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Integrating pharmacists into family practice teams

Physicians’ perspectives on collaborative care

Barbara Farrell, PharmD FCSHP
Clinical and Research Coordinator of the Pharmacy Department and a pharmacist at the Geriatric Day Hospital at the SCO Health Service, a Scientist at the Élisabeth Bruyère Research Institute, and an Assistant Professor in the Department of Family Medicine at the University of Ottawa

Susan Haydt, MA
Research Associate at the Élisabeth Bruyère Research Institute

Lisa Dolovich, PharmD MSc
Scientist at the Centre for Evaluation of Medicines and an Associate Professor at McMaster University in Hamilton, Ont, and the University of Toronto in Ontario

Connie Sellors
Part-time faculty member and consultant in the Department of Family Medicine at McMaster University

Natalie Kennie, PharmD
Primary Care Pharmacist in the Department of Family and Community Medicine at St Michael’s Hospital and an Assistant Professor in the Leslie Dan Faculty of Pharmacy and Department of Family and Community Medicine at the University of Toronto

William Hogg, MD MSc MClSc FCFP
Director of the C.T. Lamont Primary Health Care Research Centre and a Professor in the Department of Family Medicine at the University of Ottawa

Carmel M. Martin, MBBS MSc PhD MRCGP
Associate Professor of Family Medicine for the Northern Ontario School of Medicine in Ottawa

CorrespondenceDr Kevin Pottie, University of Ottawa, 75 Bruyère St, Ottawa, ON K1N 5C8; e-mailkpottie{at}uottawa.ca

OBJECTIVE To explore family physicians’ perspectives on collaborative practice 12 months after pharmacists were integrated into their family practices.

DESIGN Qualitative design using focus groups followed by semistructured interviews.

SETTING Seven physician-led group family practices in urban, suburban, and semirural Ontario communities.

PARTICIPANTS Twelve purposively selected family physicians participating in the IMPACT (Integrating family Medicine and Pharmacy to Advance primary Care Therapeutics) project.

METHODS We conducted 4 exploratory focus groups to gather information on collaborative practice issues in order to construct our interview guide. We later interviewed 12 physicians 1 year into the integration process. Focus groups and interviews were audiotaped and transcribed verbatim. Four researchers used immersion and crystallization techniques to identify codes for the data and thematic editing to distil participants’ perspectives on physician-pharmacist collaborative practice.

FINDINGS The focus groups revealed concerns relating to operational efficiencies, medicolegal implications, effects on patient-physician relationships, and work satisfaction. The follow-up semistructured interviews revealed ongoing operational challenges, but several issues had resolved and clinical and practice-level benefits surfaced. Clinical benefits included having colleagues to provide reliable drug information, gaining fresh perspectives, and having increased security in prescribing. Practice-level benefits included group education, liaison with community pharmacies, and an enhanced sense of team. Persistent operational challenges included finding time to learn about pharmacists’ role and skills and insufficient space in practices to accommodate both professionals.

CONCLUSION Physicians’ perspectives on collaborative practice 12 months after pharmacists were integrated into their family practices were positive overall. Some ongoing operational challenges remained. Several of the early concerns about collaborative practice had been resolved as physicians discovered the benefits of working with pharmacists, such as increased security in prescribing.