Background Collaborative working relationships (CWRs) between community pharmacists and physicians may foster the provision of medication therapy management services, disease state management, and other patient care activities; however, pharmacists have expressed difficulty in developing such relationships. Additional work is needed to understand the specific pharmacist-physician exchanges that effectively contribute to the development of CWR. Data from successful pairs of community pharmacists and physicians may provide further insights into these exchange variables and expand research on models of professional collaboration. Objective To describe the professional exchanges that occurred between community pharmacists and physicians engaged in successful CWRs, using a published conceptual model and tool for quantifying the extent of collaboration. Methods A national pool of experts in community pharmacy practice identified community pharmacists engaged in CWRs with physicians. Five pairs of community pharmacists and physician colleagues participated in individual semistructured interviews, and 4 of these pairs completed the Pharmacist-Physician Collaborative Index (PPCI). Main outcome measures include quantitative (ie, scores on the PPCI) and qualitative information about professional exchanges within 3 domains found previously to influence relationship development: relationship initiation, trustworthiness, and role specification. Results On the PPCI, participants scored similarly on trustworthiness; however, physicians scored higher on relationship initiation and role specification. The qualitative interviews revealed that when initiating relationships, it was important for many pharmacists to establish open communication through face-to-face visits with physicians. Furthermore, physicians were able to recognize in these pharmacists a commitment for improved patient care. Trustworthiness was established by pharmacists making consistent contributions to care that improved patient outcomes over time. Open discussions regarding professional roles and an acknowledgment of professional norms (ie, physicians as decision makers) were essential. Conclusions The findings support and extend the literature on pharmacist-physician CWRs by examining the exchange domains of relationship initiation, trustworthiness, and role specification qualitatively and quantitatively among pairs of practitioners. Relationships appeared to develop in a manner consistent with a published model for CWRs, including the pharmacist as relationship initiator, the importance of communication during early stages of the relationship, and an emphasis on high-quality pharmacist contributions.

http://www.primack.net/professional/articles/r027rsap2010.pdf

Exploring successful community pharmacist-physician collaborative working relationships using mixed methods

Objectives To assess pharmacists' actual and perceived barriers to implementing medication therapy management (MTM) services in the outpatient setting and to assess demographic and other factors associated with identified barriers. Design Cross-sectional study. Setting United States in 2007. Participants 970 pharmacists practicing in an outpatient setting. Intervention E-mail invitation to participate in an Internet-based survey. Main outcome measures Barriers to implementing MTM, practice characteristic influences on barriers, and personal characteristic influences on barriers. Results 776 of the 970 respondents (80.0%) were providing MTM or direct patient care services. Of respondents, 35% were compensated and 45% were not compensated for providing MTM services they provided to patients. The most common barriers identified for pharmacists providing MTM services with or without compensation were related to compensation. The most common barriers identified for those interested in providing MTM services were lack of additional staffing (89.6%) and poor access to medical information (84.0%). Pharmacists providing MTM with compensation were significantly less likely to agree with barriers relating to management, documentation, and compensation compared with those providing MTM without compensation. Those providing MTM with compensation were less likely to agree with most barriers compared with pharmacists who were interested in providing MTM services. Pharmacists practicing in a noncommunity setting were less likely to agree with barriers related to interprofessional relationships and documentation. Conclusion These results show that the most important barriers to implementing MTM services in the outpatient setting identified by pharmacist survey respondents were related to interprofessional relationships, documentation, and compensation. Despite the resources available to pharmacists, barriers continue to hinder the expansion of MTM and direct patient care services.

https://www.japha.org/article/S1544-3191(15)30936-5/pdf

Evaluation of pharmacists' barriers to the implementation of medication therapy management services.

