Physician Pharmacist Research Articles

Collaboration creates an IMPACT

The pharmacist–physician relationship is a hot topic in the health care world these days. As concepts like provider status and collaborative practice agreements gain momentum and acceptance, pharmacists have a golden opportunity to prove their worth in patient care. Zufall Health Center in Dover, NJ, and Fink's Pharmacy in Essex, MD, are using Project IMPACT: Diabetes to do just that.

Psychometrics of the scale of attitudes toward physician–pharmacist collaboration: A study with medical students

Background: Despite the emphasis placed on interdisciplinary education and interprofessional collaboration between physicians and pharmacologists, no psychometrically sound instrument is available to measure attitudes toward collaborative relationships.Aim: This study was designed to examine psychometrics of an instrument for measuring attitudes toward physician–pharmacist collaborative relationships for administration to students in medical and pharmacy schools and to physicians and pharmacists.Methods: The Scale of Attitudes Toward Physician-Pharmacist Collaboration was completed by 210 students at Jefferson Medical College. Factor analysis and correlational methods were used to examine psychometrics of the instrument.Results: Consistent with the conceptual framework of interprofessional collaboration, three underlying constructs, namely “responsibility and accountability;” “shared authority;” and “interdisciplinary education” emerged from the factor analysis of the instrument providing support for its construct validity. The reliability coefficient alpha for the instrument was 0.90. The instrument's criterion-related validity coefficient with scores of a validated instrument (Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration) was 0.70.Conclusions: Findings provide support for the validity and reliability of the instrument for medical students. The instrument has the potential to be used for the evaluation of interdisciplinary education in medical and pharmacy schools, and for the evaluation of patient outcomes resulting from collaborative physician-pharmacist relationships.

Implementing a clinical pharmacy survey of adverse drug events in a French emergency department

The prevalence of adverse drug events (ADEs) occurring in the ambulatory setting is high, requiring the development of a coherent and comprehensive patient-safety policy framework. Former experiences demonstrated that emergency department (ED) surveillance can help characterise the burden of outpatient ADEs. We developed a clinical pharmacy programme called the clinical pharmacy survey of adverse drug events (CPSA) to support interventions and research projects in the area of ADE prevention and management. To design a survey to identify and describe ADEs in patients visiting the medical ED of our tertiary care hospital. We report the results of the first 2 years of CPSA implementation and an assessment of its performance. The medical ED of a French 3,000-bed tertiary care hospital. Between January 2008 and December 2009, adult patients visiting our medical ED were included during randomised time slots. Data were collected by pharmacy students. ADEs were documented by a trained physician pharmacist team using the chart review method. The primary outcome was the number of patients visiting our ED with an ADE. The CPSA attributes were assessed on the basis of the Centers for Disease Control and Prevention's 2001 updated guidelines for evaluating public health surveillance systems. Of the 1,035 included patients, 201 experienced an ADE at the ED visit (19.4 %; 95 % confidence interval 15.8-23.0 %). Forty-seven ADEs (23.4 %) were unrelated to the patient's chief complaint. An ADE was the leading cause of 154 in the 1,035 admissions (14.9 %). The assessment of our method on the basis of the Centers for Disease Control and Prevention guidelines showed good performances in terms of data quality, stability, flexibility, timeliness, and acceptability, but not in terms of simplicity and representativeness. The profile of patients with an ADE at admission and detected ADEs did not significantly differ between years 2008 and 2009. Our experience demonstrates that clinical pharmacists can successfully implement a survey process of ADEs in an ED over time. Our method seems basic enough to suit most health care facilities with pharmacy students.

The impact of computerised physician order entry with integrated clinical decision support on pharmacist–physician communication in the hospital setting: a systematic review of the literature

ObjectiveTo document the issues and impact that computerised physician order entry (CPOE) with clinical decision support (CDS) can have on pharmacist–physician communication in the hospital setting.HypothesisNovel processes introduced by CPOE...

Clinical decision support for personalized medicine: an opportunity for pharmacist-physician collaboration.

Pharmacogenomics has significant potential to improve the efficacy and safety of medication therapy, but it requires new expertise and adds a new layer of complexity for all healthcare professionals. Pharmacists and pharmacy management systems can play a leading role in providing clinical decision support for the use and interpretation of pharmacogenomic tests. To serve this role effectively, pharmacists will need to expand their expertise in the emerging field of clinical pharmacogenomics. Pharmacy-based clinical programs can expedite the use of pharmacogenomic testing, help physicians interpret the test results and identify future medication risks associated with the patient's phenotype. Over time, some of these functions can be embedded in clinical decision support systems as part of the broader automation of the healthcare system.

