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.