General practitioners’ attitudes towards and frequency of collaboration with pharmacists in China: a cross-sectional study

In this cross-sectional analysis, we conducted an online questionnaire to explore GPs’ attitudes towards and frequency of collaboration with pharmacists, as well as the factors influencing such collaborations in Zhejiang Province, China. The study revealed that most respondents had a favourable attitude towards collaboration with pharmacists; however, the frequency of actual collaborations was still insufficient. We also identified several environmental determinants that exhibited a significant association with attitudes towards and the frequency of interprofessional collaboration.

In the first part of our survey, we assessed the attitudes of GPs towards collaboration with pharmacists in primary care settings. Our findings suggest that nearly 90% of GPs perceive their communication with pharmacists as open and honest, and more than 80% exhibited trust in the pharmacists’ expertise and willingness to cooperate on matters of medication management. These findings align with those reported in the study by Ameerah et al., suggesting that GPs exhibit similar attitudes towards cooperation with pharmacists, particularly regarding communication, collaboration willingness, and recognition of pharmacists’ competencies [21]. Nevertheless, our study found that approximately one-quarter of GPs felt that pharmacists lacked sufficient time to discuss patients’ medication regimens. This echoes previous research, which highlighted the lack of time as a potential barrier to achieving effective interdisciplinary collaboration in primary care settings [22, 23]. Another barrier to effective collaboration arises from issues related to limited office space and a lack of open channels for communication, which may lead to insufficient information exchange between GPs and pharmacists. A qualitative investigation executed in Australia highlighted the viewpoint of GPs that direct, face-to-face interaction could facilitate enhanced mutual collaboration; however, physical constraints within general practices and time pressures often curtail this communicative interaction [24]. The role of primary care pharmacists is frequently confined to that of “dispensers”, as most of their working hours are allocated to medication dispensing and consequently they have less time for dynamic interaction with GPs. This pattern suggests a structural problem in which pharmacists’ potential for broader clinical roles is underutilized due to routine and spatial constraints [25, 26].

We also investigated the frequency of interaction between GPs and pharmacists during routine clinical practice. We found that more than half of the GPs routinely reached out to pharmacists for specific drug-related information, while pharmacists initiated contact with GPs to clarify prescription details. These findings align with results from studies conducted in both Australia and the United Kingdom [19, 21]. Despite these routine interactions, a noteworthy finding from our study was that nearly 50% of GPs rarely adjusted patient medications based on a pharmacist’s recommendation and that they seldom involved pharmacists in medication management. This observation presents a potential gap in the collaborative practices between these two core health professions and calls for a deeper examination into the reasons for this behaviour among GPs. One possible reason is that GPs may not be fully aware of the functions of pharmacists and the potential role they could play in primary care [27]. While there is compelling evidence demonstrating that the integration of pharmacists into primary care teams can enhance patient outcomes and satisfaction, the benefits remain underappreciated among many GPs. For instance, a New Zealand survey highlighted that nearly 60% of GPs viewed the primary role of community pharmacists as being restricted to dispensing medication, yet a mere 17% acknowledged the potential for community pharmacists to assist doctors in crafting medication management plans [28]. This perception suggests a significant underestimation of the scope of a pharmacist’s professional capabilities and thus limits pharmacist involvement in primary care and reduces opportunities for interdisciplinary teamwork. A lack of confidence may also originate from the pharmacists in the form of self-doubt. Prior research indicates that approximately one-third of GPs reported that pharmacists only sometimes had the confidence to make clinical decisions [21]. Pharmacists’ lack of confidence might stem from a variety of factors, such as insufficient clinical training, a lack of exposure to certain clinical scenarios, or even the traditionally defined role of pharmacists that focuses on dispensing rather than decision-making in patient care [21]. This perception in turn leads to a reluctance from GPs to engage pharmacists in the clinical decision-making process and medication management.

The study examined the factors associated with GPs’ attitudes towards and frequency of collaboration with pharmacists. The findings revealed that there were no statistically significant differences in attitudes towards collaboration between male and female physicians in terms of joint medication management and common treatment goals, which is consistent with previous research on gender-based differences in interprofessional collaboration [29]. However, it is noteworthy that male physicians tended to decline collaboration with pharmacists, highlighting the importance of exploring the underlying reasons for this gender disparity. Possible influences could include gender-related factors such as differences in communication styles or professional norms. Furthermore, professional titles and educational background did not exert a significant influence on GPs’ attitudes towards and frequency of collaboration. These findings suggest that factors related to professional qualifications may not strongly determine GPs’ attitudes towards and engagement in collaboration. However, GPs with more years of practice and older physicians exhibited a higher likelihood of adopting pharmacist recommendations and involving them in medication management decisions. This observation suggests that as GPs accumulate experience, their recognition of the value and expertise that pharmacists bring to collaborative work increases, leading to a greater willingness to engage and cooperate with pharmacists.