Development and validation of the GP frequency of interprofessional collaboration instrument (FICI-GP) in primary care

Existing validated measures of pharmacist–physician collaboration focus on measuring attitudes toward collaboration and do not measure frequency of interactions that comprise actual collaborative behavior. Therefore, the aim of this study was to develop and validate an instrument to measure the frequency of collaboration between general practitioners (GPs) and pharmacists from the GP's perspective. An 11-item Frequency of Interprofessional Collaboration Instrument for GPs (FICI-GP) was developed and administered to 1118 GPs in eight divisions of general practice in New South Wales, Australia. Two hundred and fifty-eight (23%) GP surveys were completed and returned. Principal component analysis suggested removal of one item for a final one-factor solution. The refined 10-item FICI-GP had a Cronbach's alpha of 0.87. After collapsing the original five-point response scale to a three-point response scale, the refined FICI-GP demonstrated fit to the Rasch model. Criterion validity of the FICI-GP was supported by the correlation of FICI-GP scores with scores on a previously validated physician–pharmacist collaboration instrument as well as by predicted differences in FICI-GP scores between subgroups of respondents stratified on age, co-location with pharmacists and interactions during residency. The refined 10-item FICI-GP was shown to have good internal consistency, criterion validity and fit to the Rasch model.

Structured Inspection of Medications Carried and Stored by Emergency Medical Services Agencies Identifies Practices That May Lead to Medication Errors

Background. Medications are essential to emergency medical services (EMS) agencies when providing lifesaving care, but the EMS environment has challenges related to safe medication storage when compared with a hospital setting. We developed a structured process, based on common pharmacy practices, to review medications carried by EMS agencies to identify situations that may lead to medication error and to determine some best practices that may reduce potential errors and the risk of patient harm. Objective. To provide a descriptive account of EMS practices related to carrying and storing medications that have the potential for causing a medication administration error or patient harm. Methods. Using a structured process for inspection, an emergency medicine pharmacist and emergency physician(s) reviewed the medication carrying and storage practices of all nine advanced life support ambulance agencies within a five-county EMS region. Each medication carried and stored by the EMS agency was inspected for predetermined and spontaneously observed issues that could lead to medication error. These issues were documented and photographed. Two EMS medical directors reviewed each potential error for the risk of producing patient harm and assigned each to a category of high, moderate, or low risk. Because issues of temperature on EMS medications have been addressed elsewhere, this study concentrated on potential for EMS medication administration errors exclusive of storage temperatures. Results. When reviewing medications carried by the nine EMS agencies, 38 medication safety issues were identified (range 1 to 8 per EMS agency). Of these, 16 were considered to be high risk, 14 moderate risk, and eight low risk for patient harm. Examples of potential issues included carrying expired medications, container-labeling issues, different medications stored in look-alike vials or prefilled syringes in the same compartment, and carrying crystalloid solutions next to solutions premixed with a medication. When reviewing medications stored at the EMS agency stations, eight safety issues were identified (range from 0 to 4 per station), including five moderate-risk and three low-risk issues. No agency had any high-risk medication issues related to storage of medication stock in the station. Conclusion. We observed potential medication safety issues related to how medications are carried and stored at all nine EMS agencies in a five-county region. Understanding these issues may assist EMS agencies in reducing the potential for a medication error and risk of patient harm. More research is needed to determine whether following these suggested best practices for carrying medications on EMS vehicles actually reduces errors in medication administration by EMS providers or decreases patient harm.

Clopidogrel dose responsiveness, poststroke survival and SSRI treatment, and discontinuation of physician–pharmacist intervention

especially if the patient has a history of depression or was taking an SSRI before the stroke. The association of depres- sion diagnosis and pre- and/or poststroke selective serotonin reuptake inhibitor (SSRI) treatment with survival (days) was examined. Depression treatment and diagnosis data for 6 months before and 1 year after the stroke index date were abstracted for a retrospective cohort (n = 790). Of veterans, 12% died 1 year or less after the stroke and an additional 26% died within 7 years. Veterans treat- ed with an SSRI only before their stroke were three times more likely to die (haz- ard ratio 3.12 (95% CI 1.60-6.09)). SSRI treatment before and after the stroke was protective compared with no SSRI for 1 year after the stroke (0.31 (0.11-0.86)). However, SSRI treatment before and af- ter stroke conferred greater risk by the end of 7 years (1.36 (1.00-1.87)). Implications. Poststroke SSRI treat- ment was associated with longer survival. Possible reasons include undiagnosed or continuing depression with no opportu- nity to benefit if untreated. These findings provide additional evidence for a random- ized trial of poststroke treatment prophy- laxis.

