Physician perspectives on collaborative working relationships with team-based hospital pharmacists in the inpatient medicine setting.

OBJECTIVE: Collaborative care between physicians and pharmacists has the potential to improve the process of care and patient outcomes. Our objective was to determine whether team-based pharmacist care was associated with higher physician-rated collaborative working relationship scores than usual ward-based pharmacist care at the end of the COLLABORATE study, a 1 year, multicentre, controlled clinical trial, which associated pharmacist intervention with improved medication use and reduced hospital readmission rates. METHODS: We conducted a cross-sectional survey of all team-based and usual care physicians (attending physicians and medical residents) who worked on the participating clinical teaching unit or primary healthcare teams during the study period. They were invited to complete an online version of the validated Physician-Pharmacist Collaboration Index (PPCI) survey at the end of the study. The main endpoint of interest was the mean total PPCI score. KEY FINDINGS: Only three (response rate 2%) of the usual care physicians responded and this prevented us from conducting pre-specified comparisons. A total of 23 team-based physicians completed the survey (36%) and reported a mean total PPCI score of 81.6 ± 8.6 out of a total of 92. Mean domain scores were highest for relationship initiation (14.0 ± 1.4 out of 15), and trustworthiness (38.9 ± 3.7 out of 42), followed by role specification (28.7 ± 4.3 out of 35). CONCLUSION: Pharmacists who are pursuing collaborative practice in inpatient settings may find the PPCI to be a meaningful tool to gauge the extent of collaborative working relationships with physician team members.

Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting.

While collaborative, team-based care has the potential to improve medication use and reduce adverse drug events and cost, less attention is paid to understanding the processes of well functioning teams. This paper presents the findings from key informant interviews and reflective journaling from pharmacists, physicians and nurse practitioners participating in a multicentre, controlled clinical trial of team-based pharmacist care in hospitalized medical patients. A phenomenological approach guided the data analysis and content analysis was the primary tool for unitizing, categorizing and identifying emerging themes. Pharmacists experienced highs (developing trusting relationships and making positive contributions to patient care) and lows (struggling with documentation and workload) during integration into the medical care team. From the perspective of the participating pharmacists, nurse practitioners and physicians, the integration of pharmacists into the teams was felt to have facilitated positive patient outcomes by improving team drug-therapy decision-making, continuity of care and patient safety. Additionally, the study increased the awareness of all team members' potential roles so that pharmacists, nurses and physicians could play a part in and benefit from working together as a team. Focussed attention on how practice is structured, team process and ongoing support would enable successful implementation of team-based care in a larger context. (ClinicalTrials.gov number, NCT00351676).

Inquiry-based learning: An instructional alternative for occupational therapy education.

An inquiry-based learning (IBL) approach was used as the model of instruction in one of three sections offered annually to large introductory occupational therapy classes in a Canadian university during 1994/5, 1995/6, 1996/7. Students' final grades in this pre-entry course form part of the grade point average on which admission to the BSc OT programme is based. The IBL model was employed to (1) increase the amount of student-directed learning, (2) increase the amount of independent problem-solving, (3) increase student-instructor interaction within the learning situation, and (4) reduce the number of in-class hours for students. This study is an evaluation of whether students from the IBL sections would subsequently do as well as those from other sections in selected junior professional courses. Students from the three IBL sections (n=47) were peer matched to students who had completed other sections of the introductory course, but were part of the same admission cohort (n=68). Their grades in three junior professional courses were compared at the end of their first year in the BSc OT programme. Results indicated that students from the IBL sections did at least as well as those from other sections where a different instructional approach was used, and those from the IBL sections in 1994/5 and 1996/7 each did significantly better on two of the junior professional courses used as the outcome measure: therapeutic occupation and assessment and evaluation techniques. Students reported that the IBL experience stimulated them to learn more about the field, helped them develop problem-solving skills in relation to occupational therapy, and enabled them to learn more about career opportunities in occupational therapy. Mature students were more positive about the IBL approach than students in their first year of university.