribed directly into English by the research team. Thematic analysis was used for data analysis and reflexivity was engaged through member checking, making field notes and reporting using the Consolidated Criteria for Reporting Qualitative Studies checklist.

RESULTS

A total of six barriers and five facilitators were identified from interviewing 17 participants, which included 7 physicians and 10 nurses. The barriers identified were the public's lack of understanding and recognition of clinical pharmacists, a culture of medical dominance, lack of resources and heavy workload, the need for a more transparent and defined role of clinical pharmacist at the institutional level, lack of proactive approach and involvement in direct patient care activities. The facilitators identified were the belief in the improvement of patient outcomes and the overall pharmaceutical service efficiency, trust and confidence in clinical pharmacy services, filling the clinical gap as a medicine information provider, and direct and coherent communication as a multidisciplinary team member.

CONCLUSIONS

Physicians and nurses reported that the implementation of paediatric clinical pharmacy services was adequate, but several key barriers were identified at both the external and internal levels.

Perceptions and expectations of health professionals regarding hospital pharmacy services and the roles of hospital pharmacists: A qualitative systematic review and meta-synthesis

Background

Pharmacists have become increasingly integrated within the interprofessional hospital team as their scope of practice expanded in recent decades. However, limited research has explored how the roles of hospital pharmacists are perceived by other health professionals.

Aim/Objectives

To identify what is known about the perceptions of hospital pharmacists' roles and hospital pharmacy services held by non-pharmacist health professionals.

Methods

A systematic literature search was conducted in August 2022 in MEDLINE, Embase, and CINAHL to identify peer-reviewed articles published between 2011 and 2022. Title/abstract and full-text screening, by two independent reviewers, identified eligible articles. Inclusion criteria included qualitative studies in hospital settings that reported perceptions regarding the roles of hospital pharmacists held by non-pharmacist health professionals. Data were extracted using a standardised extraction tool. Collated qualitative data underwent inductive thematic analysis by two independent investigators to identify codes, which were reconciled and merged into over-arching themes through a consensus process. Findings were assessed to measure confidence using the GRADE-CERQual criteria.

Results

The search resulted in 14,718 hits. After removing duplicates, 10,551 studies underwent title/abstract screening. Of these, 515 underwent full-text review, and 36 were included for analysis. Most studies included perceptions held by medical or nursing staff. Hospital pharmacists were perceived as valuable, competent and supportive. At an organisational level, the roles of hospital pharmacists were perceived to benefit hospital workflow and improve patient safety. Roles contributing to all four domains of the World Health Organization's Strategic Framework of the Global Patient Safety Challenge were recognised. Highly-valued roles include medication reviews, provision of drug information, and education for health professionals.

Conclusion

This review describes the roles hospital pharmacists performed within the interprofessional team, as reported by non-pharmacist health professionals internationally. Multidisciplinary perceptions and expectations of these roles may guide the prioritisation and optimisation of hospital pharmacy services.

Understanding of healthcare professionals towards the roles and competencies of clinical pharmacists in South Africa

BACKGROUND

Incorporating clinical pharmacists in collaborative medical teams results in better patient treatment and health outcomes. In addition, the understanding of other healthcare professionals (HCPs) towards the role of clinical pharmacists can either facilitate or hinder the implementation and expansion of these services. The main distinction between pharmacists and clinical pharmacists lie in their different scope of duties. This study set out to explore other HCPs' understanding towards the role of the clinical pharmacists in South Africa, and to identify associated factors.

METHODS

An exploratory, survey-based, quantitative study was conducted. A survey assessing HCPs' understanding based on the competencies and role of a clinical pharmacist was distributed to 300 doctors, nurses, pharmacists and clinical pharmacists. An exploratory factor analysis was carried out to determine the construct validity of the measurement. Items were analysed for grouping into subscales through principal components analysis. Differences in the variable scores for gender, age, work experience and previous experience working with a clinical pharmacist were analyzed using independent t-tests. Analysis of variance was used to analyze differences in the variable scores for the different HCPs and the different departments of work in the hospital.

RESULTS

The factor analysis yielded two separate subscales, measuring HCPs' (n = 188) understanding towards the role of a clinical pharmacist, as well as the competencies of a clinical pharmacist. Doctors (85, n = 188) (p = 0.004) and nurses (76, n = 188) (p = 0.022), working in both surgical and non-surgical units, had significantly poorer understanding of the role of clinical pharmacists than clinical pharmacists (8, n = 188) and pharmacists (19, n = 188) (p = 0.028). Where specific clinical pharmacist activities were described, 5-16% of pharmacists were unsure whether an activity forms part of a clinical pharmacist's role. Over 50% of the clinical pharmacists disagreed that their role also includes pharmacist's activities, like stock procurement and control, pharmacy and administrative work, and hospital pharmacy-medication dispensing activities.