Collaborative practice comes to New York, expands in Indiana

The governors of New York and Indiana in May signed legislation allowing pharmacists in certain health care settings to collaborate with physicians in managing patients’ drug therapies. In the Empire State, where legislation on pharmacist–physician collaborative practice in some form dates back

Exploring stages of pharmacist–physician collaboration using the model of collaborative working relationship

ObjectiveTo compare factors affecting pharmacist–physician collaboration across three groups of study participants with increasing collaboration using the model of collaborative working relationship (CWR). MethodsA random sample of 750 Iowa pharmacists were surveyed. The measures for CWR constructs used 5- and 7-point scales. Descriptive statistics of exchange characteristics such as relationship initiation, trustworthiness, and role specification were calculated for each tertile group. A one-way analysis of variance (ANOVA) and post hoc ANOVAs were used to compare exchange characteristics across groups. In addition, for each tertile group, a linear regression was conducted in which collaborative care was regressed over relationship initiation, trustworthiness, role specification, professional interaction, practice setting, and physician specialty. ResultsThe usable survey response rate was 33% (n = 239). Exchange characteristics increased from the first tertile group to the third tertile group. The regression model of CWR explained variation in collaborative care for each tertile group (range 23–76%). Trustworthiness and role specification were key factors affecting collaborative care. Role specification had a strong effect on collaborative care for the first tertile group. Internal medicine as a physician specialty was a significant predictor for collaborative care for the third tertile group. ConclusionThe impact of predictors on collaborative care differed across three groups according to the tertiles of collaborative care. These findings support a multistage model of CWR. In addition, future studies of CWR can add other predictors for collaborative care.

Pharmacist–physician hypertension comanagement reduced 24-hour ambulatory blood pressure

Source Citation Weber CA, Ernst ME, Sezate GS, Zheng S, Carter BL. Pharmacist-physician comanagement of hypertension and reduction in 24-hour ambulatory blood pressures. Arch Intern Med. 2010;170:1...

Physician–Pharmacist Cooperation Program for Blood Pressure Control in Patients With Hypertension: A Randomized-Controlled Trial

The aim of the trial was to evaluate the effectiveness of a program of cooperation between physician and pharmacist to reduce cardiovascular risk factors in patients with mild to moderate hypertension by promoting better blood pressure (BP) control, appropriate changes in antihypertensive medications, and beneficial changes in lifestyle. The 132 subjects in this randomized, controlled trial were in the age range of 40-79 years. The inclusion criteria were: systolic BP (SBP) ranging from 140-179 mm Hg and/or diastolic BP (DBP) ranging from 90-99 mm Hg and treatment-naive (untreated for hypertension); or on a regimen of medication for hypertension. Of these 132 subjects, 124 (94%) were already receiving treatment with antihypertensive medications. Equal numbers of subjects were randomly assigned to one of two groups: a physician-pharmacist intervention group (n = 66) and a control group (n = 66). The 6-month follow-up rate was 97% in both groups. At 6 months, the mean decrease in SBP/DBP, as measured at home in the morning, was 2.9/3.3 mm Hg in the intervention group relative to baseline (P = 0.02 and P < 0.0001 for SBP and DBP, respectively). The mean decrease in home morning SBP in the intervention group was not significantly greater than in the control group. However, the DBP decline was significantly greater in the intervention than control groups, which showed a mean decrease of 2.8 mm Hg (confidence interval: -5.5 to -0.1; P = 0.04). The percentage of patients in whom control of home morning BP was achieved was 53% in the intervention group and 47% in the control group (P = 0.40). A higher percentage of patients in the intervention group, relative to the control group, were able to reduce the use of antihypertensive medications (31 vs. 8%, P < 0.0001), and fewer patients in this group required additional medications or increases in dosage relative to the controls (11 vs. 28%, P = 0.03). Patients of the intervention group were more likely to show reduction in body mass index and sodium intake and to stop smoking, as compared with the control group. A program of cooperation between physician and pharmacist was successful in reducing cardiovascular risk factors in patients with mild to moderate hypertension by promoting better blood pressure (BP) control, appropriate changes in antihypertensive medications, and beneficial changes in lifestyle.

