Pharmacist-physician Collaboration Research Articles

Outcome Analysis of Prescription Optimization Efforts by Physician-Pharmacist Collaboration in a Cardiology Hospital for Inpatients

Outcome Analysis of Prescription Optimization Efforts by Physician-Pharmacist Collaboration in a Cardiology Hospital for Inpatients

Pharmacist-Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability.

Inaccurate or missing medication information in medical discharge summaries is a widespread and intractable problem. This study evaluated the effectiveness and sustainability of an intervention in which ward-based hospital pharmacists reviewed, contributed and verified medication information in electronic discharge summaries (EDSs) in collaboration with physicians. Retrospective audits of randomly selected EDSs were conducted on seven wards at a major public hospital before and after implementation of the intervention and repeated two years later on four wards where the intervention was incorporated into usual pharmacist care. EDSs for 265 patients (prescribed a median of nine discharge medications) were assessed across the three time points. Pharmacists verified the EDSs for 47% patients in the first post-intervention audit and 68% patients in the second post-intervention audit. Following the intervention, the proportion of patients with one or more clinically significant discharge medication list discrepancy fell from 40/93 (43%) to 14/92 (15%), p < 0.001. The proportion of clinically significant medication changes stated in the EDSs increased from 222/417 (53%) to 296/366 (81%), p < 0.001, and the proportion both stated and explained increased from 206/417 (49%) to 245/366 (67%), p < 0.001. Significant improvements were still evident after two years. Pharmacists spent a median of 5 (range 2–16) minutes per patient contributing to EDSs. Logistics, timing and pharmacist workload were barriers to delivering the intervention. Additional staff resources is needed to enable pharmacists to consistently deliver this effective intervention.

Exploring the Health Care Challenges and Health Care Needs of Arabic-Speaking Immigrants with Cardiovascular Disease in Australia.

The Arabic-speaking immigrant group, which makes up the fourth largest language group in Australia, has a high prevalence of cardiovascular disease. The objective of this study was to explore the health care challenges and needs of Arabic-speaking immigrants with cardiovascular disease (CVD), using a comparative approach with English-speaking patients with CVD as the comparable group. Methods: Participants were recruited from community settings in Melbourne, Australia. Face-to-face semi-structured individual interviews were conducted at the recruitment sites. All interviews were audio-taped, transcribed, and coded thematically. Results: 29 participants with CVD were recruited; 15 Arabic-speaking and 14 English-speaking. Arabic-speaking immigrants, and to a lesser extent English-speaking patients with CVD may have specific health care challenges and needs. Arabic-speaking immigrants’ health care needs include: effective health care provider (HCP)-patient communication, accessible care, participation in decision-making, and empowerment. English-speaking participants viewed these needs as important for CVD management. However, only a few English-speaking participants cited these needs as unmet health care needs. Conclusion: This study suggests that Arabic-speaking immigrants with CVD may have unique needs including the need for privacy, effective HCP-patient communication that takes into account patients’ limited English proficiency, and pharmacist-physician collaboration. Therefore, there may be a need to identify a health care model that can address these patients’ health care challenges and needs. This, in turn, may improve their disease management and health outcomes.

Comprehensive medication reviews: Optimal delivery setting and recommendations for quality assessment

ObjectivesTo propose a metric evaluating the quality of comprehensive medication reviews (CMRs), and to discuss the optimal setting for CMR delivery. SummaryFirst, we provide a current assessment of the quality of CMRs performed in community, payer, and health system/clinic settings, with recommended opportunities for improvement. Thereafter, a companion metric for CMR quality is discussed, because this is critical to ensuring that patients are not just receiving CMR services, but that CMRs reflect evidence-based recommendations supporting optimal patient outcomes. ConclusionBased on the data currently available, accessibility to electronic medical records would enhance patient-specific recommendations to optimize CMR delivery and patient outcomes. Future studies may help to identify additional factors, such as pharmacist-physician collaboration in clinic and use of evidence-based recommendations, that can further enhance CMR quality.