CONCLUSION

The findings highlighted the possible impact of role expectations and lack of understanding among HCPs. A standard job description with recognition from statutory bodies could promote other HCPs, as well as clinical pharmacists' understanding of their roles. Findings further suggested the need for interventions like interprofessional education opportunities, staff induction programmes and regular interprofessional meetings to foster acknowledgement of clinical pharmacy services, promoting the acceptance and growth of the profession.

Interdisciplinary Cooperation between Pharmacists and Nurses-Experiences and Expectations

BACKGROUND

Getting to know the experience gained so far between professions such as pharmacists and nurses allows for introducing changes aimed at better cooperation, and that can improve the quality of patient care. The aim was to obtain the nurses' opinions on the ongoing cooperation with pharmacists and to analyze the possibilities of cooperation between these groups.

METHODS

The survey was conducted from January to March 2021 among 124 nurses in Poland. The link to the electronic questionnaire was sent by e-mails sourced from online social groups for nurses. Before completing the questionnaire, each participant was informed about the anonymous research and the purpose of the data obtained.

RESULTS

In total, 80.6% of the respondents confirmed that the pharmacist is a reliable advisor in the field of general information about a drug and 60.9% in the field of clinical information about the drug, and 54.8% of the nurses agreed that a pharmacist should carry out such practices as measuring blood pressure or glucose in a community pharmacy, with 70.1% agreeing that a pharmacist should provide pharmaceutical care in a community pharmacy in the future and the most convinced of this were people with a master's degree. Of the respondents, 74.1% indicated that pharmacist advice should be fully reimbursed by the National Health Fund or another insurance institution.

CONCLUSIONS

The study showed that the nursing community appreciates the role of pharmacists and has a positive attitude towards cooperation with this professional group. What is more is that it indicates willingness for interdisciplinary cooperation.

Implementation and Evaluation of Clinical Pharmacy Services on Improving Quality of Prescribing in Geriatric Inpatients in Vietnam: An Example in a Low-Resources Setting

Purpose

Geriatric inpatients generally have a high risk of drug-related problems (DRP) in prescribing following hospital admission, which are likely to cause negative clinical consequences. This is particularly evident in developing countries such as Vietnam. Therefore, clinical pharmacy service (CPS) aims to identify and resolve these DRPs to improve the quality use of medicines in the older population following hospital admission.

Patients and Methods

The study was conducted as a prospective, single-center study implemented at a general public hospital in Hanoi. Patients aged ≥60 years with at least three chronic diseases admitted to the Internal Medicine Department between August 2020 and December 2020 were eligible to be enrolled. A well-trained clinical pharmacist provided a structured CPS to identify any DRP in prescribing for each patient in the study. Clinical pharmacist interventions were then proposed to the attending physicians and documented in the DRP reporting system.

Results

A total of 255 DRP were identified in 185 patients during the study period. The most frequent types of DRP were underuse (21.2%), dose too high (12.2%), and contraindication (11.8%). There was a very high rate of approval and uptake by the physicians regarding the interventions proposed by the clinical pharmacist (82.4% fully accepted and 12.5% partially accepted). Of the interventions, 73.4% were clinically relevant (pADE score ≥0.1). In general, 9 out of 10 physicians agreed that CPS has significant benefits for both patients and physicians.

Conclusion

Improving clinical pharmacy services can potentially have a positive impact on the quality of prescribing in elderly inpatients. These services should officially be implemented to optimize the quality use of medicines in this population group in Vietnam.

Clinical pharmacists' perceptions of the barriers and facilitators to the implementation of paediatric clinical pharmacy services in Hong Kong

OBJECTIVES

To identify barriers and facilitators that influenced the implementation of paediatric clinical pharmacy service (CPS) in Hong Kong's public hospitals from clinical pharmacists' perspective.

METHODS

A qualitative study based on semi-structured interviews of clinical pharmacists who practiced in paediatrics in public hospitals in Hong Kong. Interview schedule was designed based on determined themes identified in previous research and pilot testing was performed. The coding process was performed by two researchers with the resulting topics organised by thematic analysis. Consensus was reached amongst the researchers for the identification of themes that emerged during the interviews. The Consolidated Criteria for Reporting Qualitative Research guideline was followed to ensure the complete and transparent reporting of this research. Ethical approval for this study was obtained from the research ethics committee of the relevant institutions.

