Collaborative working relationships between pharmacists and physicians: an exploratory study.

OBJECTIVES: To determine the degree of collaboration in a limited number of pharmacist-physician professional relationships and identify variables important in establishing collaboration between pharmacists and physicians. DESIGN: A multicase design, using a personal interview and a mailed survey. SETTING: Iowa. PARTICIPANTS: Pharmacists in 10 community pharmacies and physicians with whom they collaborated. INTERVENTION: Two researchers independently judged the stage of collaboration for each case and the level of effect each influence variable had on the development of pharmacist-physician collaboration. MAIN OUTCOME MEASURES: Using the Collaborative Working Relationship Model, nine indicators of collaboration were assessed. In addition, influence variables were studied, which included individual, context, and exchange characteristics believed to affect the development of collaborative working relationships between pharmacists and physicians. RESULTS: A Perrealt-Leigh reliability index of 0.89 was calculated as an estimate of interrater reliability of the judgments of nine indicators of collaboration. Four pharmacies were rated as having achieved early-stage collaboration, while six pharmacies were at late-stage collaboration. A high level of joint care activities, care communication, and increased accessibility to the physician and to patient information characterized late-stage collaboration. Six variables, labeled as discriminating, helped distinguish between early-stage collaboration and late-stage collaboration: the development of bidirectional communication, caring for mutual patients, the ability to identify a win-win opportunity, adding value to the medical practice, physician convenience, and movement toward balanced dependence between the pharmacist and physician. CONCLUSION: The development of collaboration between pharmacists and physicians is influenced by characteristics of exchanges occurring between them. Continued study of collaborative working relationships between physicians and pharmacists can assist health care practitioners in developing a team-based approach to patient care, improving the ability of pharmacists and physicians to work together to coordinate patient care.     

The adverse drug reaction: a clinical opportunity for pharmacists

A program is presented that gives the pharmacist the clinical opportunity to assess and evaluate adverse drug reactions in the hospital setting. An adverse drug reaction protocol is discussed that addresses reporting and patient care issues. The pharmacist performs adverse drug reaction assessment at the patient bedside as part of a multidisciplinary team consisting of the pharmacist, nurse, and physician. The protocol provides a method of concurrent adverse drug reaction monitoring and involves the patient in the reporting process.     

Community pharmacy-based point-of-care testing: A case study of pharmacist-physician collaborative working relationships

Building collaborative working relationships (CWRs) with physicians or other prescribers is an important step for community pharmacists in establishing a collaborative practice agreement (CPA). This case study describes the individual, context, and exchange factors that drive pharmacist-physician CWR development for community pharmacy-based point-of-care (POC) testing. Two physicians who had entered in a CPA with community pharmacists to provide POC testing were surveyed and interviewed. High scores on the pharmacist-physician collaborative index indicated a high level of collaboration between the physicians and the pharmacist who initiated the relationship. Trust was established through the physicians' personal relationships with the pharmacist or due to the community pharmacy organization's strong reputation. The physicians' individual perceptions of community pharmacy-based POC testing affected their CWRs and willingness to establish a CPA. These findings suggest that exchange characteristics remain significant factors in CWR development. Individual factors may also contribute to physicians' willingness to advance their CWR to include a CPA for POC testing.     

