Ontario family physician readiness to collaborate with community pharmacists on drug therapy management

Abstract

Background

Empirical evidence suggests that pharmacist-physician collaboration can improve patients' clinical outcomes; however, such collaboration occurs relatively infrequently in the community setting. There has been little research on physicians' perspectives of such collaboration.

Objective

To ascertain Ontario family physician readiness to collaborate with community pharmacists on drug therapy management.

Methods

The survey instrument was based on the transtheoretical model of behavior change. It enquired about 3 physician behaviors that represented low-, mid-, and high-level collaboration with pharmacists. The survey was distributed by fax or mail to a random sample of 848 Ontario family physicians and general practitioners, stratified by practice location (urban/rural).

Results

The response rate was 36%. Most respondents reported conversing with community pharmacists about a patient's drug therapy management 5 or fewer times per week. Eighty-four percent reported that they regularly took community pharmacists' phone calls, whereas 78% reported that they sometimes sought pharmacists' recommendations regarding their patients' drug therapy. Twenty-eight percent reported that they sometimes referred their patients to community pharmacists for medication reviews, with 44% unaware of such a service. There were no differences in physician readiness to engage in any of the 3 collaborative behaviors in urban versus rural settings. More accurate patient medication lists were perceived as the main advantage (pro) of collaborating with community pharmacists and pharmacists' lack of patient information as the main disadvantage (con). Collectively, perceived pros of collaboration were positive predictors of physician readiness to collaborate on all 3 behaviors, whereas perceived cons were negative predictors for the low- and mid-level behaviors. Female physicians were more likely than males to seek pharmacists' recommendations, whereas more experienced physicians were more likely to refer patients to pharmacists for medication reviews.

Conclusions

Overall, Ontario physicians were more engaged in the low- and mid-level collaboration with community pharmacists with respect to drug therapy management. The strongest predictor of physician readiness to collaborate was perceived advantages of collaboration.

Introduction

Medication-related errors have been shown to be a significant problem affecting patient care in the ambulatory setting.1, 2, 3, 4 In recent years, increasing attention has been focused on strategies to enhance the safety and effectiveness of drug prescribing and use. Collaboration between community pharmacists and family physicians is one of these strategies. There is considerable evidence that pharmacist involvement on hospital teams favorably impacts patient care, reducing mortality rates and adverse drug events.⁵ In the community setting, pharmacist-physician collaboration on drug therapy management has been associated with improved clinical outcomes in several chronic disease states.6, 7, 8 Health care authorities and organizations in Canada and the United States have expressed support for collaborative patient care9, 10 and/or increased pharmacist-physician collaboration.11, 12, 13

Since the 1990s, the pharmacy profession has increasingly embraced a patient-centered philosophy of practice termed pharmaceutical care, a key component of which involves close collaboration with physicians on drug therapy management.¹³ Individual pharmacists have expressed strong interest in collaborating with physicians; however, such collaboration occurs infrequently in the community setting.¹⁴ Pharmacists have identified a number of barriers to the implementation of pharmaceutical care, including their own attitudes, lack of time, space, training, reimbursement, and management support. Another consistently mentioned barrier is lack of cooperation from physicians.15, 16, 17, 18, 19, 20, 21 However, there have been few attempts to research the physician's point of view on collaboration with pharmacists, especially in Canada.21, 22, 23

The primary objectives of this study were to determine Ontario family physician readiness to collaborate with community pharmacists on drug therapy management and the potential predictors (sociodemographic and attitudinal) of their readiness to collaborate. Based on the work of McDonough and Doucette,²⁴ we postulated that, because physicians and pharmacists often share a greater number of patients in rural settings and are more likely to interact socially in their local community, rural physicians are more likely to collaborate with pharmacists in the management of patients' drug therapies. Therefore, a secondary objective was to examine whether physician readiness to collaborate varies across urban and rural settings.

The conceptual framework for this study of pharmacist-physician collaboration was the transtheoretical model of behavior change.²⁵ This model describes behavior change as a series of stages: precontemplation, when individuals are not considering changing their behavior; contemplation, when they are thinking about it; preparation, when they are taking concrete steps toward it; and action, when they have changed their behavior. The model also proposes that individuals continuously weigh the advantages (pros) of changing their behavior against the disadvantages (cons), and that the relative perceived importance of the pros increases and that of the cons decreases as individuals progress through the stages of change. Another predictor of change included in the model is self-efficacy, or the individual's situation-specific confidence. Finally, the model proposes a number of processes (mental or physical) used to progress through the stages (eg, substituting desirable behaviors for undesirable ones). Although the model has been widely used to study patient behavior,26, 27 it has only been used in 4 studies of physician readiness to change pertaining to cancer-screening and smoking cessation-counseling practices.28, 29, 30, 31