1271-P: Impact of Physician-Pharmacist Collaboration on A1C in an Interprofessional Endocrinology Clinic

Background: Comprehensive medication management (CMM) ensures an individualized plan for medication appropriateness, effectiveness, safety, and adherence. It is most often performed by pharmacists within a pharmacist-physician collaborative agreement. Published studies on CMM are few and mostly conducted in primary care settings. The aim of our study was to determine the impact of CMM on the proportion of patients that achieve ≥ 1% A1c reduction in an interprofessional specialty clinic. Methods: This is a retrospective study comparing 2 groups: group 1-without pharmacist collaboration, group 2-with pharmacist collaboration. Subjects were adults with diabetes and most recent A1c ≥ 8.5% with at least one visit in the interprofessional endocrinology clinic between 1/2016-12/2017. Exclusion criteria were pregnancy, no A1c within 6 weeks of initial visit, and no follow-up A1c. The 2 groups were matched for initial A1c, type of diabetes, age, and BMI. Results: A total of 162 participants were included. Baseline characteristics were similar between groups: Group 1: (mean age: 57.6 ± 15.8 years, BMI: 34.3 ± 8.1 kg/m2, A1c: 10.2 ± 1.2%, T1DM: 26%), Group 2 (mean age: 56.0 ±16.4 years, BMI: 32.6 ± 8.1 kg/m2, A1c: 10.1± 1.3%, T1DM: 26%). The percentage of subjects achieving ≥1% A1c reduction at 6 months was 58.0% in Group 2 compared to 40.7% in Group 1, p=0.041. More subjects achieved A1c &amp;lt; 8% in group 2 (32.1%) vs. Group 1 (18.5%), p=0.047. The frequency of endocrinologist visits was more in group 1 (2.37/patient) vs. group 2 (1.89/patient), p=0.01. Group 2 averaged 3.0 pharmacist visits per patient. Discussion: Physician-pharmacist collaboration led to greater A1c reduction compared to usual endocrinologist care in patients with uncontrolled A1c. However, frequency of total provider visits may account for some differences. Overall, utilizing pharmacists within diabetes health care models may reduce frequency of endocrinologist visits while improving glycemic control. Disclosure D. Isaacs: Advisory Panel; Self; BD, Sanofi-Aventis. R.S. Zimmerman: Consultant; Self; Novo Nordisk Inc. Research Support; Self; Merck &amp; Co., Inc., Novo Nordisk Inc. Speaker's Bureau; Self; Johnson &amp; Johnson Diabetes Institute, Merck &amp; Co., Inc. M. Lansang: None.

General practitioner-pharmacist collaboration in Germany: an explanatory model.

Background In Germany, no validated measure and model of pharmacist-physician collaboration existed. Objectives To provide evidence for the factor structure of the previously validated Frequency of Inter-professional Collaboration Instrument and the Attitudes Toward Collaboration Instrument in measuring attitudes toward and frequency of collaboration from the general practitioner's perspective in the context of primary care in Germany; to develop an explanatory model which illustrates factors influencing collaboration. Setting The study was conducted in the primary health care sector in Mecklenburg-Western Pomerania, Germany with a cohort of general practitioners. Method The two measures were translated into German and the survey was administered to 1438 practitioners. Exploratory factor analysis was used to assess the structure of the instruments. Structural equation modelling was used to determine how demographic variables and attitudes influence collaborative behaviour. Main outcome measure Outcome measure comprised frequency of and attitudes toward collaboration among German general practitioners and an explanatory model of practitioner-pharmacist collaboration. Results A response rate of 35.9% was achieved. Exploratory factor analysis revealed one factor for the instrument measuring attitudes and two factors for frequency. The factors were interpreted as 'Communication and Collaboration' and 'Pharmacist medication management'. The significant demographic predictors of collaboration were age, population of the surgery's location, distance to the pharmacy, specialty. Conclusion The results provide evidence for the factor structure of both measures in measuring attitudes toward and frequency of collaboration. A model of collaboration in which behaviour and extent of collaboration are directly influenced by individual and context characteristics is supported.

Physician-pharmacist collaboration on chronic non-cancer pain management during the opioid crisis: A qualitative interview study.

