Integrating pharmacists into family practice teams: physicians' perspectives on collaborative care.

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.

Reliability testing of a case-leveling framework for assigning level of difficulty of pharmacist's initial patient medication assessments.

OBJECTIVE: To develop and test the reliability of a case-leveling framework for assigning level of difficulty of the pharmacist's task for initial medication assessments conducted by pharmacists integrated into family physician offices. DESIGN: Descriptive study. SETTING: Seven family practice sites in Ontario from June 2004 to July 2006. PATIENTS: Patients referred by their family physician for pharmacist assessment. INTERVENTION: Individual medication assessments, monitoring, and follow-up by pharmacists. A case-leveling framework was developed with three levels of complexity (graded as I, II, or III) including specific descriptors and practice-based examples. Reliability was assessed between two standardized assessors and between one assessor and project pharmacists. Project pharmacist feedback was elicited through an e-mail survey. Reliability is reported using the kappa statistic. MAIN OUTCOME MEASURES: Reliability of a case-leveling framework and helpfulness of the framework as reported by pharmacists. RESULTS: 53 patient cases were evaluated for interrater reliability between standardized assessors. The mean (+/- SD) case level assigned was 1.8 +/- 0.68, and the kappa was 0.62 (95% CI 0.44-0.79), indicating a substantial strength of agreement between raters. For the second reliability test, 52 cases were rated, with a level of agreement between project pharmacists and the external assessor of 0.46 (95% CI 0.27-0.65), indicating moderate agreement. Feedback resulted in slight revisions to the original framework. CONCLUSION: The case-leveling framework was a reliable method and can be used to determine the level of difficulty of patient cases in primary care.