Pharmacist competencies for over-the-counter hearing aids: A Delphi study

BackgroundThe 2017 Food and Drug Administration Reauthorization Act established a new category of hearing aids to be available over the counter to increase accessibility and affordability of hearing aid devices. To prepare for increased consumer demand, pharmacists must be ready to meet the needs of the millions of adults eligible to seek over-the-counter hearing aids at the community pharmacy. To date, no organization has proposed competency statements to describe a pharmacist with the knowledge, skills, and abilities aligning with safe and effective use of over-the-counter hearing aids to be sold at community pharmacies.ObjectivesThe objective of this study was to establish competencies needed for pharmacists to safely and effectively assist patients seeking over-the-counter hearing aids at the community pharmacy.MethodsThe Delphi technique was selected to achieve group consensus for competency statements. The project began with a kickoff meeting in July 2019 and continued with a brainstorming round followed by 3 rounds of surveys ending in March 2020. Each survey presented competency statements for panelists to review, rate their agreement, and offer revisions. Statements that reached consensus to accept (≥80% agreement) were advanced to the final list. Statements that did not reach consensus were advanced to subsequent survey rounds.ResultsA total of 14 individuals representing pharmacy, audiology, hearing aid manufacturers, and persons with hearing loss participated. In total, 26 competency statements were accepted by consensus, 2 statements were rejected by consensus, and 11 statements did not reach consensus. All 26 accepted statements were mapped to the Pharmacists’ Patient Care Process before final approval by the stakeholder panel.ConclusionPharmacists will likely play new interprofessional roles in the delivery of hearing health care as over-the-counter hearing aids come to market. With professional competency statements, pharmacists will have a framework for the knowledge, skills, and abilities needed to safely assist patients seeking over-the-counter hearing aids at the community pharmacy.     

Advanced-practice pharmacists: practice characteristics and reimbursement of pharmacists certified for collaborative clinical practice in New Mexico and North Carolina

PURPOSE The results of a survey assessing the practice settings, clinical activities, and reimbursement experiences of pharmacists with advanced-practice designations are reported. METHODS A questionnaire was sent to all certified Pharmacist Clinicians in New Mexico and all Clinical Pharmacist Practitioners in North Carolina (a total of 189 pharmacists at the time of the survey in late 2008) to elicit information on practice settings, billing and reimbursement methods, collaborative drug therapy management (CDTM) protocols, and other issues. RESULTS Of the 189 targeted pharmacists, 64 (34%) responded to the survey. On average, the reported interval from pharmacist licensure to certification as an advanced practitioner was 11 years. The majority of survey participants were practicing in community or institutional settings, most often hospital clinics or physician offices. About two thirds of the respondents indicated that their employer handled the billing of their services using standard evaluation and management codes, with estimated total monthly billings averaging $6500. At the time of the survey, about 80% of the respondents were engaged in a CDTM protocol. The survey results suggest that pharmacists with advanced-practice designations are perceived favorably by patients and physicians and their services are in high demand, but more than one third of respondents indicated a need to justify their advanced-practice positions to administrators. CONCLUSION Pharmacists with advanced-practice designations are providing clinical services in various settings under collaborative practice arrangements that include prescribing privileges. Despite growing patient and physician acceptance, reimbursement challenges continue to be a barrier to wider use of CDTM programs.     

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

International Journal of Clinical Pharmacy - Background In Sweden there has been limited work investigating the integration and nature of collaborative relationships between pharmacists and other...     

Immunizations and pregnancy: An update for pharmacists

ObjectiveTo review the safety of immunizations in pregnancy.Data sourcesPubMed search using the termsvaccine, immunizations, andpregnancy, as well as current national guidelines.Data synthesisImmunizations for women of childbearing age are an integral component of pregnancy planning. Some vaccines are compatible with pregnancy, whereas others, in particular live-attenuated vaccines, are contraindicated because of the theoretical risk to the fetus. The immunizing pharmacist must be aware of updated guidelines regarding the safe and appropriate use of vaccines during pregnancy. Certain routine adult vaccines are contraindicated during pregnancy, including the live-attenuated intranasal influenza, measles–mumps–rubella, varicella, zoster, and human papillomavirus vaccines. The trivalent inactivated influenza vaccine is specifically recommended for all women who are pregnant during influenza season. The hepatitis B, tetanus–diphtheria–acellular pertussis, and several other routine adult and travel vaccines may be administered safely in pregnancy if the patient meets certain risk criteria. Breast-feeding is compatible with all routine adult vaccines. Vaccinia (smallpox) and yellow fever vaccines are cautioned against use except in certain circumstances.ConclusionPharmacists can play an important role in recommending safe and appropriate vaccines before and during pregnancy.