Management of chronic non-cancer pain is complex, requiring clinicians to balance pain management with the risk of opioid abuse. The role of ambulatory care pharmacists in chronic pain management is well-established, but little research has explored the feasibility of building collaboration on chronic pain and opioid management between physicians and community pharmacists. To explore physician and pharmacist perspectives on the opioid crisis and the possibility of physician and community pharmacist collaborations to manage chronic non-cancer pain in the context of the opioid crisis. Semi-structured interviews were performed with a snowball convenience sample 15 physicians and 25 pharmacists in North Carolina between November 2016 and April 2017. Transcribed data were analyzed using applied thematic analysis, and resulting codes were organized into themes and domains which emerged from analysis. Both physicians and pharmacists described current care deficiencies and steps needed to mitigate opioid abuse and diversion. Physicians discussed the need for additional supports and resources for chronic pain management and regarded positively the role of the community pharmacist in chronic pain management and mitigating opioid abuse. Pharmacists identified cost as the major barrier to implementing new services, and expressed willingness to participate in new chronic pain and opioid interventions. Within the study sample, strong interest exists for collaboration between physicians and community pharmacists. This highlights a potential opportunity to expand care for patients with chronic non-cancer pain.

Cardiovascular disease risk screening by pharmacists: a behavior change wheel guided qualitative analysis.

In common with many developed countries, Saudi Arabia is currently experiencing an increasing cardiovascular disease (CVD) burden. However, systematic screening programs for early identification and minimization of CVD risk within community or general clinical settings are limited. Globally, research suggests that pharmacists can play an effective role in identifying, assessing, managing and referring people at risk of CVD in the community as well as in the hospital setting. This role is not yet developed in Saudi Arabia. This study aimed to explore the perspectives of hospital and community pharmacists in Saudi Arabia about potential roles in CVD risk screening. The purpose of the study was to propose potential interventions to facilitate the development of pharmacist delivered models for CVD risk prevention and management services in Saudi Arabia. A qualitative study was conducted using semi-structured in-depth interviews and focus group discussions with a purposive convenience sample of hospital and community pharmacists in Saudi Arabia. Data collection continued until saturation was achieved. All interviews were audio recorded, transcribed verbatim and thematically analyzed. A total of 50 pharmacists (26 hospital and 24 community pharmacists) participated in this study. Twenty hospital and eight community pharmacists were interviewed individually, while the remaining participants contributed to three focus groups discussions. Currently, it appears that CVD risk prevention services are rarely provided, and when offered involved provision of discrete elements only such as blood pressure measurement, rather than a consolidated evidence based approach to risk assessment. Participating pharmacists did not appear to have a clear understanding of how to assess CVD risk. Four key themes were identified: pharmacists' perception about their current roles in CVD, proposed future clinical and service roles, impeding factors and enabling factors. Subthemes were mainly related to determinants likely to influence future CVD services. These subthemes included public perception of pharmacists' roles, pharmacist-physician collaboration, legislative restrictions, systemic issues, sociocultural barriers, organizational pharmacy issues, lack of professional motivation, government and organizational support and professional pharmacy support frameworks. These influencing factors need to be addressed at micro, meso and macro systems level in order to facilitate development of new pharmacist delivered cognitive services in Saudi Arabia. Pharmacists in Saudi Arabia are willing to expand their role and offer pharmacy-based services, but influencing determinants have to be addressed at the individual, professional and health system levels. Further work is needed to clarify and develop practical and appropriate protocols for pharmacist CVD prevention and management services within the Saudi public and health care system. Such work should be guided by implementation science frameworks rather than embarking on conventional research trial pipelines where public benefit of generated evidence is delayed or limited.

"My pharmacist": Creating and maintaining relationship between physicians and pharmacists in primary care settings.