Improving Heart Failure Outcomes with Pharmacist–Physician Collaboration: How Close are we?

Improved management of chronic disease can improve health outcomes and has the potential to reduce health service costs. Heart failure is one of the chronic diseases in which improved management involving multidisciplinary care leads to improved health outcomes. Numerous studies have shown that multidisciplinary teams involving a doctor, pharmacist, nurse, health educator and/or a social worker can improve health outcomes for heart failure patients. Fewer studies have examined the effect of collaborative interventions that specifically involve pharmacists and physicians. This review focuses on the efficacy of pharmacist-physician collaborative medicines reviews in improving health outcomes for heart failure patients. The translation of results from randomized controlled trials to the practice setting is discussed, and barriers to the implementation of collaborative medicines reviews in practice are described.

Physician—pharmacist collaboration, reduced drug use and hospitalization rates, and gentamicin dosing

Physician–pharmacist collaboration Carter et al.1 reported that “a physician and pharmacist collaboration intervention achieved significantly better mean BP and overall BP control rates compared with a control group.” Six clinics were randomized to a control (n = 3; 210 patients) or intervention (n = 3; 192 patients) group. Educational lectures, published national guidelines, and clinical trial evidence were provided to physicians at all six clinics before the study. Pharmacists made clinical recommendations to physicians consistent with the guidelines. Research nurses collected blood pressure (BP) values using standardized guidelines. Clinical pharmacists at control sites did not provide direct care to patients but continued to answer physicians’ general treatment questions. During 6 months’ follow-up, mean adherence levels rose by 8.1% in the control group versus 55.4% in the intervention group, and BP was controlled in 29% of the control group and nearly 64% of patients in the intervention group. Implications. A model that is gaining favor in primary care delivery is the “medical home” model. The cornerstone of this model is demonstrable enhancement of the collaboration among health providers in an individual patient’s care. An important discussion point in the health care debate focuses on demonstrations of the added value of a pharmacist in patients’ medical home. This study provides credible and scientifically rigorous evidence. This article should be in the repertoire of supporters of pharmacy–physician collaboration and those advocating collaborative care agreements.

Fostering the pharmacist–physician relationship

In 1999, the Institute of Medicine (IOM) issued a report calling for increased coordination of care to improve the quality of health care in the United States.[1][1] The IOM report led to a change in the culture of our health care system and to the advancement of multidisciplinary teams known today

Physician–pharmacist collaborative care in cardiovascular disease prevention: A cluster randomized controlled trial in primary care

Background:Dyslipidemia treatment is suboptimal in primary care. The TEAM study evaluated the effectiveness of pharmacist-physician collaborative care of dyslipidemia patients. The physician is responsible for the diagnosis and prescription of pharmacotherapy, while the pharmacist initiates treatment, requests appropriate laboratory tests, monitors effectiveness, safety and adherence to treatment and adjusts medication dosage accordingly.Methods:At the end of the TEAM study, focus groups with patients (2 groups, 12 patients) and pharmacists (2 groups, 12 pharmacists) and individual interviews with physicians (7) were conducted. Qualitative analysis was performed using a phenomenological approach.Results:All participants reported that collaborative care was more structured and systematic. Patients felt they received better follow-up and admitted being reassured and well informed about their condition and the need for treatment, which leads them to taking better care of themselves. These positive impacts we...

Pharmacist and family physician collaboration to optimize community-based drug therapy: Results of a 15-year research program

Project Objective:This research program was initiated in 1992 in Ontario to improve drug therapy in the community by providing access to independent information about drugs to both primary care providers and patients. The first major initiative was the development and distribution of the Anti-infective Guidelines for Community-acquired Infections. The program has evolved and expanded nationally to provide evidence-based prescribing materials and interdisciplinary continuing professional development (CPD) on a number of common topics.Target Groups:All community-based primary health care professionals, including pharmacists, physicians, and nurse practitioners.Activities:A number of activities were undertaken and evaluated over the last 15 years, including academic detailing (5 studies), drug regimen review, clinical practice guideline (CPG) development and distribution and MAINPRO-C accredited CPD featuring a small group, case-based learning model with pharmacist-physician facilitator team delivery. The ou...