KEY FINDINGS

Of the 32 clinical pharmacists from across the study sites, 12 were interviewed. Five barriers and three facilitators were identified as main themes. The barriers that were identified which hindered service implementation include the service penetration into the healthcare system, practice environment constraints, lack of affirmation from the administrative stakeholders, governance of the profession and partnership with universities. The facilitators that were identified which enabled service implementation include other healthcare professionals' trust and confidence in the service, the support from the pharmacy management team and clinical pharmacists' self-efficacy.

CONCLUSIONS

Clinical pharmacists interviewed reported that the successful implementation of CPS in paediatrics in public hospitals in Hong Kong is an area of continued development with several key barriers identified.

A pilot study to assess the need for new hospital pharmaceutical services in Algerian patients and physicians’ perspective

Objectives

The objective of this study was to assess the needs for pharmaceutical services from the perspectives of physicians and patients in the hospital setting and to contribute to the implementation of new hospital pharmacy activities.

Methods

A cross-sectional descriptive study was carried out among the doctors and patients encountered in hospital departments in Sidi Bel Abbès (Algeria); each service was evaluated using a Likert scale. Associated characteristics with an important need were evaluated by univariate analysis and binary logistic regression.

Key findings

All pharmaceutical services were important to the patients, particularly providing treatment advice and therapeutic education. Women presented an important need for insurance of the availability of pharmaceutical products (P = 0.02) and lifestyle and dietetic information (P = 0.05). High frequency of taking medication was associated with an important need for information about drug interactions (P = 0.005). Patient-oriented pharmaceutical services were not important to the physicians who considered drug information and therapeutic education to be the most important need.

Conclusions

To implement patient-centred services, it is important to improve the contact between pharmacists and physicians and to provide information about pharmaceutical services that can benefit patients. Implementation of new practices in university hospital is more feasible than in public health facilities.

Factors affecting physician implementation of hospital pharmacists' medication appropriateness recommendations in older adults

AIMS

Non-implementation of pharmacist recommendations by physician prescribers may prolong potentially inappropriate prescribing in hospitalised older adults, increasing the risk of adverse clinical outcomes. The aim of this study was to ascertain the key factors affecting physician prescriber implementation of pharmacists' medication appropriateness recommendations in hospitalised older adults.

METHODS

Semi-structured interviews were conducted with hospital pharmacists and physicians who provided care to older adults (≥65 years) in 2 acute university teaching hospitals in Ireland. Content analysis was employed to identify the key themes that influence physician prescriber implementation of pharmacist recommendations.

RESULTS

Fourteen interviews were conducted with 6 hospital pharmacists and 8 hospital physicians between August 2018 and August 2019. Five key factors were found to affect physician implementation of pharmacist recommendations: (i) the clinical relevance and complexity of the recommendation-recommendations of higher priority and those that do not require complex decision-making are implemented more readily; (ii) interprofessional communication-recommendations provided verbally, particularly those communicated face to face with confidence and assertion, are more likely to be implemented than written recommendations; (iii) physician role and identity-the grade, specialty, and personality of the physician significantly affect implementation; (iv) knowing each other and developing trusting relationships-personal acquaintance and the development of interprofessional trust and rapport greatly facilitate recommendation implementation; and (v) the hospital environment-organisational issues such as documentation in the patient notes, having the opportunity to intervene, and the clinical pharmacy model all affect implementation.

CONCLUSION

This study provides a deeper understanding of the underlying behavioural determinants affecting physician prescriber implementation of pharmacist recommendations and will aid in the development of theoretically-informed interventions to improve medication appropriateness in hospitalised older adults.

An Overview on Patient-Centered Clinical Services

Drug-related problems (DRPs) had often been a concern in the system that needed to be detected, avoided, and addressed as soon as possible. The need for a clinical pharmacist becomes even more important. He is the one who can not only share the load but also be an important part of the system by providing required advice. They fill out the patient's pharmacotherapy reporting form and notify the medical team's head off any drug-related issues. General practitioners register severe adverse drug reactions (ADRs) yearly. As a result of all of this, a clinical pharmacist working in and around the healthcare system is expected to advance the pharmacy industry. Its therapy and drugs can improve one's health quality of life by curing, preventing, or diagnosing a disease, sign, or symptom. The sideshows, on the other hand, do much harm. Because of the services they offer, clinical pharmacy has grown in popularity. To determine the overall effect and benefits of the emergency department (ED) clinical pharmacist, a systematic review of clinical practice and patient outcomes will be needed. A clinical pharmacist's anatomy, toxicology, pharmacology, and medicinal chemistry expertise significantly improves a patient's therapy enforcement. It is now important to examine the failure points of healthcare systems as well as the individuals involved.