Pharmacists and physicians are being increasingly encouraged to adopt a collaborative approach to patient care, and delivery of health services. Strong collaboration between pharmacists and physicians is known to improve patient safety, however pharmacists have expressed difficulty in developing interprofessional working relationships. There is not a significant body of knowledge around how relationships influence how and when pharmacists and physicians communicate about patient care. This paper examines how pharmacists and primary care physicians communicate with each other, specifically when they have or do not have an established relationship. Thematic analysis of data from semi-structured interviews with nine primary care physicians and 25 pharmacists, we examined how pharmacists and physicians talk about their roles and responsibilities in primary care and how they build relationships with each other. We found that both groups of professionals communicated with each other in relation to the perceived scope of their practice and roles. Three emerging themes emerged in the data focusing on (1) the different ways physicians communicate with pharmacists; (2) insights into barriers discussed by pharmacists; and (3) how relationships shape collaboration and interactions. Pharmacists were also responsible for initiating the relationship as they relied on it more than the physicians. The presence or absence of a personal connection dramatically impacts how comfortable healthcare professionals are with collaboration around care. The findings support and extend the existing literature on pharmacist-physician collaboration, as it relates to trust, relationship, and role. The importance of strong communication is noted, as is the necessity of improving ways to build relationships to ensure strong interprofessional collaboration.

Exploring physicians, nurses and ward-based pharmacists working relationships in a Swedish inpatient setting: a mixed methods study

Background In Sweden there has been limited work investigating the integration and nature of collaborative relationships between pharmacists and other healthcare practitioners. Objective To explore the working relationships of physicians, nurses and ward-based pharmacists in a rural hospital after the introduction of a clinical pharmacy service. Setting General medical ward in a rural hospital in northern Sweden. Method Mixed methods involving face-to-face semi-structured interviews with nurses, physicians and pharmacists, and a physician survey using the Physician-Pharmacist Collaboration Index to measure the extent of physician-reported collaborative working relationships. Main outcome measure Perceptions about collaborative working relationships between physician, nurses and pharmacists. Results All physicians (n = 9) who interacted with the clinical pharmacists completed the survey. The mean total score was 78.6 ± 4.7, total 92 (higher scores represent a more advanced relationship). Mean domain scores were highest for relationship initiation (13.0 ± 1.3, total 15), and trustworthiness (38.9 ± 3.4, total 42), followed by role specification (26.3 ± 2.6, total 30). The interviews (with nurses and physicians), showed how communication, collaboration and joint knowledge-exchange in the intervention changed and developed over time. Conclusion This study provides new insights into collaborative working relationships from the perspectives of physicians and nurses. The Physician-Pharmacist Collaboration Index scores suggest that physicians felt that clinical pharmacists were active in providing patient care; could be trusted to follow up on recommendations; and were credible. The interviews suggest that the team-based intervention provided good conditions for creating new ways to work to achieve commitment to professional working relationships.

Process of translation and cross-cultural adaptation of two Australian instruments to evaluate the physician-pharmacist collaboration in Germany.

Building interprofessional working relationships between physicians and pharmacists is essential to ensure high-quality patient care. To assess which factors influence the performance and success of their collaboration, validated instruments should be used, such as the Australian "Attitudes Toward Collaboration Instrument (ATCI)" and the "Frequency of Interprofessional Collaboration Instrument (FICI)". Both instruments were already translated in a previous German study, but not pretested for comprehensibility or cultural appropriateness to ensure that the target group is able to adequately answer the translated items. To translate and particularly cross-culturally adapt two Australian instruments measuring physicians' and pharmacists' attitudes towards interprofessional collaboration and the frequency of their interactions for use in Germany. The ATCI and FICI were translated following internationally recognised guidelines. Two-step cognitive interviewing was performed with physicians and pharmacists working in ambulatory care in Germany. The "Standards for Reporting Qualitative Research" were used to report this study. Overall, 2 forward and 2 back translations, and 38 cognitive interviews, i.e. cognitive probing (N = 10) and behaviour observation (N = 28), with 18 physicians and 20 pharmacists were performed. Experts discussed all potential changes. The ATCI and FICI were translated introducing 15 minor (e.g. paraphrasing, item order) and 6 major (e.g. 2 more items in FICI, additional response options) adaptations. The ATCI-P/GP-German and FICI-P/GP-German were found to be easy to answer and clearly-phrased. This study shows the importance of using recognised methods to translate and adapt questionnaires, consisting of at least four steps: forward translation, back translation, cognitive interviewing and finalisation (each reviewed by an expert panel making their decisions by consensus). A profoundly pretested German-speaking instrument is now available to evaluate and describe interprofessional collaboration between physicians and pharmacists. However, collecting further sociodemographic and contextual information seems necessary for enhanced interpretation of future results.

