Abstract
Background: Studies have shown physician-pharmacist collaboration can improve outcomes and management of chronic disease states; however, there is limited knowledge of the barriers to implementing these models. Objective: To evaluate the perceived effectiveness of and barriers to physician-pharmacist collaborative management (PPCM) in diverse primary care medical offices. Methods: Prospective cluster-randomized mixed methods trial in 32 primary care offices. Each medical office was randomized to a 9 or 24 month hypertension intervention or a 9 month asthma intervention with usual care hypertension management. A post study summative evaluation of physician and pharmacists was conducted to identify obstacles and suggest facilitators for implementation of PPCM in primary care offices. Results: A total of 63 physicians and 26 pharmacists from 27 (84%) and 26 (81%) offices, respectively, completed the summative evaluation. Collaboration for the duration of the Collaboration Among Pharmacists and Physicians To Improve Outcomes Now (CAPTION) Trial resulted in expanded clinical pharmacy services for the management of chronic diseases. Both physicians and pharmacists participating in the study reported that physicians at their sites were generally receptive to pharmacist’s recommendations both prior to and following the study. Physicians appear to be confident in the expertise of pharmacists and their ability to manage chronic diseases. Over 98% of physicians reported accepting pharmacist recommendations. In addition, 100% of responding physicians and pharmacists believed the model implemented in the CAPTION Trial could be expanded to disease states beyond blood pressure (BP) and asthma. Collaboration reportedly increased as physician workload became heavier. A major reported barrier to collaboration was access to pharmacists including conflicts with other non-clinical responsibilities. Collaboration had a positive impact on patient-provider relationships and 100% of the surveyed physicians responded that they believe a pharmacist’s involvement in chronic disease management improved patient outcomes. When asked if pharmacists should be recognized as healthcare providers, 95% of physicians responded affirmatively. Conclusions: The results of this summative evaluation indicate both physicians and pharmacists perceived collaboration in primary care settings as a means to improve the quality of patient care and treatment outcomes. Physicians and pharmacists perceived collaborative care as well received by patients and that it strengthened patient-provider relationships. Physicians’ desire to collaborate with pharmacists to manage chronic diseases is promising but will require ongoing efforts to develop and maintain positive professional relationships as well as reimbursement strategies for clinical services provided by pharmacists.
Highlights
As the health care system adapts to the growing population living with chronic disease there has been a shift in the delivery of primary care towards a team-based, patient-centered model [1,2]
The American College of Clinical Pharmacy (ACCP) Ambulatory Care Practice and Research Network (PRN) recently published a paper stressing the importance of pharmacists in the optimization of
When the most recent 2014 blood pressure (BP) guidelines were considered [21], BP control was achieved in 61% of intervention patients and 45% of usual care patients [(adjusted odds ratio for BP control, 2.03 [95% CI 1.29-3.22], p=0.003) [18]
Summary
As the health care system adapts to the growing population living with chronic disease there has been a shift in the delivery of primary care towards a team-based, patient-centered model [1,2]. The benefits of including a pharmacist as a member of a collaborative medical team have been well established. Several systematic reviews and metaanalyses have shown the positive impact pharmacists have on improving BP control and managing other cardiovascular risk factors [3,4,5]. The American College of Clinical Pharmacy (ACCP) Ambulatory Care Practice and Research Network (PRN) recently published a paper stressing the importance of pharmacists in the optimization of. Studies have shown physician-pharmacist collaboration can improve outcomes and management of chronic disease states; there is limited knowledge of the barriers to implementing these models
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