Research Notes
Physician perceptions of pharmacist-provided medication therapy management: Qualitative analysisDisclosure,Acknowledgments,Funding,Previous presentations

https://doi.org/10.1331/JAPhA.2010.08186Get rights and content

Abstract

Objective

To identify physician perceptions of community pharmacist-provided medication therapy management (MTM).

Methods

Three focus groups consisting of family and internal medicine physicians were conducted in Pittsburgh, York, and Philadelphia, PA, using a semistructured topic guide to facilitate discussions. Each participant completed an exit survey at session conclusion.

Results

23 physicians participated in one of three focus groups conducted in Pittsburgh (n = 9), York (n = 6), and Philadelphia (n = 8). Participants identified common medication issues in their practices: nonadherence, adverse effects, drug interactions, medication costs, and incomplete patient understanding of the medication regimen. Receipt of a complete patient medication list was reported as the greatest potential benefit of MTM. Participants believed that physicians would be better suited as MTM providers than pharmacists. Concerns identified were the mechanism of pharmacist payment, reimbursement of time spent by physicians to coordinate care, and the training/preparation of the pharmacist. The need for a trusting relationship between a patient's primary care physician and the pharmacists providing MTM was identified.

Conclusion

This study provides information to assist pharmacists when approaching physicians to propose collaboration through MTM. Pharmacists should tell physicians that they will receive an updated patient medication list after each visit and emphasize that direct communication is essential to coordinate care.

Section snippets

Design

Three physician focus groups were conducted in market research facilities in Pittsburgh, York, and Philadelphia, PA. Geographic locations were chosen to provide a diversity of participants from urban, suburban, and rural locations and were limited by facility location. Facilitators with experience leading focus groups conducted the 2-hour sessions, which were audio recorded and transcribed. The resulting text was analyzed using qualitative methods.13–17 This study was approved by the University

Results

A total of 23 primary care physicians participated in one of three focus groups conducted in Pittsburgh (n = 9), York (n = 6), and Philadelphia (n = 8). Participant demographic characteristics are summarized in Table 2. The majority of participants were male (83%) family medicine (61%) physicians in private practice (91%).

The results of the exit survey are presented in Table 2. Of 23 participants, 4 (17%) currently work side-by-side with pharmacists to optimize patient care. The majority of

Discussion

An overwhelming finding across all groups was the lack of understanding of MTM by physician participants. The Pittsburgh group was uniquely negative overall because some participants stated false information regarding MTM and other participants reacted to this misinformation. This response emphasizes a need for clear communication about the mechanics of MTM. In the two other groups, physicians wanted more information about MTM. Despite the verbal and written description of MTM, participants

Limitations

This study involved primary care physicians from Pennsylvania in the context of its health maintenance organizations, insurance payers, pharmacy law, and medical law; conditions may differ in other states. Participants were in practice on average greater than 20 years. Future research on a broader scope should include generalists and specialists with practices across the country and in various stages of practice.

During the first focus group (Pittsburgh), false information regarding MTM from one

Conclusion

These study results reveal that pharmacists must clearly explain MTM and demonstrate their ability to provide medication-related patient care. Pharmacists should discuss the physician–pharmacist relationship in person, detail their clinical training, and demonstrate competence. Community pharmacists may propose a defined trial period to meet with patients in the physician's office. Above all, pharmacists must build a trusting relationship with physicians in order to provide enhanced patient

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Disclosure

The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.

Acknowledgments

To the Pennsylvania Medical Society for organizational support. Also to Shelby Corman, PharmD, for serving as research mentor; Jaqueline Farrell, PharmD, for assisting with data collection; Coleen Kayden, BPharm, and Cynthia A. Sanoski, PharmD, for serving as project mentors during data collection; and Teresa McKaveney for assisting in preparing the manuscript.

Funding

American Pharmacists Association Foundation and the National Association of Chain Drug Stores Foundation, Inc.

Previous presentations

American Pharmacists Association Annual Meeting, San Diego, CA, March 16, 2008, and 2008 Eastern States Pharmacy Residency Conference, Hershey, PA, April 30, 2008.

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