Background To have a positive impact on patient outcomes achieved with drug therapy, it is likely that pharmacists will work more closely with physicians to manage medications collaboratively. Yet, little is known about the factors that will support such collaborative care between pharmacists and physicians. Objective The objective of this study was to identify significant influences on collaborative care between pharmacists and physicians, from the perspective of pharmacists. Methods Data were collected through a survey mailed to a national sample of 321 pharmacists identified by state pharmacy associations as being innovative practitioners. Three types of influences were assessed: individual characteristics, contextual factors, and exchange characteristics. Individual characteristics included demographics and a personality measure. Context variables included practice environment and professional interactions between pharmacists and physicians. Exchange characteristics were trustworthiness, role specification, and relationship initiation. Four items asked about the pharmacist's collaborative care with a physician. A hierarchical linear regression analysis was performed with collaborative care as the dependent variable and the individual, context, and exchange characteristics as the independent variables. Results One hundred sixty-six usable surveys (53.4%) were returned. About 64% of the respondents were male, with a mean age of 43.7 (SD±11.2) years. Linear regression analysis of the complete model produced an R 2 =0.805 ( P Conclusion Overall, the collaborative working relationship model largely explained collaborative care between pharmacists and physicians. Researchers are encouraged to use these findings when studying pharmacist-physician collaboration. In addition, pharmacists seeking to work with physicians should attend to developing trustworthiness and clarifying their clinical roles with physicians.

Factors affecting collaborative care between pharmacists and physicians.

Despite their common history, there are many cultural, attitudinal and practical differences between the professions of medicine and pharmacy that ultimately influence patient care and health outcomes. While poor communication between doctors and pharmacists is a major cause of medical errors, it is clear that effective, deliberate doctor-pharmacist collaboration within certain clinical settings significantly improves patient care. This may be particularly true for those patients with chronic illnesses and/or requiring regular medication reviews. Moreover, in hospitals, clinical and antibiotic pharmacists are successfully influencing prescribing and infection control policy. Under the new Irish Pharmacy Act (2007), pharmacists are legally obliged to provide pharmaceutical care to their patients, thus fulfilling a more patient-centred role than their traditional ‘dispensing’ one. However, meeting this obligation relies on the existence of good doctor-pharmacist working relationships, such that inter-disciplinary teamwork in monitoring patients becomes the norm in all healthcare settings. As discussed here, efforts to improve these relationships must focus on the strategic introduction of agreed changes in working practices between the two professions and on educational aspects of pharmaceutical care. For example, standardized education of doctors/medical students such that they learn to prescribe in an optimal manner and ongoing inter-professional education of doctors and pharmacists in therapeutics, are likely to be of paramount importance. Here, insights into the types of factors that help or hinder the improvement of these working relationships and the importance of education and agreed working practices in defining the separate but inter-dependent professions of pharmacy and medicine are reviewed and discussed.

Improving the working relationship between doctors and pharmacists: is inter-professional education the answer?

Background: Pharmacists are viewed as highly trained yet underutilised and there is growing support to extend the role of the pharmacist within the primary health care sector The integration of a pharmacist into a general practice medical centre is not a new concept however is a novel approach in Australia and evidence supporting this role is currently limited This study aimed to describe the opinions of local stakeholders in South-East Queensland on the integration of a pharmacist into the Australian general practice environment Methods: A sample of general practitioners, health care consumers, pharmacists and practice managers in SouthEast Queensland were invited to participate in focus groups or semi-structured interviews Seeding questions common to all sessions were used to facilitate discussion Sessions were audio recorded and transcribed verbatim Leximancer software was used to qualitatively analyse responses Results: A total of 58 participants took part in five focus groups and eighteen semi-structured interviews Concepts relating to six themes based on the seeding questions were identified These included positively viewed roles such as medication reviews and prescribing, negatively viewed roles such as dispensing and diagnosing, barriers to pharmacist integration such as medical culture and remuneration, facilitators to pharmacist integration such as remuneration and training, benefits of integration such as access to the patient’s medical file, and potential funding models Conclusions: These findings and future research may aid the development of a new model of integrated primary health care services involving pharmacist practitioners

https://espace.library.uq.edu.au/view/UQ:279146/PAC11_Poster_Final.pdf

Integrating a pharmacist into the general practice environment: opinions of pharmacist’s, general practitioner’s, health care consumer’s, and practice manager’s

A comparison between various emulsions made with carrageenin and acacia as a standard was made. Individual emulsions were evaluated on the basis of viscosity and particle counts.

B.W. Fitzgerald

Papers

An evaluation of the emulsifying properties of carrageenin