As the twig is bent, so is the tree inclined: a survey of student attitudes toward interprofessional collaboration supported with the curricula analysis

ABSTRACTPharmaceutical care was legally introduced as an interprofessional service in Poland in 2009. However, a collaboration between physicians and pharmacists remains incidental. Proper education at the undergraduate level is necessary to shape the attitudes of students toward establishing interprofessional relations. The aim of the study was to assess the perception of physician-pharmacist collaboration among final-year medical and pharmacy students through questionnaires with both closed-ended and open-ended questions. The study also includes an analysis of medicine and pharmacy curricula in terms of promoting interprofessional collaboration between the two fields. The statistical analysis of data obtained from 502 respondents revealed significant differences between the perceived areas for such collaboration. Moreover, the division of roles and responsibilities during the pharmacotherapy process between both professions seems to be unclear. Importantly, only 10.14% of the respondents evaluated these professional relations as ‘good’ or ‘very good’. Also, 66.87% of the students emphasized the importance of educational interventions to improve interprofessional collaboration between pharmacists and physicians. Although 70% of medical and 87% of pharmacy students wish to establish such collaboration in the future, only 15% and 35%, respectively feel adequately prepared for the task. Understanding similarities and differences in this field appears to be the key to designing effective educational solutions for promoting interprofessional attitudes among healthcare undergraduates.

Evaluation of students' attitudes towards pharmacist-physician collaboration in Brazil.

Objective:To measure undergraduate pharmacy and medical students’ collaborative attitudes regarding Pharmacist–Physician collaboration.Methods:A cross-sectional descriptive study was conducted from September 2016 to February 2017 in Northeast Brazil. Pharmacy and medical students from the first and the last year of courses were invited to complete Portuguese version of Scale of Attitudes Toward Pharmacist-Physician Collaboration (SATP2C). Descriptive and comparative analyses were performed using IBM SPSS (22 version). Differences were considered significant when p<0.05.Results:Three hundred seventy students completed the SATP2C. Overall, the students had positive attitudes towards physician-pharmacist collaboration. There was no significant correlation between age and score (p=0.79). Women showed a more positive collaborative attitude than men (53.1, SD=6.8 vs. 55.1, SD=6.3). Pharmacy students had a higher score than medical students (57.5, SD=4.7, vs. 51.1, SD=6.4). The first-year medical students had a higher score than last-year medical students (52.3, SD=6.0 vs. 49.5, SD=6.6; p<0.007). There was no significant difference in the attitudes between the first and last year pharmacy students (p<0.007).Conclusions:Pharmacy and medical students showed positive attitudes towards physician-pharmacist collaboration. However, pharmacy students presented more collaborative attitudes than medical ones. Additionally, the first-year medical students had more collaborative attitudes than last-year medical students. Studies should be conducted to provide recommendations to improve interprofessional education efforts to further enhance the positive attitudes toward physician-pharmacist collaboration.

PND114 - IMPACT OF A PHARMACIST-LED COMMUNITY INTERVENTIONAL PROGRAM TO PREVENT COGNITIVE DETERIORATION IN COMMUNITY-DWELLING HONG KONG ELDERS WITH HIGH ANTICHOLINERGIC COGNITIVE BURDEN

With the emerging evidence of high anticholinergic exposure being associated with cognitive decline or dementia in older adults, this study evaluated whether a pharmacist-led interventional program could decrease the anticholinergic cognitive burden (ACB) in a group of community-dwelling elders in Hong Kong. This study also evaluated whether lifestyle habits could be improved after said intervention regarding cognitive-beneficial lifestyles. 4462 elders referred from the CU CHAMPION outreach network during 2016 and 2017 were screened for clinical characteristics, including the ACB score and cognitive function (as measured by the Memory Impairment Screen (MIS)). Those who had a clinically relevant ACB score of 3 or above, not diagnosed with dementia, and were communicable were recruited for intervention. In the intervention, pharmacists aimed to decrease the ACB score of the elders by suggesting changes to their drug regimens through writing letters to the respective physicians or through other methods deemed appropriate. Habits towards cognitive beneficial lifestyles and diets were also assessed through a “lifestyle questionnaire”, and an educational session was arranged afterwards. After an approximate two-month period, the ACB score and lifestyle habits of these elders were reassessed. Of the 45 elders who completed the study, chlorpheniramine and other cardiac medications were found to be major contributors to the anticholinergic burden. The ACB score did not decrease at a statistically significant level after intervention, however it was found that most interventions made targeted antihistamines - suggesting sub-optimal antihistamine use. The score achieved from the lifestyle questionnaire improved significantly (p < 0.05), suggesting improvement in cognitive-beneficial lifestyle knowledge and habits. The pharmacist-led intervention improved lifestyles and antihistamine-use in community-dwelling elders. Antihistamine-use might be a potential area of focus for future pharmacist-physician collaboration opportunities in the community. Future research should evaluate whether ACB score adjustment is clinically relevant in the target population.