Attitudes, Opportunities, and Challenges for Clinical Pharmacy Services in Mizan-Tepi University Teaching Hospital, Southwest Ethiopia: Health Care Providers' Perspective

Background

Clinical pharmacy is a branch of health sciences that focuses more on the patient than on drug product-oriented services to optimize drug therapy. This study aimed to assess attitudes, opportunities, and challenges for clinical pharmacy services from the health care providers' perspective in Mizan-Tepi University Teaching Hospital.

Methods

A cross-sectional study was conducted among physicians, nurses, pharmacy professionals, and public health officers working in Mizan-Tepi University Teaching Hospital. A total of 119 health care providers participated in the study, and data were collected using a pretested self-administered questionnaire. The study tool was designed based on the instruments used in the previously conducted studies. Collected data were coded, entered, and analyzed using Statistical Package for the Social Sciences (SPSS, version 21). Furthermore, the descriptive and inferential statistics were performed.

Results

Out of 119 health care providers included in the study, 59.66% of them were nurses. The majority of the health care providers (85.71%) had a positive attitude towards clinical pharmacy services. Most of the study participants mentioned that acceptance of clinical pharmacy services among health care providers as a major opportunity to clinical pharmacy services in Mizan-Tepi University Teaching Hospital. The major challenges described for the clinical pharmacy services include lack of support from hospital management, absence of clearly defined roles and responsibilities for the clinical pharmacists, and shortage of pharmacy workforce and staff turnover.

Conclusion

Proper strategies should be in place to improve clinical pharmacy services and promote pharmacists' role in providing patient care.

Influence of Pharmacy Characteristics and Customer Quality of Life on Satisfaction of Community Pharmacy Customers

OBJECTIVES

The study objectives were to evaluate customer satisfaction with community pharmacy services and measure the relationships between customer satisfaction and pharmacy/pharmacist characteristics and customer quality of life.

METHODS

This was a cross-sectional survey of a convenience sample of customers at 20 community pharmacies in 10 different geographical areas in Baghdad city between May and September 2018. We used the satisfaction items which were developed by Paterson and colleagues in 2013. The survey also assessed customer quality of life (QoL) with 12 QoL items.

RESULTS

The study recruited 400 pharmacy customers. Overall, customers reported good satisfaction with community pharmacy services. The most three satisfying aspects were the professional appearance of the pharmacy, the professionalism of pharmacy staff and explanations of possible adverse medication effects. Three customer characteristics were associated with high satisfaction rates including male gender, buying medications without a prescription, and seeking services for themselves. Three pharmacy characteristics increased the customer satisfaction rate including the availability of female pharmacists, having more than one pharmacist, and whether the pharmacy is open full time. For quality of life, patients who had a limitation in their activities and those who accomplished less than they would like were less satisfied with pharmacy services.

CONCLUSIONS

To improve pharmacy services, pharmacists need to enhance their professional appearance, allocate more time for patient counselling, help patients to manage their medications and extend their working hours to meet customer needs.

Exploring physicians, nurses and ward-based pharmacists working relationships in a Swedish inpatient setting: a mixed methods study

Background In Sweden there has been limited work investigating the integration and nature of collaborative relationships between pharmacists and other healthcare practitioners. Objective To explore the working relationships of physicians, nurses and ward-based pharmacists in a rural hospital after the introduction of a clinical pharmacy service. Setting General medical ward in a rural hospital in northern Sweden. Method Mixed methods involving face-to-face semi-structured interviews with nurses, physicians and pharmacists, and a physician survey using the Physician-Pharmacist Collaboration Index to measure the extent of physician-reported collaborative working relationships. Main outcome measure Perceptions about collaborative working relationships between physician, nurses and pharmacists. Results All physicians (n = 9) who interacted with the clinical pharmacists completed the survey. The mean total score was 78.6 ± 4.7, total 92 (higher scores represent a more advanced relationship). Mean domain scores were highest for relationship initiation (13.0 ± 1.3, total 15), and trustworthiness (38.9 ± 3.4, total 42), followed by role specification (26.3 ± 2.6, total 30). The interviews (with nurses and physicians), showed how communication, collaboration and joint knowledge-exchange in the intervention changed and developed over time. Conclusion This study provides new insights into collaborative working relationships from the perspectives of physicians and nurses. The Physician-Pharmacist Collaboration Index scores suggest that physicians felt that clinical pharmacists were active in providing patient care; could be trusted to follow up on recommendations; and were credible. The interviews suggest that the team-based intervention provided good conditions for creating new ways to work to achieve commitment to professional working relationships.