The logistic regression analysis revealed that various environmental determinants, such as the presence of a regular communication protocol, engagement in joint continuing education, pharmacist provision of medication review recommendations, and communication with pharmacists during resident training, were significantly associated with more positive attitudes and increased frequency of collaboration. The regular communication protocol serves as a critical platform to foster interaction between GPs and pharmacists. It aids in cultivating mutual understanding, establishing robust communication, and fostering cooperative relationships. As exemplified in a UK study, over 90% of GPs reported that pharmacists’ activities were orchestrated through mutual agreements between the two professional groups [21]. This finding underscores the necessity of instituting formal regular protocols or meetings in primary care settings. Previous studies also revealed the direct impact of medication review recommendations as well as engagement in joint continuing education on GPs’ attitudes and collaborative frequencies [18, 30‐32]. Communication with pharmacists during residency training presents a pivotal opportunity to inculcate an understanding of the potential contributions pharmacists can make to medication management during the formative years of a physician’s career. The timely establishment of this understanding is essential, as professional identity perceptions are often solidified early in a physician’s career [33‐35]. Thus, integrating early exposure to and interaction with pharmacists in the training of future physicians could be instrumental in fostering better collaborative attitudes and practices.

Moreover, our study revealed a positive correlation between geographical proximity and collaboration frequency between GPs and pharmacists in primary care settings. It is conceivable that closer physical locations provide more opportunities for regular interaction, allowing for the development of rapport and fostering positive working relationships. This observation is corroborated by numerous previous studies [18, 21, 36, 37]. For instance, research conducted by Harding et al. indicated that GPs who worked near on-site health centre pharmacists demonstrated more favourable attitudes towards GP-pharmacist collaboration compared to their counterparts who worked in settings separate from pharmacists [36]. Similarly, a study featuring interviews with GPs in New Zealand showed a widely held belief among practitioners that closer proximity to pharmacists would enhance communication, thereby improving collaboration [37]. These findings emphasize the impact of spatial configurations in healthcare settings on collaborative practice and the potential benefits of rethinking and redesigning physical spaces in healthcare facilities to encourage increased interaction and collaboration between GPs and pharmacists.

Our research highlights several important implications. First, there is a pressing need to fortify the recognition of pharmacists’ roles and augment the active communication between pharmacists and GPs. Achieving this may necessitate a dedicated campaign to enlighten GPs about the broadened scope of pharmacists’ roles, which go well beyond the traditional dispensary functions, highlighting their capacity to contribute significantly to patient care outcomes. Educational tools for this campaign could include structured information sessions, collaborative workshops, or even interprofessional education programs, all with the aim of fostering an atmosphere of mutual respect and collaboration. Second, GPs need an environment that promotes frequent, meaningful interactions with pharmacists in primary care settings. Such an environment is instrumental in ensuring that both parties are thoroughly informed about a patient’s medication management plan. Consequently, this would enable them to work in unison, efficiently ensuring optimal patient outcomes. Future research should therefore focus on identifying effective strategies to create such an environment. In this context, establishing regular, structured communication protocols could be a stepping stone towards facilitating mutual understanding and cooperation. Third, the disparity we observed between positive attitudes and actual collaboration frequency among GPs and pharmacists underscores the role of policy intervention. Healthcare policymakers need to devise supportive policies that facilitate collaboration, potentially by providing shared training programs or interprofessional networking opportunities. Other systemic changes, such as creating integrated care models or redefining job descriptions, could also help overcome barriers to collaboration. Policies promoting the integration of pharmacists into primary care teams could be particularly impactful. They could validate and reinforce the value of the pharmacists’ role in the eyes of other healthcare professionals and patients, which could lead to enhanced patient satisfaction and outcomes.

Our study had several limitations. First, the frequency of collaboration between GPs and pharmacists was assessed using the FICI-GP instrument, which queries GPs about their interactions with the pharmacists they most frequently engage with in the preceding month [19]. While this scale has been translated and validated formally in the Chinese context, it could potentially introduce recall bias, as it relies on participants’ ability to accurately remember and report their interactions [38]. Second, our study sample is limited to a single province in China, and thus, the findings might not be generalizable to other geographical regions. Despite the potential limitations in external validity, the results of our study contribute meaningfully to the understanding of GP–pharmacist collaboration in primary care settings within the sampled region and can provide a reference for future comparative studies in different regions. Third, our sampling methodology may have potentially introduced nonresponse bias. However, we stress that given the robust sample size and the systematic approach to data collection, the impact of nonresponse bias on our conclusions is likely to be minimal.