The pharmacy clinical experience: A physician-pharmacist trainee collaboration

Abstract Adverse drug reactions are a common and preventable cause of hospitalizations in older adults. Therefore, educating physicians and trainees on appropriate medication management is a priority. The Liaison Committee on Medical Education requires graduating medical students to be adequately prepared to collaborate with health professionals from other disciplines. This study aimed to improve medical student confidence and ability to document a patient's complete medication list and improve students' attitudes towards collaboration with pharmacists and pharmacy trainees. Second-year medical students rotated through pharmacist run clinics, working with pharmacists, pharmacy residents, and visiting pharmacy students during their Clinical Skills 2 course. During the session, students practiced documenting the complete medication list for at least one patient. Before and after this pharmacy clinical experience (PCE), they completed a survey asking about their confidence in documenting a complete medication list, the usefulness of the PCE, and their agreement with statements from the Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education (SPICE) instrument regarding attitudes about physician-pharmacist collaboration. Participants also completed a 3-month follow-up survey. The PCE resulted in an increase in understanding of pharmacist and physician roles in an interdisciplinary care team and an increase in confidence in documenting a complete medication list. Students generally agreed that the PCE improved their skills related to the three medication management geriatrics competencies for graduating medical students. This curricular intervention is useful for incorporating interprofessional (IP) experience into the pre-clinical medical school curriculum, especially at institutions where other professional schools may not be represented. Additionally, this intervention addresses gaps in medical student education regarding medication management in order to prepare them for post-graduate training. Surveys and handouts used in the study can be found at the end of this report.

Exploring pharmacy service users' support for and willingness to use community pharmacist prescribing services.

In 2012, community pharmacists in Ontario, Canada gained regulatory authority to independently prescribe, including renew and adapt prescriptions. Studies have explored views of pharmacists, physicians and policymakers about pharmacist prescribing but less is known about the views of community pharmacy services users. To describe Ontario community pharmacy service users' support for and stated willingness to use pharmacist prescribing services. A qualitative descriptive study was conducted with 19 adults who had filled or refilled prescription(s) at a community pharmacy within the past three months. Participants were recruited through purposive and snowball sampling. Data were collected through one-on-one, semi-structured interviews between May and September 2016. Interview transcripts were coded and thematic analysis conducted. The first two transcripts were independently coded and analyzed by 2 researchers and after consensus was achieved, the lead researcher coded and analyzed the remainder of the data. Most community pharmacy service users lacked experience with pharmacist prescribing services but perceived some potential benefits, including personal convenience. The majority of participants supported pharmacist prescribing. Support for and stated willingness to use pharmacist prescribing services varied by the type of service and was contingent upon the clinical purpose of the prescription, pharmacists' access to patient clinical information (e.g. health records), and the extent of pharmacist-physician collaboration during the prescribing process. Community pharmacy service users in Ontario expressed varying support for and stated willingness to use pharmacist prescribing services. This seemed to be due to their perceptions of the pharmacists' role (compared to physicians) and concerns about risks. Understanding these contributing factors will help implement strategies that address concerns and facilitate use of community pharmacists' prescribing services.

More Than Information Access: A Cognitive Work Analysis On Physician-Pharmacist Collaboration Through Electronic Medical Records

More Than Information Access: A Cognitive Work Analysis On Physician-Pharmacist Collaboration Through Electronic Medical Records

Validation of pharmacist-physician collaboration in psychiatry: 'the Eichberger-model'.

