Collaboration Between Community Pharmacists and Family Physicians: Lessons Learned from the Seniors Medication Assessment Research Trial

doi:10.1331/154434503322452193

Journal of the American Pharmacists Association

Volume 43, Issue 5, September–October 2003, Pages 566-572

https://doi.org/10.1331/154434503322452193 Get rights and content

Objectives

To learn about the experiences of specially trained expanded role pharmacists (ERPs) and family physicians in a program in which they worked together to optimize drug therapy for elderly patients (aged 65 and older) and to identify shortcomings of the program, obstacles to its implementation, and strategies to overcome these obstacles. Design: Qualitative opinion analysis. Participants: Six family physicians and six community-based ERPs who had participated in a randomized controlled trial (Seniors Medication Assessment Research Trial [SMART]). Intervention: In-depth interviews. Main Outcome Measures: Themes that emerged from the interviews regarding the strengths and weaknesses of and ways to improve the program. Results: ERPs and physicians differed in their perceptions of appropriate roles for ERPs. ERPs saw the program as an opportunity to take on new professional roles. Physicians appreciated the information they received from ERPs about their patients' adherence and use of nonprescription medications, but they did not want ERPs to directly counsel their patients. Some physicians questioned the value of the program for some patients, since the inclusion criteria for patients were broad and not all patients meeting the criteria needed intense interventions by ERPs. Both ERPs and physicians identified the need to refine the referral process and to work out professional role relationships and ongoing collaboration more fully. If the program were to be implemented as a routine service, physicians were concerned about the demands on their staff and office space and the need for an external compensation mechanism. Conclusion: Issues to be addressed for future programs include clarification of the roles of pharmacist and physician when the professionals work together, targeting of appropriate patients for the program, identification of a more efficient way to deliver recommendations, and development of an appropriate compensation mechanism.

Section snippets

Objectives

The SMART project intervention introduced a new role for ERPs and a new level of collaboration between physicians and ERPs. The objective of the qualitative study reported here was to learn about the experiences of specially trained ERPs and family physicians in a program in which they worked together to optimize drug therapy for elderly patients (age 65 and older) and to identify shortcomings of the program, obstacles to its implementation, and strategies to overcome these obstacles.

Randomized Trial Design

The intervention was evaluated using a cluster randomized controlled trial design that has been described elsewhere.³² Briefly, 48 family physicians whose practices were located within approximately 100 km of McMaster University in Hamilton, Ontario, Canada, and 889 (approximately 20 per practice) of their patients aged 65 and older and taking 5 or more medications daily (according to their medical chart) participated. Twenty-four physicians caring for a total of 431 patients were randomly

Sample Description

Interviews usually lasted between 10 and 15 minutes for physicians and 45 minutes for ERPs. This substantial difference was due, in part, to the limited time allotted by physicians for the interview. ERPs, in contrast, were eager to discuss their experiences with the program for longer periods. The response rate for both the patient and physician satisfaction questionnaires was 95%. Of the six physicians, two were women, and the mean year of graduation from medical school was 1978 (± 12.6

Discussion

Our results provide several important lessons that may inform the development of a consultation program focused on pharma- cist-physician collaboration in primary care.

Physicians and ERPs diverged in their perceptions of appropriate roles for ERPs, primarily with regard to direct patient counseling. Physicians were generally uncomfortable with ERPs performing this role, whereas ERPs often felt that they had sufficient skills and knowledge of the patient from the medical chart to discharge this

Conclusion

This study provided important insights into a new model of professional collaboration between family physicians and community-based, specially trained pharmacists. Although the program was acceptable to both groups of professionals, disparities in role expectations for both ERPs and physicians need to be resolved. Suggestions to make the collaboration more feasible included better targeting of patients who could benefit from the program, such as those referred by their physician for specific

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The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, gifts, or honoraria.

This study was supported by Health Transition Fund (Health Canada) grant ON-221.

This article was presented, in part, at the North American Primary Care Research Group Conference, on Amelia Island, Fla., November 2000.

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RESEARCHCollaboration Between Community Pharmacists and Family Physicians: Lessons Learned from the Seniors Medication Assessment Research Trial

Objectives

Section snippets

Objectives

Randomized Trial Design

Sample Description

Discussion

Conclusion

J Am Pharm Assoc.

J Am Pharm Assoc.

J Am Pharm Assoc.

Am J Med.

Soc Sci Med.

J Am Pharm Assoc

Drug-related admissions to a family medicine inpatient service

Arch Intern Med.

Potential medication-related problems in the noninstitutionalized elderly

Drug Intell Clin Pharm.

Drug-associated hospital admissions in older medical patients

J Am Geriatr Soc.

The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly

Arch Intern Med.

Drug-related events and drug utilization in patients admitted to a geriatric hospital department

Dan Med Bull.

The nature of adverse events in hospitalized patients

N Engl J Med.

Drug-related hospital admissions

Ann Pharmacother.

Preventable drug-related morbidity and mortality in older adults: a Canadian cost-of-illness model

Can Pharm J.

Indicators for the selection of ambulatory patients who warrant pharmacist monitoring

Am J Hosp Pharm.

Types of interventions made by clinical pharmacists in the IMPROVE study. Impact of managed pharmaceutical care on resource utilization and outcomes in Veterans Affairs medical centers

Pharmacotherapy

Impact of a pharmaceutical care model for non-institutionalised elderly: results of a randomized, controlled trial

Intl J Pharm Pract.

Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice

BMJ.

The effect of pharmaceutical review of repeat prescriptions in general practice

Intl J Pharm Pract.

RESEARCH
Collaboration Between Community Pharmacists and Family Physicians: Lessons Learned from the Seniors Medication Assessment Research Trial