Perceptions of interprofessional collaboration of general practitioners and community pharmacists - a qualitative study

Abstract

BackgroundDespite numerous evidences for the positive effect of community pharmacists on health care, interprofessional collaboration of pharmacists and general practitioners is very often limited. Though highly trained, pharmacists remain an underutilised resource in primary health care in most western countries. This qualitative study aims at investigating pharmacists’ and general practitioners’ views on barriers to interprofessional collaboration in the German health care system.MethodsA total of 13 narrative in-depth interviews, and two focus group discussions with 12 pharmacists and general practitioners in Mecklenburg-Western Pomerania, a predominantly rural region of North-Eastern Germany, were conducted. The interviews aimed at exploring general practitioners’ and pharmacists’ attitudes, views and experiences of interprofessional collaboration. At a second stage, two focus group discussions were performed. Fieldwork was carried out by a multi-professional team. All interviews and focus group discussions were audio taped and transcribed verbatim. The constant comparative method of analysis from grounded theory was applied to the data.ResultsThere are three main findings: First, mutual trust and appreciation appear to be important factors influencing the quality of interprofessional collaboration. Second, in light of negative personal experiences, pharmacists call for a predefined, clear and straightforward way to communicate with physicians. Third, given the increasing challenge to treat a rising number of elderly patients with chronic conditions, general practitioners desire competent support of experienced pharmacists.ConclusionsOn the ground of methodological triangulation the findings of this study go beyond previous investigations and are able to provide specific recommendations for future interprofessional collaboration. First, interventions and initiatives should focus on increasing trust, e.g. by implementing multi-professional local quality circles. Second, governments and health authorities in most countries have been and still are reluctant in advancing political initiatives that bring together physicians and pharmacists. Proactive lobbying and empowerment of pharmacists are extremely important in this context. In addition, future physician and pharmaceutical training curricula should focus on comprehensive pharmacist-physician interaction at early stages within both professional educations and careers. Developing and fostering a culture of continued professional exchange and appreciation is one major challenge of future policy and research.

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.…”

Evaluation of a chronic kidney disease risk assessment service in community pharmacies

“…Additionally, a qualitative study of Australian GPs showed that most did not favour pharmacists’ provision of screening services, as they believed screening to be the role of the GP and lacked confidence in the accuracy of screening tests and pharmacists’ competence . These findings suggest that any pharmacy‐based screening services, even with a robust in‐pharmacy protocol, are likely to have a low success rate unless there are close working relationships between community pharmacists and GPs . More specifically, there is a need to develop an innovative referral pathway, which can ensure that patients who have undergone screening at community pharmacies are subjected to further investigation during their routine visit to the GP …”

“…27 These findings suggest that any pharmacy-based screening services, even with a robust in-pharmacy protocol, are likely to have a low success rate unless there are close working relationships between community pharmacists and GPs. 28,29 More specifically, there is a need to develop an innovative referral pathway, which can ensure that patients who have undergone screening at community pharmacies are subjected to further investigation during their routine visit to the GP. 27,29 A distinctive aspect of our study, compared with other pharmacy-based screening studies, was the availability of participant pathology results.…”

Community pharmacists: members or bystanders of the primary care multidisciplinary team?

“…CPs are seen to be in an ideal position to take on the routine management of long‐term conditions, and there is evidence that they can do this . However, establishing collaborative relationships between general practice and community pharmacy has proved difficult . Poor integration of CPs on primary care teams may be one reason why the CPs’ clinical role is not more developed.…”

“…[3] However, establishing collaborative relationships between general practice and community pharmacy has proved difficult. [4] Poor integration of CPs on primary care teams may be one reason why the CPs' clinical role is not more developed.…”