Background Collaboration between physicians and pharmacists can increase medication safety. In the "Eichberger model" a clinical pharmacist is employed and working full time in a psychiatric hospital. Objective The aim of this study was to determine the expected type of expertise from a clinical pharmacist in psychiatry and the acceptance of the pharmacist's recommendations. Method All email requests to the clinical pharmacist from January 1st to April 30th 2015 were screened retrospectively and type of requester and content of request were extracted. Maintenance rate of drug therapy was analyzed by reviewing patient charts2weeks after medication prescription. Results A total of 147 requests were included. 85 (57.8%) requests were from attending physicians and 62 (42.2%) from residents. 82.1% of all physicians were contacting the clinical pharmacist during the study period. Most common reasons for requests were: appropriate drug selection (31.3%), drug interactions (25.2%), possible adverse drug events (17%) and switching drugs (12.2%). The acceptance rate by the physicians was 100%, with an implementation and maintenance rate of both 98.6%. Conclusion We found a high acceptance level of the pharmacist's recommendations. The pharmacist's skills were requested by the majority of physicians and included a in a large variety of specific questions. A pharmacist can play an important role to optimize patient care in collaboration with the physician in psychiatry.

Impact of Pharmacist-Physician Collaboration on Osteoporosis Treatment Rates.

The vast majority of women at high risk for osteoporotic fractures are not treated, despite known significant clinical and economic consequences of this prevalent condition. To date, this is the first study of this size and duration to examine the role of pharmacists in management of osteoporosis in a family medicine clinic. To compare the initiation or continuation of prescription antifracture therapy in high-risk patients with collaborative pharmacist-physician to physician-only management; secondarily, to evaluate recommendation rates for antifracture therapy and calcium and vitamin D. This retrospective cohort analysis included women older than 65 years with a dual-energy X-ray absorptiometry (DXA) scan ordered by a family medicine physician. High risk was defined as T-scores ≤-2.5 at the lumbar spine, femoral neck, or 33% radius, or a FRAX 10-year fracture risk score ≥20% for major osteoporosis-related or ≥3% for hip fractures. There were 466 (311 high-risk) pharmacist-physician and 549 (237 high-risk) physician-managed DXAs included. For high-risk DXAs, collaborative management resulted in increased rates of receiving antifracture therapy prescriptions over physician-only management (66% vs 34%, P < 0.001), advisement for antifracture therapy (87% vs 32%, P < 0.001), and calcium and vitamin D (97% vs 45%, P < 0.001). Collaborative management also improved calcium and vitamin D advisement among all DXAs (96% vs 46%, P < 0.01). There was no difference in adverse events documented in the pharmacist-physician compared with physician-only management (7.2% vs 3.7%, P = 0.32). Conclusion and Relevance: Pharmacist-physician collaboration is associated with higher treatment rates of osteoporosis. This study supports the pharmacist-physician partnership as one method of improving osteoporosis management.

Physicians’ perspectives of pharmacist-physician collaboration in the United Arab Emirates: Findings from an exploratory study

ABSTRACTInterprofessional collaborative care has been shown to improve patient outcomes. Physicians’ views on collaboration with pharmacists give an insight into what contributes to a well-functioning team. Little is known about these views from low and ​middle-income countries and nothing from the United Arab Emirates (UAE). The purpose of this study is to investigate physicians’ opinions on collaborative relationships with community pharmacists in the UAE. Semi-structured individual interviews and group discussions are conducted with a purposive sample of physicians. Thematic analysis based on the framework approach is used to generate themes. A total of 53 physicians participated. Three themes about collaboration emerged: perceived benefits of collaboration, facilitators of collaboration and perceived barriers to collaboration. Perceived benefits include reducing the burden on physicians, having the pharmacist as an extra safety check within the system, having the pharmacist assist patients to manage their medications: coping with side effects, reducing drug waste and costs, and attaining professional and health-system gains. Perceived facilitators included awareness and trust building, professional role definition, pharmacists’ access to patient records and effective communication. Perceived barriers included patient and physician acceptance, logistic and financial issues and perceived pharmacist competence. This study has, for the first time, provided useful information to inform the future development of pharmacist-physician collaboration in the UAE and other countries with similar healthcare systems.