Exploring the nature of power distance on general practitioner and community pharmacist relations in a chronic disease management context

Abstract

To improve collaboration in Australian primary health care, there is a need to understand aspects of the general practitioner (GP)/community pharmacist relationship, its influence on collaborative chronic disease management (CDM) and if this influence can be explained by a pre-existing theory or concept. Adopting a grounded theory approach, 22 GP and 22 community pharmacist semi-structured interviews were undertaken. Analysis of the transcripts identified common themes regarding the GP/community pharmacist relationship. Trustworthiness of the themes identified was tested through negative case analysis and member checking. Hofstede's (in 1980) phenomenon of power distance was employed to illuminate the nature of GP/community pharmacist relations. The majority of GPs and community pharmacists described the characteristics of this phenomenon. The power distance was based on knowledge and expertise and was shown to be a barrier to collaboration between GPs and community pharmacists because GPs perceived that community pharmacists did not have the required expertise to improve CDM above what the GP could deliver alone. Power distance exists within the GP/community pharmacist relationship and has a negative influence on GP/community pharmacist collaborative CDM. Understanding and improving GP awareness of community pharmacist expertise has important implications for the future success of collaborative CDM.

Factors influencing interprofessional collaboration between community pharmacists and general practitioners—A systematic review

“…Professional boundaries were commonly identified as impeding collaboration between GPs and CPs (Bradley et al., ; Dey, de Vries, & Bosnic‐Anticevich, ; Dinnie, Bond, & Watson, ; Howard et al., ; Hughes & McCann, ; Kelly et al., ; Lalonde et al., ; Laubscher, Evans, Blackburn, Taylor, & McKay, ; Legault et al., ; Löffler et al., ; Maidment et al., ; Moore, Kennedy, & McCarthy, ; Pojskic et al., ; Pottie et al., ; Rieck & Pettigrew, ; Rieck, ; Rubio‐Valera et al., ; Sake, Wong, Bartlett, & Saini, ; Saw et al., ; Tan, Stewart, Elliott, & George, , ; Van, Costa, Mitchell, Abbott, & Krass, , , ; Van, Krass, & Mitchell, ; Van, Mitchell, & Krass, ; Varela et al., ; Weissenborn, Haefeli, Peters‐Klimm, & Seidling, ; Wustmann, Haase‐Strey, Kubiak, & Ritter, ; Zillich, McDonough, Carter, & Doucette, ). Professionals’ previous experience with collaboration and a lack of clarity regarding the roles and responsibilities of the GPs and CPs were the most common issues; followed by attitudes, feelings, hierarchy and power, and trust and respect.…”

“…For example, several GPs reported concerns about older generation GPs having negative attitudes towards collaboration with CPs due to their lack of multidisciplinary approach in training (Connie Van et al., ). A negative opinion of the other professional was reported to hinder interactions, possibly due to the public–private conflict (Rubio‐Valera et al., ) or overlapping responsibilities and assuming each other's roles (Rieck, ).…”

“…Hierarchy and power‐related issues were commonly reported (Dinnie et al., ; Hughes & McCann, ; Löffler et al., ; Maidment et al., ; Rieck & Pettigrew, ; Rieck, ; Tan et al., , ; Weissenborn et al., ) with GPs who often perceived the CP as a retailer (Dinnie et al., ; Hughes & McCann, ; Löffler et al., ; Rieck & Pettigrew, ; Tan et al., , ). In some cases, GPs believed this could create a conflict of interest due to incentives in selling more medication, this was also acknowledged by pharmacists (Hughes & McCann, ).…”

“…Perceptions of each professions’ skills and knowledge affected collaboration, described in 29 studies (Bidwell & Thompson, ; Bradley et al., ; Dey et al., ; Dinnie et al., ; Farrell, Pottie, Haydt, Kennie et al., ; Hashemian et al., ; Howard et al., ; Hughes & McCann, ; Kelly et al., ; Lalonde et al., ; Laubscher et al., ; Legault et al., ; Löffler et al., ; Maidment et al., ; Moore et al., ; Pojskic et al., ; Pottie et al., , ; Rathbone et al., ; Rieck & Pettigrew, ; Rieck, ; Rubio‐Valera et al., ; Sake et al., ; Tan et al., , ; Van, Costa, Abbott, Mitchell, & Krass, ; Van et al., ; Van et al., ; Van et al., ; Varela et al., ; Weissenborn et al., ).…”

Validation of a tool for reporting pharmacists' interventions in everyday community pharmacy

“…1 With the increasing involvement of CPs in patient care, it has become necessary to describe the role of the CP in medication order review. [2][3][4][5] A pharmacist intervention (PI) is defined as a change in drug therapy initiated by a community pharmacist (CP). 6 To be precise, a PI is any proposition of action initiated by a pharmacist concerning a prescription from a licensed prescriber and directly resulting in intention to change the patient's management or therapy.…”