How to help patients manage their dyslipidemia: A primary care physician–pharmacist team intervention

Dyslipidemia treatment in primary care is far from optimal — adherence and persistence to pharmacotherapy are low, and physicians tend not to titrate statin dosages. Consequently, a large proportion of patients do not attain their recommended lipid targets. This has serious clinical and economic consequences. Several studies have shown that community-pharmacist interventions and collaborative management of pharmacotherapy by physicians and pharmacists improve dyslipidemia treatment. In Quebec, as a result of legislative changes (Bill 90) made in 2002, community pharmacists may initiate and adjust drug therapy in accordance with a physician’s prescription and request laboratory analyses when needed. This new legislation increases the potential for a physician-pharmacist team approach to the management of dyslipidemic patients. In Quebec, in order to implement these collaborative practices, a treatment protocol has to be approved by members of a hospital’s Conseil des Medecins, Dentistes et Pharmaciens (Council of Doctors, Dentists, and Pharmacists). In this article, we present a treatment protocol for the management of statin therapy that was developed by pharmacists (LL, JV, DL, MCV, SP), family physicians (MTL, EH), and a cardiologist (JG) as part of a randomized controlled trial. The treatment protocol describes a physician-pharmacist team intervention for the management of patients with dyslipidemia in a primary care setting.

Description of pharmacist interventions during physician–pharmacist co-management of hypertension

The aim of this study is to describe recommendations made by clinical pharmacists when co-managing hypertension with physicians. Two family medicine clinics at a major teaching hospital in the mid-western United States. This report details the specific recommendations made by pharmacists during a prospective randomized controlled clinical trial. Patients with uncontrolled hypertension were enrolled in a 9-month intensive pharmacist-physician co-management study. Clinical pharmacists saw patients at baseline, 2, 4, 6, and 8 month visits. Optional visits were allowed between required visits. For this analysis, pharmacist recommendations were grouped. Physician acceptance of the pharmacists' recommendations was also evaluated. Data from 101 patients were included and analyzed in this study. Changes in drug therapy were recommended 267 times for these 101 patients. Most recommendations for a change in treatment involved adding a new antihypertensive medication (46.4%) or increasing a dose (33.3%). The majority of pharmacist recommendations to modify drug therapy were made at the baseline visit (41.6%), with 76.8% of recommendations made by the 2 month visit. Physicians accepted and implemented 95.9% of the 267 pharmacist recommendations to modify drug therapy. Pharmacists recommended no change in the treatment plan 361 times, most often because the patient's blood pressure (BP) had achieved the goal. Average BP decreased from 153.1+/-10.0/84.9+/-12.0 mmHg (average+/-SD) at baseline to 124.2+/-9.7/74.7+/-9.6 mmHg (P<0.001) at the end of 9 months, with 89.1% (P<0.001) of patients reaching their BP goal. Pharmacist recommendations for alterations in drug therapy generally occurred early in the course of the study and were largely to intensify therapy through higher dosages or additional medications. Pharmacist-physician co-management of BP is effective at reducing BP and improving BP control rates.

Chronic obstructive pulmonary disease

Title: The Australian and New Zealand Guidelines for the Management of Chronic Obstructive Pulmonary Disease. Date of latest update: April, 2006. Date of next update: Not mentioned. Patient group: Adults with Chronic Obstructive Pulmonary Disease (COPD). Intended audience: Practitioners working with people with COPD. Additional versions: Original guidelines published as a supplement to the Medical Journal of Australia in March 2003. Expert working group: Twenty-three people from Australia and New Zealand comprised the writing and steering committees. This included respiratory physicians, respiratory medical scientists, thoracic physicians, a pharmacist, physiotherapist, consumer representative, general practitioner, epidemiologist, cardiothoracic surgeon, respiratory and lung transplant physician, and a respiratory educator. Twenty-three other experts encompassing the above areas of expertise plus respiratory nurses and psychologists also contributed. Funded by: The Australian Lung Foundation. Consultation with: A draft of the original guideline was circulated to key stakeholder groups and professional organisations, and published on the Australian Lung Foundation website for feedback. Approved by: The Thoracic Society of Australia and New Zealand, The Australian Lung Foundation. Location: http://www.copdx.org.au. Chronic obstructive pulmonary disease