BackgroundPrimary care needs to be patient-centered, integrated, and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, increasing attention has been paid to how and when medication-related decisions should be coordinated across multidisciplinary care teams. Improved knowledge on how integrated electronic health records (EHRs) can support interprofessional shared decision-making for medication therapy management is necessary to continue improving patient care.ObjectiveThe objective of our study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of EHRs.MethodsThis study is part of a broader cross-Canada study between patients and health care providers around how medication-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semistructured interviews with physicians and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data.ResultsWe collected data from 19 pharmacies and 9 medical clinics and identified 6 main themes from 34 health care professionals. First, Interprofessional Shared Decision-Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by EHRs that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician-Pharmacist Relationship, often predicated by colocation.ConclusionsWe observed limited communication and collaboration between primary care providers and pharmacists when managing medications. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management so that pharmacists and physicians can move beyond task-based work toward a collaborative approach.

ORIGINAL RESEARCH 680226C PHXXX10.1177/1715163516680226C P J / R P CC P J / R P C

No abstract

Traversing scientific information has become increasingly fraught, as the new information landscape allows anyone to access endless information with a few keystrokes. However, those trying to find information, understand authorities and navigate experts need a deeper understanding not only of the information itself, but also of how and why information is shared. Increasingly, questions of expertise, locale and bias are driving the scientific information ecosystem and creating or expanding disinformation, misinformation and propaganda efforts. Librarians are in the centre of this maelstrom of information and are obligated to help people learn to be critical of information. This article presents an illustrative case study, using the example of scientific information around the safety and efficacy of the Oxford-AstraZeneca vaccine to demonstrate how modern scientific information sharing is shaped by the ways in which misinformation and fake news spread.

Background: Primary care needs to be patient-centred, integrated and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, there is increasing attention on how and when medicationrelated decisions should be coordinated across multi-disciplinary care teams. Improved knowledge on how integrated EHRs can support interprofessional shared decision-making for medication therapy management is necessary to continue to improve patient care.Objective: This objective of this study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of electronic health records. Methods:This study is part of a broader cross-Canada study between patients and health care providers around how health-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semi-structured interviews with physician and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data. Results:Data was collected at 19 pharmacies and 9 medical clinics and we identified six main themes from 34 health care professionals. First, Interprofessional Shared Decision Making was not occurring and clinicians made decision based on their understanding of the patient. Physicians and pharmacist reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by electronic health records that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician/Pharmacist Relationship which was often predicated by co-location. Conclusion:When managing medications, there was limited communication and collaboration between primary care providers and pharmacists. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management, so that pharmacists and physicians move beyond task-based work toward a collaborative approach. In the children's game of telephone, players sit in a circle and whisper a message from ear to ear until the message makes its way around the circle. In most cases, the original message is drastically different by the time it reaches the final player. In clinical settings, medication-related decisions are often passed verbally among patients, doctors, nurses and pharmacists, the message can be similarly distorted...